Want to Lower Health Costs? Start Fighting Fat

December 2nd, 2010 at 9:01 am | 61 Comments |

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With little notice, UnitedHealth released a major paper last week considering diabetes in America.

First the bad news: a large portion of our population either has the disease or is pre-diabetic.

Now, the really bad news: diabetes and pre-diabetes rates are going to soar in the coming decade, according to the analysis, in part driven by the obesity crisis.

I’ll return back to the study in a moment, but it underscores a paradox: medicine has never been better; our overall health, however, is worsening.

Indeed, after seventy years of staggering medical progress – whereby medicine has evolved from passive care to miraculous cure – we seem to have entered into a new age, one in which personal decision will increasingly influence our health and the cost of our health care.

The problem is that almost no one in Washington seems to have noticed.

 

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On this, we can all agree. Medicine has been transformed in the past decades.

Pre-1941: Prior to 1941, the state of medicine is well represented by Luke Fildes’ famous etching.

The doctor looks august, thoughtful and pensive. But notice what he isn’t doing – much of anything. Frankly, there isn’t much difference between the passive approach of physician here and the distraught mother in the background. Outside of thyroid supplement and insulin, medicine offered little but empathy to its patients.

The Modern Era: On February 12, 1941, the era of modern medicine was ushered in when the first clinical use of penicillin. Medicine went from passive care to miraculous cure. The doctor in that famous etching got off his chair and started to do things.

The latter part of the twentieth century saw one discover after another. Steroids, antipsychotics, open heart surgery, kidney transplants – all within a dozen years of penicillin’s first clinical use. The pace of change has been extraordinary.

Today, medicine has never been so advanced. Surgeries are done on fetuses months before birth; death by cardiovascular disease has fallen by two thirds in fifty years; diseases that were once death sentences, like childhood leukemia, are curable.

The Age of Preventable Illness: But if medicine has never been so advanced, the actual health of Americans is far less robust. The Era of Modern Medicine has given way to the Age of Preventable Illness. Americans have embraced a culture of extremes: too much alcohol, tobacco, drugs, and food, and not enough exercise and restraint. American leads the way in medical innovation, winning more Nobel Prizes in Medicine than all other countries combined. We also lead the world in obesity, and have the poor life expectancy statistics to show for it.

The consequences of the culture of extremes are unfortunate.

Indeed, as others have argued, including Dr. Steven Schroeder in the New England Journal of Medicine, we have reached a point where traditional causes of premature death – environmental exposure or lack of access to health care – are modest. What isn’t modest? Dr. Schroeder argues “behavioral patterns.”

The statistics are discouraging: 1 in 5 smoke; 3 in 10 are obese; 1 in 3 don’t even take their prescribed medications for illnesses like hypertension.

Which brings us to that study on diabetes.

In “The United States of Diabetes,” researchers at UnitedHealth estimate the rising cost of diabetic care in America. Diabetes has no single cause but, with profound weight gain, it’s clear that our obesity problems are causing diabetes to become ever more common.

This new study estimates that health spending associated with diabetes and pre-diabetes is currently $194 billion a year (7% of total U.S. health spending). That cost is projected to rise to $500 billion by 2020, as the percentage of people with diabetes and pre-diabetes rises to 52% of the population.

Interestingly, taxpayers are the ones who would be most on the hook for diabetic care and the treatment of diabetic complications, since the majority of diabetics will be on Medicare and Medicaid.

A few thoughts on the UnitedHealth study:

1) Washington Doesn’t Get It

For much of the last two years, Washington politicians of both parties have debated how to reign in healthcare costs. But as obesity rates rise and the resulting illnesses like diabetes become ever more common, we stand little chance no matter what happens to ObamaCare.

The larger debate is not about the IPAB or health-insurance exchanges or Medicaid expansion, it’s about health.

2) The ObamaCare Model is Dated

For Democrats, the view of healthcare is dated – they see illness as an act of God, leaving patients stricken with disease that could not have been avoided. Not surprisingly, then, ObamaCare seeks to divorce people from the financial consequences of their health decisions – regulating insurance to treat people equally regardless of age or illness (community rating), offering many no-deductible services, mandating the coverage of other services, and sweetening the deal with heavy subsidies.

Let’s be clear: a patient with Schizophrenia shouldn’t be punished because his father and grandfather had the disease. But many illnesses are preventable. Rather than encourage health, ObamaCare seeks to socialize the costs of bad health.

3) Public Health Efforts Have Been Weak

In the past, governments looked to “knee-jerk regulation.” Anti-obesity efforts – well meaning as they are – represent “feel-good regulation.”

Calorie listings, salt reductions, trans-fat bans. These efforts offer little potential of success.

Consider a NYU-Yale study that surveyed 1,100 fast food customers in poor New York neighborhoods. While people claimed making healthier choices when given the calorie-count information, researchers found that customers actually ordered more calories, not less.

The issue isn’t ignorance (does anyone really order a Big Mac and assume it to be a healthful meal?) or the plague of one bad ingredient (like salt), it’s a culture of excess. Policy prescriptions need to address the larger problem.

4) Conservatives Need More to Say

The conservative response to date has been anemic. With rising rates of obesity and diabetes, many have been happy to attack meddlesome liberal efforts, without offering anything in its place.

Take as an example Sarah Palin. Speaking in Plumsteadville, PA, the former VP candidate criticized the Pennsylvania’s State Board of Education’s plan to limit sweets in classroom parties. Earlier in the day, she had brought cookies to a classroom. She explained:

I heard there’s a debate going on in Pennsylvania over whether public schools were going to ban sweets. I wanted these kids to bring home the idea to their parents for discussion: Who should be deciding what I eat? Should it be government or should it be parents? It should be the parents.

The issue is more complicated than portrayed by the media, and Ms. Palin isn’t entirely wrong. The State Board of Education is considering pushing all children’s celebrations to one month and requiring that there be non-sugary food options at classroom parties.

It’s difficult to find this compelling (January kids would then celebrate their birthdays in, say, June?) or particularly practical (will children in large numbers opt for a medley of vegetables over the birthday cake?). And involving parents is reasonable enough.

But Ms. Palin’s attack is also paper-thin. Yes, the Board of Education seems to have identified a real issue and matched it with a bureaucratic answer, but what to do about the larger issue? Conservatives seem happy to attack the “nanny state” (to quote Palin’s Tweet) but offer little in its place.

And there is a conservative response on this issue. At a time of rising rates of obesity, we should emphasize physical education in our schools and better food in their cafeterias. Washington spends billions subsidizing big business and bad health choices through agricultural subsidies – it’s difficult to ever see the justification for this, but, at a time of record deficits, there is none. Health insurance needs to move from a model of sick care to one that promotes wellness. And, finally, we need to practice more restraint in our eating habits.

Conservatives have long argued for the need for personal responsibility, bemoaning fatherlessness and divorce. It would be a pity, then, to see the movement fall into obesity nihilism.

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61 Comments so far ↓

  • KBKY

    @forgetn
    I too watched and enjoyed Jamie Oliver’s Food Revolution, but if you remember the last episode he had to return to West Virginia because things were starting to revert back to their old ways. Not entirely, but slowly, and that is with the town having a national audience.

    I’m not advocating for the government to completely abandon all efforts at reducing the obesity rate. As I said in my previous post, I think that the President and First Lady have had good ideas. My point is more that until we start acknowledging that people are making decisions in spite of nutrition knowledge (and not because of a lack of it), we won’t be able to figure out solutions. I felt that the government sponsoring cooking/nutrition classes were an inappropriate use of tax payer funds, but that doesn’t preclude all government policy. Keeping on the Food Revolution track, I think that it is absurd that french fries are considered a vegetable for school lunches. School lunches are, for many students, already paid for/subsidized by the government. Thus, in this case it would be the government’s responsibility to not use tax payer dollars to promote obesity.

  • Mcdonalds Nutrition Menu

    [...] Want to Lower Health Costs? Start Fighting Fat | FrumForum It's cheaper and easier to go to Mcdonalds and get a dozen dollar menu items than take the care to shop for and cook good wholesome ingredients. They are there they are not really expensive and they need skill to cook properly. I don't want it going to folks who did not take the time to educate themselves on nutrition My city has roads falling apart, children who can't read at grade level, and a good number of folks out of work. It is not my job, or my government's, [...]

  • KBKY

    @armstp
    You make a good point in regards to health care, but a government funded education program isn’t the only tool that the government has at its disposal (and my previous post gives two examples of policies that I’d agree with). There are two reasons that I am against the idea of such an education program:

    1) I don’t think that it actually would be effective. As I described in my previous post, I think that we can’t approach this problem without acknowledging that the majority of people know the nutritional information, they just don’t care on a day to day basis. This is why obesity is a different (and harder) issue than smoking. We have to eat, we don’t have to smoke. Also, with smoking, in many ways it’s more about preventing people from starting than quitting. Thus, it’s preventing one unhealthy decision. For food, the government would need to convince people to make hundreds of healthy decisions and that’s just in one week.

    2) It strikes me as unfair. I love fatty food as much as the next person and my family didn’t have tons of time to cook meals growing up. But, we made the effort to teach ourselves about nutrition and to purchase healthier food. I have an negative, gut reaction to being asked to pay to educate those who were unwilling to make the same effort, especially since in today’s age it would require less than an hour on google. I apologize if this seems cold, but I am just trying to answer your question honestly.

    I want to reiterate that I don’t think that government has no place in this discussion. But, until we recognize that adults are, for the most part, making informed choices, we aren’t going to get anywhere and we’ll probably waste a lot of money on the way.

  • armstp

    KBKY,

    The only thing that will be effective is more regulation on the food industry. The food industry will not stop their practices on their own, part of that being the large con they play in terms of not informing people exactly what they are eating or misinforming them and the other part of it is the negligence in selling food that is actually bad for people (like cigarettes). The public will never have a clue about what they are actually eating. It is fine to say that people should be making their own decisions, but how can they make their own decisions when they either do not have the information they need to make those decisions or are straight out lied to.

    The other thing is the food industry needs to be exposed like with the movie Supersize Me with McDonalds. Not only do they produce and sell bad food, but they also keep out competition, so there is no free market. If you look at what Monsanto has done with regard to soy beans it is frankly criminal. I suggest you go and rent the very good movie Food Inc. You will be surprised at what you learn.

    See the trailer here:

    http://www.youtube.com/watch?v=5eKYyD14d_0

    Or this:

    http://video.pbs.org/video/1143263943/

  • KBKY

    @armstp
    There may be a role for additional regulation on the food industry – I honestly don’t know enough about what regulations exist and what don’t. And, while I would agree that the public may not have all of the information that could be relevant or helpful – I would disagree that the public doesn’t know enough to avoid obesity.

    This doesn’t mean that our society wouldn’t be healthier if there were fewer hormones in our meat or less high fructose corn syrup in, well, everything, but I don’t think that we can regulate the food industry enough to solve this problem, because we’d have to regulate it enough to remove all of the bad options out there (and there are thousands beyond fast food).

  • nhthinker

    Schools used to serve reasonable lunches that tasted bland but included vegatables.
    You only had one or two choices.

    Schools decided to use cafeterias to generate revenue and dramatically destroyed the health of the food choices. They added a large number of unhealthy choices and candy machines and soda machines as well. Now they are changing from soda to “sports drinks” still encouraging kids to spend close to a $1000 a year on flavored drinks dispensed through the school.

    This even occurs for especially young children whose parents would never allow them such choices at a restaurant that the parent was present at. Peer pressure for consuming the best tasting food, “coolest” food can be very compelling. MickyDees and Papa Ginos should have been kept out of schools. Put in filtered water dispensers and get rid of the vending machines. School Boards and School Administrators made vile choices.

  • sinz54

    armstp: The only thing that will be effective is more regulation on the food industry.
    No.

    The only thing that will be effective is to change the entire collection of subsidies and hidden taxes (you were right the first time), so that a working-class person can afford to buy healthier foods.

    The corn subsidy makes corn syrup a cheap, calorie-rich filler.

    Whereas the devaluation of the dollar has made fresh produce (much of which is imported these days from Spain and Latin America) at the supermarket much more expensive.

    Right now, working-class folks buy junk foods because they are an inexpensive way to get enough calories for a day. Time was when junk foods offered convenience too. But that’s changed. You can pop a bag of frozen vegetables into a microwave and have it ready in minutes. But that bag of frozen vegetables costs a few bucks for a few hundred calories, a far worse ratio than a Big Mac at McDonald’s.

    When the Government tells us that food prices haven’t increased much in recent years, they don’t bother to tell us which foods they’re talking about.

    Regulation of the food industry won’t make fruits and vegetables more affordable.

    And devaluation of the dollar, cheered by wealthy affluent liberals in New York and San Francisco who live by exporting products, is hurting the working poor who now depend on imported goods to live.

  • Rob_654

    I agree with sinz54 // Dec 3, 2010 at 9:53 am

    I would also add that if we want to look at a some personal responsibility we make people who are fat more responsible for their health care costs as long as they want to be fat.

  • anniemargret

    Read Michael Pollan’s eye-opener (you could read it in one day): “In Defense of Food”

    The food industry is dooming all of us, folks. Sure, it takes self-discipline. But we’ve got parents working all day and picking up kids at the end of the day to take them to soccer and little league. There are no ‘sit-down’ and chat and eat families anymore. Wake up! This is America, 2010. The 50s Beaver Cleaver family is long gone.

    Add in a car-dependent society. When I grew up in NYC, hardly anyone kept a car, or if they had, they only used it for long trips. Everyone took buses, subways, biked or walked. Now the majority of cities are car-dependent.

    The average family cannot afford to purchase whole or high quality food. Anyone want to ck out how much it costs to buy just fresh fruit, veggies, meat or poultry? I can understand why people choose the easier or fastest option. Not good, but understandable.

    Here’s another problem. The increasing amounts of food additives in groceries. How many people are looking at the number of additives, which wreck extreme havoc on the metabolism of millions. Pollan even suggests that the food industry purposefully adds these chemicals to your diet because it is *addictive.* Think all those very obese folks are not addicted to food?

    A recent column in the paper revealed that “eating disorders’ are on the rise….much much higher than than ever were, especially for women. Women’s bodies naturally have more fat because we get pregnant and have children. So women struggle even more than men to reduce calories and fat to keep healthy.

    Anorexia is now being seen in girls as young as the age of 10 or 11 – terrified they will get ‘fat’ and stop eating before puberty even sets in. This is extreme damage to the circulatory, digestive, nervous systems, and wrecks their hormones. The impossibly high and absurd ideals for young girls with starved and emaciated looking TV and movie stars, or magazine models who are rail skinny takes its toll on society.

    Some women give up the struggle – they feel defeated before they start.

    Anorexia, bulemia, obesity – something is wrong with this society – and it is not just about exerting ‘self-control.’ Way more complex that that!

    PS: And a Pox on Palin! How idiotic to deplore what Michelle Obama was trying to do. The woman is a political pitbull alright – always goes for the jugular. Not very attractive at all.

  • anniemargret

    And be fair, please. Everyone’s body is different chemically. I know many people who can eat a half a pie in a sitting everyday and never gain weight. Others eat like birds and every morsel goes to padded hips.

    If it were easy to lose weight, or maintain a healthy weight, we wouldn’t have a national problem!

  • nhthinker

    “If it were easy to lose weight, or maintain a healthy weight, we wouldn’t have a national problem!”

    There is not one shred of evidence that life is supposed to be easy.

    Typically, the difference between knowing what is good for you and doing what is good for you is the interplay between impulsive urges and willpower.
    Belief in authority and anticipation of receiving social humiliation tends to enhance willpower and control bad behavior- Having constant reminders from people you respect can have great influence.
    Many people have not developed enough willpower to break bad habits that were forced on them or those bad habits they fell into themselves. Other people easily rise above instinctive behaviors- its a combination of social training and genetics- but social training can always help.
    The earlier in life social training to resist temptation begins, the easier the rest of life becomes.

    Churches tend to shame people that they are mental weaklings and must help themselves and each other to break bad habits. Churches use shame and encouragement- stick and carrot all the time.

    Modern democratic social government tend to address the symptoms: prohibit or heavily tax temptation and heavily support the costs of the temptations without telling people they are mental weaklings and must help themselves. The stick is nuanced and the carrot distorts the results of the bad habits to allow more people to decide not to address their bad habits.

    It seems that if societies associated with democracies give up on strong moral codes through religion and replace it with generic humanism codified through the government- over the long term it becomes unstable as the emphasis on honing the willpower of the masses to make decisions based on their moral code instead of their urges, makes society increasing less efficient.

    Authoritarian social states, such as China, imprint strong moral training into the masses- they are winning the battle for efficiency and productivity and education. They have those good things at the same time they have brutality and suppression of dissent.

    Better get your dissent for government out of your system now, the future does not look very encouraging.

    “The 50s Beaver Cleaver family is long gone”
    Nope. There are still many left. But for the general society, the Cleavers’ moral values and boring life were not hip enough- parents are expected to spend more of their time making money so their children can have material things and spend much less time focusing on their children’s moral code and willpower- Also parents are expected to indulge themselves more in adult activities that do not include the kids.

    You don’t have to eat too many meals with the kids- but you do have to spend enjoyable time with them that includes lessons of morality and willpower. That is what the Cleavers did.