Over the past two decades, the adult population in the United States has, on average, become much heavier. From 1987 to 2007, the fraction of adults who were overweight or obese increased from 44 percent to 63 percent; almost two-thirds of the adult population now falls into one of those categories. The share of obese adults rose particularly rapidly, more than doubling from 13 percent to 28 percent. That sharp increase in the fraction of adults who are overweight or obese poses an important public health challenge. Those adults are more likely to develop serious illnesses, including coronary heart disease, diabetes, and hypertension. As a result, that trend also affects spending on health care.
So begins CBO Director Doug Elmendorf in his recent blog on his office’s latest issue brief. It says much about our times that a congressional appointee would choose to communicate with the very modern medium of blogging. And that the topic would be the very modern problem of obesity.
Washington has been consumed with the issue of healthcare reform since inauguration. But in all of the proposals and counter-proposals, Democratic and Republican, little attention has been paid to actually bettering the health of Americans, as if we could divorce healthcare from health.
The CBO projections show the problem with this approach.
Obesity will push up health spending – not dramatically, but palpably. One reason for that: obese people cost more in health spending. From the CBO report:
Note the column on the far right: the obese who, to go back to the Director’s comments, have doubled as a percentage of the population in the past twenty years.
The CBO report draws out three scenarios: if the rate of obesity remains stable; if it continues to grow; if it shrinks back to 1987 levels.
A few observations:
- Health inflation is a major problem. Over the thirteen years of study, health costs will rise under an obesity-frozen scenario from $4,500 an adult to $7,500.
- Obesity costs us. The per adult cost jumps to $7,760 if the number of obese Americans continues to climb. This is a conservative scenario (certainly compared to, say, the work of economist Ken Thorpe).
- If we cut our obesity rate back down to 1987 levels, the difference between our present path (rising rates) and ’87 levels would be 7% per adult – in other words, if we drop down to the weight we were back in the 1980s, we’d achieve vastly more in savings than even the spin-doctors can argue about Obamacare.
But the CBO’s third scenario isn’t more than simply fantasy. Down to the 1987 percentage of obesity? That’s not exactly realistic given that all the early data suggests that our obesity curbing efforts are a failure.
Perhaps part of the problem is the approach. Public health officials lecture us on the need for better eating habits. Politicians mandate calorie listings for restaurants as though we assume McDonald’s is healthful. Some, like physician and bestselling author David Kessler, argue that we are victimized by corporations into eating “hyperpalatable foods.”
Americans aren’t ignorant and they aren’t victims.
Let’s push it further: for that matter, America doesn’t have an obesity problem. It has a bad health problem – and obesity is just one aspect of that. Today, 1 in 4 adults is obese and 1 in 5 smoke. Even when seeking medical care, 1 in 3 do not take the medications prescribed by their doctor.
The sad result? For millions of Americans with, say, hypertension, the high blood pressure was avoidable in the first place; it’s now treatable; and yet it will result in major and potentially devastating health events in the future. Add to the list: high cholesterol, diabetes, and a host of other ailments.
It’s the paradox of modern healthcare. Medicine can do more than ever and yet we aren’t particularly healthy. Forget the tall rhetoric about electronic medical records and greater accountability for insurance companies. We need to cut out the fatty foods, butt out the cigs, and listen to the good doctor.
What’s to be done? Start by taking our health more seriously.
Our Schools. In the 1960s, during the space race, we revamped school curriculums to emphasize science. Today, we need to rediscover physical education.
And Their Cafeterias. Children need to have better choices and less junk food.
Our Health Insurance. Employers need to start rewarding wellness, instead of just paying for illness. Companies like Safeway (yes, Safeway) are leading the way.
Our Government. At a time of record deficits, we’re spending record amounts on subsidizing corn, helping to fund the obesity crisis with cheap sweeteners. End the farm bill.
When the CBO director starts scoring the high cost of obesity, you know you have a problem. When Americans take more responsibility for their diet and exercise, then we’ll have the makings of a solution.