Thursday, July 02, 2009

Unhealth Care

This is an interesting convergence of news articles.

President Obama is pushing health care reform, talking about the catastrophic consequences of high-cost medical care. At the same time, a report come out that Americans are fatter than ever.

(See CNN: Mississippi tops U.S. obesity rankings; Obama takes health care push to the airwaves)

Here is a recipe for cutting trillions of dollars of health care costs every year.

Eat less, exercise more.

A great many of our health-care costs are due to lifestyle choices. Overeating, smoking, drinking, the use of drugs, and unhealthy sexual activities. If people would reduce their involvement in these activities, he medical community would be able to devote more of its resources to caring for those who really need the help – those whose illnesses and injuries are of a type that afflict people regardless of the choices they make.

This is a medical cost containment program that does not cost a dime in government money. In fact, it would increase government revenue, allowing the government to collect more money that it can then use on other programs that actually have real merit. This is because healthier Americans are more productive. They miss less work due to health-related issues, and they are simply able to do more when they do work.

Furthermore, this program will help to fight the effects of global warming, as people leave their vehicles in the drive way and walk more – whether they walk to the store for groceries, or walk to the bus stop and use public transportation.

Unfotunately, we are heading for a health-care system that is built on the principle of abdicating personal responsibility for one’s choices and forcing other people to pay the bill. The current health care reform proposals are, to a large degree, a license for everybody else in the country to make poor lifestyle choices, and then charge much of the costs of their poor choices on my credit card.

And if I should decide to take greater responsibility for my health – if I should decide to put in an hour of exercise every day, to maintain a healthy diet, to choose not to smoke or drink or engage in unhealthy sexual activities, I get none of the savings. My paycheck still gets drained by the rest of the population that takes less care of itself and then garnishes my paycheck to pay their medical bills.

One thing I expect is that the government is substantially underestimating the cost of this health care bill. To the degree that people can pass on even more of their health care costs to others, to that degree people will make choices that will increase their demand for health-care services.

Whatever the government decides to subsidize, it can expect people to demand more of. If the government were to offer universal free gasoline, SUVs and gas-burning vacations would become the rage while public transportation and evenings at home with the family would take a beating. As the government pays for more health care services, people will discover needs for medical care that they never even imagined before.

So, this health care reform is going to end up being a very useful government program for encouraging more obesity, more smoking, more irresponsible sexual activity, and more of the things that people would have a greater incentive to avoid if they were to suffer the total costs of their own irresponsibility.

By the way, this is not so much an argument against adopting the health-care reform package. It is a warning against some of the costs of that type of legislation. However, against the fact that some people have legitimate healthcare issues, these consequences may well be necessary evils.

However, it does provide an argument for taking those consequences seriously. This means that the choice of whether and how much to drink, smoke, and eat, as well as with whom and how one has sex, are no longer private choices. They are private so long as the individual is willing to pay the costs of his or her mistakes.

However, as soon as he demands the authority to garnish the wages of other people to pay for those effects, those others being forced to pay gain the right to have a say in the activities that a person engages in. These choices gain a moral taint . . . or, more precisely, an immoral taint . . . that they would not otherwise have.

So, do you want to be a better person? Give up smoking. Eat less, get some exercise, keep your car in the garage. Quit sleeping around – find a partner that you can be happy with and declare your fidelity to each other.

Most important, be willing to deal with these as moral issues. This means that the desires behind these behaviors become a legitimate target of praise and condemnation. In a public health care community, people who do not take care of their health are not just harming themselves. They are displaying a selfish willingness to do harm to others who do not deserve to be harmed and without their consent.

21 comments:

Kip said...

Health care is not a commodity. People generally do not want to be sick and have to go to the doctor. Saving money (obviously) is not a big incentive for people to maintain healthy lifestyles.

So, with those taken out of the equation, what is left is 1) finding ways to promote the desire for people to be healthy, and 2) easing the suffering of people who are sick. I think a new health insurance system will help with #2. I'm not sure about #1.

Alonzo Fyfe said...

Health care is not a commodity. People generally do not want to be sick and have to go to the doctor.

In all cases, the more and stronger desires outweigh the weaker and fewer desires.

Of course people do not want to be sick or go to the doctor. However, these are two things that they do not want in a sea of things that they do and do not want.

Many people did not want to go to work this morning. However, in spite of the fact, they intentionally went to work - they choose to go to work - because something they did not want was outweighed by more and stronger desires.

It appears quite obvious that many intentional actions have health consequences. Shifting people's desires will shift their intentional ations and can, in turn, result in changes in their health.

Kip said...

> It appears quite obvious that many intentional actions have health consequences.

It's also obvious that genetics plays a huge role in health consequences.

I'm all for incentives for people to live healthier lives. However, the current system does not do that, either. The proposed new system is no better or worse in that regard.

However, it is better in the regard that it sets up a not-for-profit alternative to the current health insurance system, and gives doctors incentives to focus on the outcome of the health care.

Alonzo Fyfe said...

It's also obvious that genetics plays a huge role in health consequences.

Yep.

I'm all for incentives for people to live healthier lives. However, the current system does not do that, either. The proposed new system is no better or worse in that regard.

For the most part, I agree.

However, it is better in the regard that it sets up a not-for-profit alternative to the current health insurance system, and gives doctors incentives to focus on the outcome of the health care.

I am not so sure about this.

I'm quite confident that the final result will be a bill that serves the interests of lobbiests and special-interest groups more than those the public interest.

Steve Gibson said...

We pay for the unfit people anyway, we just do so at a total sytem-wide administrative cost that is about triple the rest of the industrialized world, because we insist on a cluge of a supposed "free market," rather than any type of single payer. The argument that we shouldn't become competitive in the world by reducing system-wide costs because people still won't continue to care for themselves rings hollow--as does the argument that there will be rationing, which we also have now.
Somewhat on a different--but related--item, you did not do so, but for the interest of many who are discriminated against: we clearly have a problem with lack of fitness in the US, but we must use caution when we leap to the conclusion that anyone without an "ideal" body shape/size (bmi) is unfit and/or lazy. (See Paul Campos' work on the Obesity Myth; or hear my interview with him at www.truthdriventhinking.com in the free historical section)

mike said...

Whatever the government decides to subsidize, it can expect people to demand more of. If the government were to offer universal free gasoline, SUVs and gas-burning vacations would become the rage while public transportation and evenings at home with the family would take a beating. As the government pays for more health care services, people will discover needs for medical care that they never even imagined before.

This line of reasoning is absurd. Getting access to quality treatment when you are ill is a necessity, not a convenience, and is not remotely comparable to getting a subsidy to support the use of a larger, roomier vehicle.

Even if health care was made more available, there is little incentive to wait in a doctors office, take your clothes off, be inspected, probed, and stuck with needles, other than treatment for a condition serious enough for the patient to be aware of. Dealing with heath care when it is afforded to you, is unpleasant enough, and many people are guilty of not getting treatment or diagnosis when they should and can do so.

Furthermore, the people who can least afford health care also are likely to have the poorest health habits, so their lack of access has not been a deterrent to their behavior. Suggesting that providing them access to treatment will give them a green light to abuse themselves further, is the kind of 'resent-the-poor' rhetoric employed by the most base politicians pandering to a racist constituency.

Hume's Ghost said...

The United States has one of the worst ranked health care systems in the developed world, with multiple nations having more cost effective public systems (Netherlands springs to mind.)

On average, the U.S. system spends about $6,000 per person on health care, including whatever the government, employers and individuals pay out of pocket. For less than half that — about $2,700 — the Dutch get better care, research indicates.

You're making an argument that seems to have already been disproved.

Hume's Ghost said...

"I'm quite confident that the final result will be a bill that serves the interests of lobbiests and special-interest groups more than those the public interest."

That I have little doubt of. I haven't realy seen anyone yet note the role that Sen. Baucus played in the passage of Bush's attrocious Medicare expansion which was written for the benifit of Big Medicine.

Alonzo Fyfe said...

Steve Gibson

The argument that we shouldn't become competitive in the world by reducing system-wide costs…

Where did I write such a thing? In fact, I did not even write that the proposed legislation should not pass. What I wrote is that when people acquire the liberty to force the costs of their actions on others, then those others gain a moral vote in what those actions will be.

It sound to me that this part of your comment was boiler-plate invented elsewhere in other discussions and thrown in here out of habit in a discussion where the points are not relevant.

we clearly have a problem with lack of fitness in the US, but we must use caution when we leap to the conclusion that anyone without an "ideal" body shape/size (bmi) is unfit and/or lazy.

This is true. The inference is not valid, and people have a right to a presumption of innocence unless proven guilty. Yet, this does not change the fact that voluntary choices are behind much of our unfitness. This seems to be the best explanation for the increase in obesity within each age group over time.

mike

This line of reasoning is absurd. Getting access to quality treatment when you are ill is a necessity, not a convenience, and is not remotely comparable to getting a subsidy to support the use of a larger, roomier vehicle.

Actually, the main choices that I am interested in are not those about whether or not to get treatment when ill, but the question of whether or not to engage in behavior that puts one at risk of becoming ill. Not smoking so as to avoid lung cancer and heart disease. Eating low-cholesterol foods to reduce heart risk. Getting exercise so as to improve overall fitness.

Your argument makes it sound like going to the doctor is so unpleasant that nobody would ever choose to perform an action that puts their health at risk. That is clearly false.

Hume’s Ghost

On average, the U.S. system spends about $6,000 per person on health care, including whatever the government, employers and individuals pay out of pocket. For less than half that — about $2,700 — the Dutch get better care, research indicates.

Yep. Our current system is quite well designed to drive up health care costs without increasing overall health care.

Kip said...

Alonzo> "In fact, I did not even write that the proposed legislation should not pass."

This seems intellectually dishonest to me. You clearly were indicating that the new legislation would make things worse than they currently are.

You started out great. Clearly we could use some encouragement to be more healthy. However, you then slid into this diatribe:

Alonzo> "Unfotunately, we are heading for a health-care system that is built on the principle of abdicating personal responsibility for one’s choices and forcing other people to pay the bill. The current health care reform proposals are, to a large degree, a license for everybody else in the country to make poor lifestyle choices, and then charge much of the costs of their poor choices on my credit card."

Alonzo> "So, this health care reform is going to end up being a very useful government program for encouraging more obesity, more smoking, more irresponsible sexual activity, and more of the things that people would have a greater incentive to avoid if they were to suffer the total costs of their own irresponsibility."

I think you're wrong. We'll see, I guess.

Eneasz said...

I have little to add that hasn't already been said. It is interesting to note that Europeans are generally much more physically fit than Americans, even though they get their healthcare free(ish). On the other hand, they do smoke and drink more, on average.

Also of interest is that, as a previous commenter observed, generally the richer people are (in the US), the more likely they are to be physically fit and refrain from bad habits, while the poorer they are the more likely they are to be out of shape and smoke.

I'm not sure what conclusions can be drawn with such general info. Maybe only that monetary concerns have almost no influence on healthy life-style choices?

Luke said...

Couldn't agree more, Alonzo!

Kip said...

Oh. Come on.

Anonymous said...

Question. Looking purely at costs, who costs more? The obese smoker who dies of a heart attach at 55? Or the healthy guy who lives to be 95, but his last 20 years were associated with the normal things old people get -- high blood pressure, frequent Dr's visits, 20 different pills for many differnt problems, maybe some cancer, and perhaps a slow and expensive death.

This is an empirical question. It is always assumed that the common list of deleterious bahviors that lead to early death -- smoking, obesity, and so on -- cost us much more. But I've always wondered if their early death ends up costing less.

Not that early death isn't a bad thing. Of course it is. I'm talking about he economic argument that is frequently cited.

Alonzo Fyfe said...

Kip

An argument that a particular policy will make one thing worse is not an argument that it should be rejected overall.

There are other factors to consider.

Of particular importance is the fact that some people (particularly children) simply are not insured.

Also, the fact that most people get their current insurance through work means that some people are trapped in their jobs. An affordable group policy available through an independent source would give some people an option to quit jobs they would otherwise have to stay in.

And the current insurance system provides medical researches with little incentive to focus their research on finding cheeper ways of accomplishing particular ends.

This is a large and complex issue.

Alonzo Fyfe said...

On the idea that wealthier people tend to be healthier than poorer people, there are two principle contributors here.

(1) Health costs money. From memberships to health clubs to the purchase of exercise equipment, to even the purchase of quality food, a person with money can purchase health benefits that the poor cannot afford.

(2) More importantly, there is a link between health and education. Better educated people tend to make themselves healthier simply because they better understand and appreciate what the options are. They also tend to make more money.

Anonymous said...

"On the idea that wealthier people tend to be healthier than poorer people, there are two principle contributors here."

I would just add that there are two traits -- conscientiousness and intelligence -- that are known to correlate with health and longevity.

Both of these traits are reliable and valid, and both predict and are often the source of the two you mention.

Kip said...

Alonzo> "This is a large and complex issue."

Fair enough.

Hume's Ghost said...

"the fact that most people get their current insurance through work means that some people are trapped in their jobs."

Yep, Johnston mentions that this is a big drag on the economy in Free Lunch (the link I linked to in the previous comment.)

Another thing that gets overlooked is a point raised by Robert Reich in Supercapitalism: we already have a form of public health insurance.

Even though employer-provided health care has diminished since [the previous era of democratic capitalism], in 2006 it still constituted the biggest tax break in the whole federal tax system. According to recent estimates, if health care benefits were considered taxable income, employees would be paying $126 billion a year more in income taxes than they do now. In other words, employer-provided health care is a backdoor $126 billion-a-year government health insurance system that’s already up and running.

Employee insurance counts as non-taxed income, but this ends up being a regressive plan since the people who need insurance the most don't have the access; and it also provides employers with an incentive to try and figure out ways to employ people without providing them with insurance or to hire people who are low risk.

Left-wing Wacko said...

Alonzo,
Regarding the original post, it seems you have things exactly backwards when you focus on individual responsibility at the expense of a more socialized accounting of things.

This seems to be a rather myopic view of things that is perhaps a left-over from your days as a libertarian and objectivist.

On the other hand, not to be overly critical, some of your responses would seem to suggest you see the problem from a more social responsibility perspective.

In many countries with a national health insurance/or medicine much more emphasis is put on incentives towards prevention and healthy life choices. So your conclusion doesn't necessarily follow from your premise. Although, unfortunately it may in America's case. But it doesn't have to be that way.

Another point you allude to correctly in my opinion in your subsequent comment that it is easier for lower income peoples to feed themselves on junk rather than eat in a healthy manner.

Have you seen or heard of this new film Food Inc., or heard or read of any of Michael Pollan's arguments about our food system? From this it would seem that government subsidies provide incentives to encourage unhealthy eating. So why not aim these type of policies in the other direction?

Also, since the 1950's America's whole mode of urban planning and transportation has overly-emphasized the individual reliance on the automobile at the expense of pedestrian friendly urban landscapes. It is often flat out difficult to nearly impossible to walk to a grocery store.

So anyway, my broader point is that it is myopic and inaccurate to focus on "individual choice and responsibility" when social, political and economic forces have set up a structure that guides these individual choices. I think it better to think in more systematic terms.

funchy said...

I agree with your suggestions, but you're making a logical jump without proof. Heavier does not automatically mean unhealthier. In the US we have a weight chart and Body Mass Index calculation to tell us how overweight we are. I never in my life was inside the "normal" range (5'10" female, large frame & naturally stocky). When I was in college, I was at my thinnest (180lbs), and I had so little padding around my bones, it hurt to lay on a hard floor. BUT the weight charts called me "fat" and I had to wear plus size clothes because of my height. I will never be a size zero, and I really don't care.

I am concerned when a stranger looks at my scale, calls me fat, and says I'm the reason healthcare is so high. I can stack more bales of hay at my farm in a morning than more women half my weight.

I also don't eat a high sugar or high meat diet. My cholesterol, bp, blood sugar, and other numbers are not only acceptable, they're "ideal". Compared to my friends who weigh less, I believe I am healthier.

Please also be aware that 20-30% of teen girls have severe body image issues and a good % of them have bulimia or anorexia. I just lost a friend to anorexia-related organ failure, after a lifetime of battling it and going in/out of hospitals.

A little extra padding is not evil. If you're going to go after me for exceeding an arbitrary weight chart, you need to talk first to the alcoholics, drug users, sugar-eating diabetics, meat eating cardiovascular patients, junkfood-eating cancer patients, etc.

Add to this that the US government controls food prices via things like the Farm Bill. A high-corn food like doritos are made of govt subsidized products, while my organic grown grapes and strawberries are not. Consumers buy based on price. We need to reverse it and stop using tax $$$ to make bacon doublecheeseburgers and icecream so cheap -- and fruits, nuts, veggies, & whole grains more affordable.

It's a very complext issue.