Ironically, I started writing this early last week, before Mayor Bloomberg's announcement about his desired ban on large sugary drinks and the ensuing outcry. This topic has been on my mind though for quite some time. The thing that bothers me most is that this is a problem for which we already have a solution. However, we are either unwilling or unable to act. Why?
Has anybody seen the HBO series that's been airing recently called "Weight of the Nation"? It's a sobering look at the obesity epidemic in this country. One episode highlighted the school lunch problem that our kids face these days. Administrations, hamstrung by cost restraints, are left no other option but to serve up mass-produced, over-processed food to our kids. Coupled with the sodas and juices that are readily available in vending machines throughout our schools, these meals fall far short of what we should expect and demand from a nation that's so wealthy. Why should we care? Just look around. With more children tethered to electronic devices, parents too fearful to send their kids outside to play without supervision, and physical education cuts across the board, we're watching our kids blow up. Now, I'm not writing this intent on stigmatizing overweight kids. They are undoubtedly already dealing with that burden. But when more and more children are visiting doctor's offices across the country displaying signs and symptoms of problems more typically seen in much older people, I find it alarming. And sadly, when you see a kid who's 50 pounds overweight, you usually don't have to look very far to find the parents. The problem is becoming generational.
So who cares, you might ask? There are so many reasons that we should care about this problem that have nothing to do with the aesthetic of being thin. The most obvious one to me is economic. I see a huge irony at play regarding efforts to control trans-fats and other bad foods by some governmental officials, New York City Mayor Michael Bloomberg most notably. Those in opposition cry out that they do NOT want the government to tell them what to do. "How dare they! If I want to eat a greasy cheeseburger, that's my right!!" On the flip side, these same "hands-off" folks howl about the notion of "socialized" health care. Well, there are huge economic costs to obesity and we all share in those costs whether we think we do or not. Obesity is a socialized problem, not just an individual issue. How, you might ask? Well, with all the medical issues associated with obesity, more and more health care dollars are allocated towards treatment of those problems. Who is paying for it? Usually insurance companies. How do insurance companies pay providers while still maintaining their own ever-increasing profit margins? Through raising your premiums!! It would be great if your insurance premiums were directly tethered to your own personal habits. Consumers would have a lot of control over their own costs, which ought to incentivize good behavior. However, the insurance companies don't do nearly enough to reward good individual behavior. Instead, your high premiums go toward treating many of these preventable maladies in other people. I don't know, but to me, that sounds kind of like socialized medicine in some regard, doesn't it?
I'm going to go off on a brief tangent here regarding our current health insurance crisis. I call it a health insurance crisis rather than a health care crisis, because I believe that by fixing the way the insurance companies conduct themselves, then the health care crisis will be vastly improved, meaning there will be far fewer uninsured people. I love my work as a physical therapist, but I hate dealing with insurance companies. I find it laughable how they go to great measures to make their members and providers fight for reimbursement. One quick example that is a microcosm of the type of behavior I'm referencing. I had a patient tell me last week that his wife was denied reimbursement for an emergency appendectomy which required a 4 day hospital stay (price tag: $40,000). The reason for the denial? It was a pre-existing condition!!!! You've got to be kidding me! Since when is an emergency appendectomy (is there really any other kind?) a pre-existing condition. If you've ever spent any time trying to rectify an insurance claim, you'll understand the frustration of navigating the automated systems. Something has to be done, because our current course is not sustainable. Which brings me back to the economics of healthcare and socialized medicine.
Mitt Romney has vowed to make repealing Obamacare the number one priority should he assume office in January. In some ways, I don't blame him. The reality is that President Obama's health care act is nothing like he originally intended it to be. It was rammed down our throats and nobody really knows how it's going to play out long-term. How can we? When the very people drafting this monstrous bill admit to not reading it, how high can we reasonably set our expectations? Aside from being too unknown and unwieldy, the primary argument against it appears to be that we must fight socialized medicine at all costs! But as Thomas Friedman recently pointed out in his New York Times column, we already have socialized medicine. The fact that someone (yes, even an illegal alien) can go into a hospital and cannot be turned away means that we are already caring for everyone. Now, is this an ideal system? Of course not. It is completely inefficient and costly. We have already been paying for these uninsured people well before Obama's plan in the form of higher premiums through our "private" insurances. And we've also frequently heard the concern that "I don't want anyone coming between my doctor and me." Please, stop kidding yourselves. Unless you pay directly out of pocket and don't rely on private health insurance (not many of us), then your relationship has never been between just you and your doctor. Rather, it has been about you and your doctor in his/her office, with the out-of-sight insurance company heavily influencing your health care decisions.
How does our increasing obesity epidemic and our current health care system tie together? The answer lies in the fact that we don't allocate our health care dollars efficiently. Not even close. The finances of our health care system and our health itself can both be greatly improved through one simple solution: PREVENTION. Years ago I read an article about the epicenter of diabetes in this country, East Harlem. The article sited the fact that private health insurance companies wouldn't cover a $200 well visit to a podiatrist for diabetics (a population for whom maintaining healthy, clean feet is essential if they want to keep them), yet it would pay for a $30,000 amputation. Does this make sense?!! Of course not. And to make matters worse, that uninsured person showing up to the ER is undoubtedly not there because they have the sniffles. They're likely there as a last resort, meaning their medical care is probably going to cost a lot, not a little. Now, imagine if that emergency room patient was able to seek attention in a preventative setting 6 months prior? Perhaps the person would not only be in much better shape, but their level and cost of care would likely have been much less in the beginning.
If prevention is really a key answer to two HUGE health care issues, then why aren't we doing anything about it? The solution is right there in front of us! Is it because we are incapable? We don't have the time or money to eat healthier? Are we too lazy to get more exercise? Are we much happier to get a shot or take a pill to handle things on the back end, rather than to live our lives with prevention in mind? Another recent article I read sited a doctor who described the following scenario: If a patient comes into his office who is 150 pounds overweight, with all the maladies that typically accompany such obesity (diabetes, high blood pressure, COPD, heart disease, painful joints, etc.), he knows that the single best thing that he can do for that person is take them for a walk. Imagine that! But he can't, because guess what? He won't get paid to take his patient for a walk. Nor should he. Instead, he will choose the best medications to control all those issues, at huge costs to the insurance companies and large profits to the pharmaceutical companies. And the cycle just continues.
So, when Bloomberg gets lambasted for infringing on the freedom to eat a bacon cheeseburger, I say to him, "Kudos"! If adults (and the kids who model after them) can't control themselves via the course of prevention, then I'm fine with the government stepping in. For those of you who can't stand this take, think of the next time you're ready to bemoan the high cost of taking care of our citizens (which I think is pretty important). Would you rather the government reach across your table and remove your salt, or would you rather they dip into your pocket to take your money? I for one say, "take my salt, and while you're at it, feel free to tax my soda as well. It's not doing any of us any good anyway."
