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Sunday, August 02, 2009

The feedbag problem 


We have already socialized health care for older people, or at least the payment for it (as opposed to the provision of it), so we taxpayers are eating the costs of caring for them, even when they incur massive costs because of their own choices. For instance:

We estimate that the medical costs of obesity could have risen to $147 billion per year by 2008.

I had the privilege of spending an hour this afternoon in the Atlantic City Hard Rock Cafe. If the clientele in that joint is any indication, we have only just begun to pay for obesity. So, yes, you can expect growing pressure from the wonks and the nanny-staters to regulate what we eat and how we live whether or not Obamacare becomes law.

Here's a pdf of the full paper.

10 Comments:

By Anonymous Anonymous, at Sun Aug 02, 10:29:00 PM:

I call BS.

Obese people die sooner and save the government huge money.

It's just like smokers die early - the big anti-sm0king crusade is the main reason Social Security is in trouble.

Want to save SS? Pass out smokes in the grade schools and make any restriction of smoking illegal.  

By Blogger TigerHawk, at Sun Aug 02, 10:58:00 PM:

You are, of course, correct about smoking. I wonder if obesity, which tends to lead to long degenerative diseases like diabetes, operates the same way. I would guess not, but confess to no expertise on the subject.  

By Blogger Foxfier, formerly Sailorette, at Sun Aug 02, 11:00:00 PM:

What are they going to say?
"Gee, since women started running track in high school and that first wave of girls is now hitting the age that the damage is showing, the costs went way up! Shall we say this is because everyone is fat, or because they beat the s@#$ out of themselves in high school? Uuuhh... fat."

(My mom was a track star in high school. After two knee operations, they just replaced the dang knee.)

Oh, not to mention the phenomia of "well, fifty years ago you'd have been dead for ten years. These days, we can keep you alive and living on your own for another ten years from now. But it costs."  

By Blogger TigerHawk, at Mon Aug 03, 06:01:00 AM:

Clearly true, but you can compare costs to rich countries without much obesity. France, for instance, which has virtually no obesity because of its radically different approach to food.  

By Anonymous feeblemind, at Mon Aug 03, 09:12:00 AM:

Lots of facets to the increase in obesity TH. Some feebleminded thoughts about obesity: 1) As we age, we gain weight and it gets harder to keep it off. How much of the increase in obesity is due to an aging society? 2) Smoking: When people quit smoking they often gain weight. How much of the increase in obesity is due to the drive to stamp out smoking? 3) Immigration: This is based on observation: Latinos seem to really blimp out as they age, at far higher rates than whites. It looks to me to be a genetic difference. How much has immigration increased the obesity rate? BMI scores: Has the BMI score equalling "fat" remained the same over the years or does a person now qualify as "fat" with a lower BMI as compared to 15 years ago? If the BMI=fat threshold has been lowered, then in stands to reason that obesity rates have risen. Anyway, I am wondering if we fully understand the problem? Also wonder why if abortion is all about 'control of one's body' and 'right to choose', why can't the same argument be made for obesity? Oh BTW, I believe McDonald's is the most popular place for Frenchmen to eat.  

By Blogger Foxfier, formerly Sailorette, at Mon Aug 03, 10:49:00 AM:

Feeblemind- women starting or stopping birth control also gain weight.  

By Blogger JPMcT, at Mon Aug 03, 11:08:00 AM:

Disney is another place where it's painfully evident that there are a large number of people who are literally too fat to walk long distances. Sometimes it seems there are more obese people in motorized scooters than there are kids in strollers. If I were unfortunate enough to be one of the truly handicapped patrons trying to navigate around in a stroller, I would really be chagrined.

Public health awareness may help those obese individuals who are wealthy enough to afford the better food and gym memberships....and may reduce the number of fatties at the Hard Rock Cafe and Disney parks.

The reality is that obesity, for many obvious reasons, is endemic in lower socioeconomic classes. The same Democrat social formulas that have rewarded us with a "subclass" that eschews education, work ethic and marriage has, logically, resulted in pandemic obesity as well.

I predict that we will continue to feed the beast by establishing new "programs" to give those "unlucky at life" access to food and exercise (at taxpayer expense), health care (at taxpayer expense), counseling, etc., etc.

All of this will fail, of course...just as the trillion or so dollars spent on the "War on Poverty" has done little more than fan the flames.

What is needed is a "program" to lift people out of the environment of low income, bad education, cultural ignorance and poor life habits. That's not a "program" that any government will ever be able to do...because government is the PROBLEM!

A good start would be putting a stop to the current cultural genocide bequeathed to us by decades of Democrats and similar mindsets...and then getting back to our American roots in self-reliance and hard work.

Yeah...that's gonna happen...  

By Blogger Elise, at Mon Aug 03, 11:39:00 AM:

I haven't gotten through the whole book yet but I strongly recommend that anyone who wants to write on health costs and obesity read Paul Campos' The Obesity Myth. I have not looked at the raw data behind his specific assertions but it is worth noting that the medical establishment has been warning about the dangers of fat for years (going back to the 19th century) while life expectancy rates have continued to climb in the US. In particular, Campos quotes a series of dire medical warnings about the oncoming obesity epidemic that will raise mortality, lower life expectancy, and swamp this country. Those warnings were issued in the 1950s.

As for the study TH cites, there are a couple of problems (from page 9). First:

This analysis has several limitations. One is the reliance on self-reported height and weight.

Well, nobody ever lies about their height.

Second:

Finally, the regression-based approach allows for quantifying the spending attributable to obesity by payer and point of service, but it does not directly allow for apportioning spending across specific diseases or the underlying behavior that causes excess weight (that is, poor diet and inactivity). This should be an area of future research.

I’d really like to see those “specific diseases”. Are we talking extra tests to look for the diseases everyone “knows” fat people suffer from? Are we talking more fat people than thin people being put on statins and, if so, is it because their lab numbers are different or just because they’re fat? Can we compare treatments for osteoporosis?

And that little parenthetical note about not considering “poor diet and inactivity”? This is Campos’ main point: what causes the illnesses we think are obesity-related is not weight but lack of physical activity and poor eating habits. Campos contends that existing studies show fat people who are active and eat normally have the same life expectancy as thin people who are active and eat normally - and a higher life expectancy than thin people who are sedentary. If you want to sneer at the people who really use too much health care, send everyone to the Cooper Clinic in Dallas and figure out who meets their criteria for being in reasonably good cardiovascular health.

Most important, even if you reject every single other claim Campos makes - and many people do - it is hard to argue with his statement that no one has found an effective method for losing weight and keeping it off. Therefore, if you believe that overweight people incur greater medical costs and that it is not fair to the rest of us to pay those costs, you have only one choice: deny or limit medical care to the overweight. At last, a health care rationing plan that will have bipartisan support.

Campos also has some very interesting things to say about the classism and racism surrounding this issue. And, yes, optimal BMI does change. According to Wikipedia:

In 1998, the U.S. National Institutes of Health brought U.S. definitions into line with World Health Organization guidelines, lowering the normal/overweight cut-off from BMI 27.8 to BMI 25. This had the effect of redefining approximately 30 million Americans, previously "healthy" to "overweight".[citation needed]

If you don’t want to plow through Campos’ book, read Megan McArdle. She’s doing some great writing on the intransigence of weight. That’s where I found Campos’ book.  

By Blogger Foxfier, formerly Sailorette, at Mon Aug 03, 11:47:00 AM:

Article including BMI info.  

By Anonymous Opinionated Vogon, at Mon Aug 03, 06:44:00 PM:

http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html

LONDON — Preventing obesity and smoking can save lives, but it does not save money, according to a new report.

It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.

"It was a small surprise," said Pieter van Baal, an economist at the National Institute for Public Health and the Environment in the Netherlands, who led the study. "But it also makes sense. If you live longer, then you cost the health system more."

Much more on the subject here:

http://meganmcardle.theatlantic.com/archives/2009/07/americas_moral_panic_over_obes.php  

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