Consuming too many potato latkes and Christmas cookies has left its
mark on our waistlines. Unfortunately for Americans and their medical
care, the seasonal overeating seems to last all year. Indeed, the
American Medical Association has declared that obesity is a disease.
It may be more accurate to describe obesity as a contributor to certain diseases. Obesity
raises the risk
of premature death, heart disease, high blood pressure, stroke, type 2
diabetes, gallbladder disease, breathing problems, certain cancers, and
osteoarthritis. Certainly, obesity can result from certain uncommon
diseases and hereditary factors, but
most people become obese simply because they eat too many unhealthy foods and do not exercise.
At its last count, the Centers for Disease Control and Prevention (CDC) estimated that
40% of U.S. adults age 20 and over, 21% of teens, and 14% of preschoolers are obese. A December 2019
study that analyzed 26 years of
body mass index
(BMI [the relation of weight to height]) data concluded that half of
U.S. adults will be obese (BMI>25) by 2030. Some 25% will be severely
obese (BMI>35). Moreover, less than
5%
of adults get the recommended 30 minutes a day of physical activity.
And even when people living in “food deserts” were presented with
healthy options, only
10% changed their evil ways of eating.
According to the CDC’s last comprehensive analysis, the
annual medical cost
of obesity in the United States to Medicare, Medicaid, and private
insurers was $147 billion in 2008. And the medical costs for obese
people were $1,429 higher than those of healthier weights.
The saddest development is the cultural normalization of obesity with
lingerie models,
singers, and
television shows
celebrating fatness. Do we high-five people with other
lifestyle-related conditions such as alcoholism, emphysema, or coronary
artery disease? Of course not.
The obese are easy targets for drug company peddlers of quick fixes
or “providers” who want to extract money from third-party payors. U.S.
pharmaceutical companies spent
$6.1 billion
on direct-to-consumer prescription drug advertising in 2017. Many ads
feature chunky type 2 diabetics happily frolicking about, thanks to the
drug company’s magic pill. The ads might as well say, “pass the
chocolate cupcakes with statin sprinkles drizzled with insulin.” We all
know the prescription of eating less and exercising more is free of
charge.
Alas, we are losing the battle of the bulge. A recent
study
found that participants failed to lose weight despite reporting that
they were exercising and watching their diet. The authors concluded that
“many of [the participants] might not have actually implemented weight
loss strategies or applied a minimal level of effort, which yielded
unsatisfactory results.”
While politicians debate the merits of spending trillions of dollars
on government-sponsored medical care, a correctable source of high
medical costs is hiding in plain sight. Irrespective of who pays for
medical care, rational economic decisions must be made. The Affordable
Care Act (ACA) waved a magic wand and removed preexisting conditions
from the underwriting equation when calculating premiums. A sick person
and a healthy person of the same age could purchase insurance at the
same price. Consequently, the ACA doubled the costs for people who made
the effort to take care of themselves.
The ACA did allow a “
tobacco surcharge”
of up to 50% more for premiums. Why not an obesity surcharge? This
would provide an incentive for consumers to take obesity seriously.
Additionally, health-conscious persons would not have to pay for the bad
habits of others through taxes to fund government health insurance
programs or through higher private insurance premiums.
Those who are stricken with illnesses through no fault of their own
need a path to affordable medical care. A good start for lowering costs
would be eliminating costly middlemen by encouraging consumers to
pay directly
for day-to-day medical expenses. Expanding contribution limits and
eligible uses of Health savings accounts would help pay for the more
reasonably priced
direct-pay surgery and other alternatives to insurance like
direct primary care.
With regard to insurance, we need a revival of competition in the
insurance market with multiple products and carriers. Once again, single
men could opt to decline pregnancy coverage. We need to restore the
pre-ACA availability of low-cost catastrophic (major medical) insurance
policies to all ages. Even before mandated by the Health Insurance
Portability and Accountability Act of 1996 (HIPAA), the large majority
of insurers offered guaranteed renewable policies. Here, assuming timely
payment of premiums, at the end of the policy period, the insurer must
renew coverage regardless of the health of the insured. Naturally, this
valuable feature costs more but provides consumers with a strong
incentive to not let the insurance lapse.
Let’s confront the elephant in the room. Health care policy should
promote personal responsibility, rather than encourage free riders. In
America, we are free to overeat and under-exercise, but we have no right
to make innocent bystanders pay for the consequences.
Marilyn M. Singleton is an anesthesiologist.
Obesity is America’s self-inflicted preexisting condition
