A reader of the blog suggested the following post on the Blaze. Great article and it tells you where we are heading. This is getting very scary folks.
Conservative Tom
Conservative Tom
EXPERTS ARGUE CARING FOR SMOKERS, THE OBESE MAY BE TOO COSTLY: ‘WHY NOT JUST LET THESE HEALTH SINNERS DIE?’
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A woman passes an advertisement outside a fast food outlet on January 7, 2013 in Bristol, England. (Photo: Getty Images)
(TheBlaze/AP) — Faced with the high cost of caring for smokers and overeaters, experts say society must grapple with a chilling question. The Associated Press summarizes: “Instead of trying to penalize them and change their ways, why not just let these health sinners die?”
Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong lives, including surgery, chemotherapy and other measures.
But despite these rescue attempts, smokers tend to die 10 years earlier on average, and the obese die five to 12 years prematurely, according to various researchers’ estimates.
And attempts to curb smoking and unhealthy eating frequently lead to backlash: Witness the current legal tussle over New York City’s first-of-its-kind limits on the size of sugary beverages and the vicious fight last year in California over a ballot proposal to add another $1-per-pack cigarette tax, which was ultimately defeated.
“This is my life. I should be able to do what I want,” said Sebastian Lopez, a college student from Queens, speaking last September when the New York City Board of Health approved the soda size rules.
Critics also contend that tobacco- and calorie-control measures place a disproportionately heavy burden on poor people. That’s because they:
-Smoke more than the rich, and have higher obesity rates.
-Have less money so sales taxes hit them harder. One study last year found poor, nicotine-dependent smokers in New York – a state with very high cigarette taxes – spent as much as a quarter of their entire income on smokes.
-Are less likely to have a car to shop elsewhere if the corner bodega or convenience store stops stocking their vices.
Critics call these approaches unfair, and believe they have only a marginal effect. “Ultimately these things are weak tea,” said Dr. Scott Gottlieb, a physician and fellow at the right-of-center think tank, the American Enterprise Institute.
But Gottlieb’s view is contested, and the debate rages on in similarly unsettling directions. For instance, some studies suggest that because smokers and the obese often die younger, they may actually cost society less than those who tend to live longer and develop chronic conditions like Alzheimer’s disease.
So let’s return to the original question: Why provoke a backlash? If 1 in 5 U.S. adults smoke, and 1 in 3 are obese, why not just get off their backs and let them go on with their (probably shortened) lives, the Associated Press asks?
A smoker snuffs out a cigarette at the Capitol in Sacramento, Calif. , Friday June 22, 2012. (Photo: AP)
Because it’s not just about them, say some health economists, bioethicists and public health researchers.
“Your freedom is likely to be someone else’s harm,” said Daniel Callahan, senior research scholar at a bioethics think-tank, the Hastings Center.
Smoking has the most obvious impact. Studies have increasingly shown harm to nonsmokers who are unlucky enough to work or live around heavy smokers. And several studies have shown heart attacks and asthma attack rates fell in counties or cities that adopted big smoking bans.
But it can be harder to make the same argument about soda-size restrictions or other legislative attempts to discourage excessive calorie consumption.
“When you eat yourself to death, you’re pretty much just harming yourself,” S. Jay Olshansky, a professor at the University of Illinois-Chicago’s School of Public Health, said.
But that viewpoint doesn’t factor in the burden to everyone else of paying for the diabetes care, heart surgeries and other medical expenses incurred by obese people, John Cawley, a health economist at Cornell University, noted.
“If I’m obese, the health care costs are not totally borne by me. They’re borne by other people in my health insurance plan and – when I’m older – by Medicare,” Cawley said.
From an economist’s perspective, there would be less reason to grouse about unhealthy behaviors by smokers, the obese, motorcycle riders who eschew helmets and other “health sinners” if they agreed to pay the financial price for their choices.
That’s the rationale for a provision in the Affordable Care Act – “Obamacare” to its detractors – that starting next year allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums. A 60-year-old could wind up paying nearly $5,100 on top of premiums.
The new law doesn’t allow insurers to charge more for people who are overweight, however.
It’s tricky to play the insurance game with overweight people, because science is still sorting things out. While obesity is clearly linked with serious health problems and early death, the evidence is not as clear about people who are just overweight.
That said, public health officials shouldn’t shy away from tough anti-obesity efforts, said Callahan, the bioethicist. Callahan caused a public stir this week with a paper that called for a more aggressive public health campaign that tries to shame and stigmatize overeaters the way past public health campaigns have shamed and stigmatized smokers.
National obesity rates are essentially static, and public health campaigns that gently try to educate people about the benefits of exercise and healthy eating just aren’t working, Callahan argued. We need to get obese people to change their behavior. If they are angry or hurt by it, so be it, he said.
“Emotions are what really count in this world,” he said.
I watched a program on CSPAN yesterday on reducing health care costs. The Commonwealth Fund just came out with a new study outlining how to save $2 trillion on health care costs over the next 10 years. The first thing they mentioned is that 5% of the population accounts for 65% of all health care costs in this country. These are people with multiple chronic diseases like diabetes, heart disease, COPD, etc.
ReplyDeleteThere are a lot of options between "let them die" (do nothing to help them) at one extreme and have government pay for absolutely everything possible (tests, surgeries, experimental expensive drugs, etc.) at the other extreme. An intelligent approach to reducing health care costs in this country must analyze all these options, or else our per capita health care costs will continue to be double the cost in other OECD countries.
Their formula: Value = Quality/Cost
That formula needs to replace the fee-for-services model. We pay for value, not services.
--David
How do you determine quality--it means different things to different people. With the Obama Administration in charge we will see quality fall and costs rise dramatically.
ReplyDeleteThe OECD and World Health Organization (WHO) have developed a whole spectrum of measures of population health. Look at the international rankings. Most other OECD countries outrank the U.S. in quality and all have much lower cost per capita. We need to get our system more in line with the rest of the world. If I have time, I will download the Commonwealth Fund report and post some of it key points.
ReplyDelete--David
One of the main reasons why other countries beat the U.S. on quality, is that they don't have a large percentage of their population uninsured. Because they nearly all have health insurance, their people get regular physical checkups, which enables early detection and treatment of diseases that turn into much more complicated/expensive cases in the U.S. where millions of our citizens only get diagnosis and treatment AFTER the symptoms have progressed so far that they go to the emergency room. Forget about "Obamacare" for two seconds, and think about that.
ReplyDeleteOn the cost side, other countries crack down on prices charged by doctors, hospitals, and drug companies. Also, on so-called "utilization" -- meaning they don't pay for every conceivable test, procedure, surgery, experimental drugs, etc. that we have here in the U.S. fee-for-services model for people who are going to be dead within a year regardless how many medical services they receive. As a result, other countries don't have 5% of the population accounting for 65% of health care costs (as in the U.S.). That is the other big driver of health care costs, and it will change.
The third thing is what your article discusses. Namely, Americans have a horribly unhealthy lifestyle. We drink, we smoke, we overeat, we don't exercise. I agree with the article that, when you do these things, you not only harm yourself, but you impose costs on other people indirectly through higher insurance premiums, etc. As a Libertarian, I am still wrestling with the problem from a public policy standpoint, but I agree that it is a societal issue, not just a matter of individual decision-making about health choices. In that respect, it is not ENTIRELY different than an alcoholic's decision to drink and drive his car.
--David
The rest of the world benefits from our outstanding health care. Why do you think that world leaders come here for their health care? Because it is inferior? Hardly. They know they get the best care here.
ReplyDeleteWe also invent more procedures that reduce hospital care and get people home sooner. Micro surgery was invented here and it is not inexpensive. Many of the countries to which you refer do not have these procedures.
Most of the worlds drugs are invented here. Canada does regulate cost of drugs, why, because the government directs the costs. None were invented there so they can import them. If we had to depend upon drugs invented in Sweden, Canada, Germany etc, we would be 50 years behind. They invent nothing. Drug trials cost money and most do not make the grade.
The reason that doctors order tests is that if they do not and a patient has a bad outcome, they will be sued and the lack of testing will be used against the doctor. We need to terminate 3/4 of the attorneys in this country and then maybe some of these nuisance cases would go away.
I hope that you never have a disease that requires experimental drugs or a very expensive surgery. Under Obamacare, you will not get it! In Canada, if you have a rotator cuff injury, you have to suffer for months to get an MRI and then even more months to get the operation. That is why Canadians come to the border cities to get US operations. They pay their own money!
I hope that your wife does not get pregnant and have a delivery in the last quarter. The doctor may not get paid for the delivery under Obamacare. It happens in Canada.
As far as our lifestyle choices--we should let the smoking fat diabetic die--right? Well, that is what will happen under Obamacare. Additionally, if that person is older they get the privilege of paying thousands of dollars extra for the privilege of having ObamaCrapCare.
By the way one interesting issue, there was much hullabaloo about ending of "pre-existing conditions" with the understanding that now everyone will be covered. That all is true, except for one small detail. Every condition, every issue that anyone has EVER had will be used to calculate the premium that has to be paid by the patient. Lets say you have that overweight, smoking diabetic. What would be her/his premium. Hardly not the standard one. We have heard increases of 2 or 3 times the standard premium as the insurance companies or ObamaCrapCare when it become the single payer in a few years. Not what everyone thought.
What happens when the person just cannot afford to pay the premium? Let's say the person earns $35000 and his premium is $10,000. He is required to have health insurance but cannot afford it. Does the government pick up the premium? If so, what have we accomplished? We have increased the debt and not accomplished anything.
ObamaCrapCare will end the US as a healthy country and will crash it financially.
Here is more information on various health issues, however, the last article about Canadian officials coming to the (as David wants to assume) poor and overpriced care in the States is enlightening.
ReplyDeletehttp://blog.heritage.org/2010/02/09/the-canadian-patients%E2%80%99-remedy-for-health-care-go-to-america/
http://www.medcarelink.com/destinations/united-states
http://diplomatdc.wordpress.com/2010/02/19/canadian-leaders-come-to-the-u-s-for-health-care-by-gregory-hilton/
Canada has one of the worst records for access to medical services among OECD countries. There is no reason why we can't do much better than them as we move toward universal health care. For example, Australia, France, Germany, Netherlands, New Zealand, Norway, Sweden, and Switzerland are mostly as good, or better, than the United States on such measures as…
ReplyDeleteSame Day/Next Day Appointment When Sick
Waited Two Months or More for Specialist Appointment
Waited Four Months or More for Elective Surgery
On the measure "Experienced Access Barrier Due to Cost in Past Year", the United States is, by far, the WORST of all (33%), including even Canada.
http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2011/Nov/1562_Squires_Intl_Profiles_2011_11_10.pdf
I agree that the U.S. has some of the best hospitals,surgeons, and pharmaceutical companies in the world, BUT we also have an extremely ineffective and costly health care system when compared to the rest of the world due to the three things I mentioned in my last note, which you chose to ignore in your reply.
--David
Wait until we start paying $20,000 per family for health care in 2016 and then tell me how ineffective and costly our health system is. ObamaCrapCAre will be just that!
ReplyDelete