Tuesday, July 28, 2009

American Adipose Act

And now for something a little less serious . . . or maybe it is serious. You choose:

Many observers of national politics worry about the establishment of new entitlement programs and the lack of fiscal discipline that can accompany them. That may account for a lot of the current discourse about the President's proposed public insurance plan.

A colleague has come up with a scenario that would help ensure that the number of people subscribing to a public plan would be kept to a minimum -- and would be consistent with other societal health and well-being goals.

The idea would be to create the American Adipose Plan ("AAP"), the public insurance plan. Only citizens with a body mass index above a certain number would be eligible for insurance from AAP. Because overweight people tend to have more difficult and expensive health care needs, and would therefore draw more public subsidies, Congress would have an incentive to try to minimize the number of people in this plan. Thus, goes the theory, they would be less likely to fund certain programs that undermine public health by promoting obesity. For example, subsidies for corn and sugar, two of the major federal programs that have contributed to excessive calories in fast food and school lunches, would be seen as less desirable by Congress. A positive feedback loop could result, saving money in both arenas, while contributing to the entire nation's health.

Perhaps, too, the government's Food Pyramid would be revised to reflect the actual nutritional value of food groups, as opposed to the financial clout of various sectors of the food industry.

In the best of Washington traditions, lobbyists who wish to advocate for this plan are free to do so.


Anonymous said...

Haha, that's not so farfetched. I just read somewhere that obesity-related health spending (I believe it was in Medicare, but don't quote me) was 6% of total health spending and heading for 10%, and that we would never control health spending unless we control the obesity epidemic. That's a fairly astounding statistic. The primary reason was that obesity is related to diabetes, and diabetic complications such as foot ulcers, etc. are more refractory to treatment in obese patients. I do know all the surgeons at my hospital used to hate to operate on those people because the complication rate was higher. Maybe we really do need an "obesity tax", or at least that soda tax being discussed. Just think, a junk food tax would raise billions!


Anonymous said...

Correction: This morning's Washington Post corrects my faulty memory: the study was published in Health Affairs and the % spending is NOW 9.1%, up from 6.5% in 1998. It costs $1400/yr more for an obese person's medical treatment. The obesity rate in that time period rose 37%.
Think of that - 37% in a decade. That is an astonishing number. American Adipose Act, indeed.


e-Patient Dave said...

Yeah, right: considering that the major lobbying spend in DC right now seems to be oriented toward *avoiding* reductions in spending (each player protecting its own piece of the pie), I anticipate that a move like this would end up getting BACKING from Congress, under some rationale that these are the poor souls who most need our help.

It's just ludicrous that our per capita spending on health care is 50% higher than other developed nations yet when we talk about covering the 20% who have no insurance, it seems nobody talks about just becoming more efficient (i.e. reducing spending); all the noise is about "Gasp! Who's going to pay for that??"

I gave up months ago on trying to "bend the spend" as a path to improvement. That's when I wrote my Thousand Points of Pain post, which IBM picked up in March.

Hmm, now that I think of it, that was part of my concluding that patients' best path to getting what we need is to git bizzy ourselves, doing what we can to help, which led to my deciding to move my data into Google Health. Huh.

Jerry said...

Well, talking about health (care and financing) without talking about obesity doesn't make any sense to me.

Anonymous said...

I realize this was meant to be tongue in cheek, however you are contributing to the discrimination against people who are obese. Why is it tolerable to make these types of comments? I think it is mean spirited. Most people do not chose to be obese, it is a poorly understood disease process. To single out a group of peeple based on appearance is discrimination, and it is wrong.

Anonymous said...

Dear Anon 6:53;

I am not presuming to respond for Paul, but I do not find his post discriminatory at all. The only "funny" thing might be the choice of the title for the Act, and even that only uses the medical term for fatty tissue. As I noted in my comments above, obesity IS a most serious condition in this country and the steps suggested in Paul's post merit serious consideration.
Your attitude could also be applied to smokers, who become addicted and therefore "can't help it" - should we forbid any and all comments against smoking?
Obesity is a medical condition, first and foremost, the treatment of which usually requires behavior modification by the patient. So does congestive heart failure. So listen to whatever your doctor is telling you.

nonlocal MD

e-Patient Dave said...

Anon 6:53,

Like nonlocal, I don't see Paul's remarks as discriminatory. (I am hardly lean myself, in case you're wondering.) He spoke not of imputed personality traits or worth as a person (the hallmarks of biased remarks, baseless relative to physical traits) but of well documented correlations. If you're obese too, I'm sure you're aware that you have higher risks of heart attack and lots of other things. Doesn't make us bad people; just medical facts.

Further to what nonlocal said, the new field of Participatory Medicine emphasizes a collaborative partnership between provider and patient. The provider is the skilled coach, but it's the patient who actually "makes the moves" on the playing field, or doesn't.

I wrote about this on the e-patient blog last New Year's Eve (Stanley Feld's "Physicians are coaches, patients are players") and again nine days later, when a review of Robert Veatch's new book Patient, Heal Thyself led me to take a post-New-Year's assessment of my own personal responsibility for how I'm doing. Not like a guilt thing (I don't do guilt) but just as a realism thing. Medicine seems to be one of those areas where being in touch with physical reality is really useful.

FatHealthNut said...

I struggle with a weight problem. I have a coworker who smokes excessively who is thin. We are both professionals in healthcare with sharp minds and a desire to better ourselves. When I up my exercise regimen significantly, watch every single bite of food that I eat, make sure I squeeze in at least 7.5 hrs of sleep, drink water and exercise self control, I still have people comment to me that perhaps I should exercise more, or choose better foods, or even better yet..."you should lose weight, it isn't healthy for you in the future".

When my friend stops smoking, or trys to stop, or hides it from others so that they don't know she smokes, or talks about her run last evening, it is instantaneously assumed that she is a healthy, fit, self-disciplined person.

Obesity is a disease, it does involve behavior change, but it also involves overcoming the painful emotional challenge of dealing with rude comments, dirty looks, lower pay, silent treatment, blatant disrespect.

We should all absolutely spend time talking about obesity and seeking solutions to the obesity epidimic; encouraging financial punishment of individuals because they are in a certain category at a given point in time counterproductive and meanspirited and immature.