You Can’t Fix Healthcare Without Fixing Obesity

by Jill Richardson / Daily Kos / July 21, 2009

Trying to fix our rising health care costs without fixing our food system is like trying to fix our defense budget without ending our two wars in the Middle East. In fact, it would be like trying to get a grip on defense spending while invading Pakistan. Or something like that.

UPDATE: This is NOT intended to imply that we don’t need single payer or a public option. We do. Desperately. But AFTER that – in addition to that – if we want to get a grip on rising costs, we ALSO need to address our food system. Also, costs are not the only issue in health care that needs fixing. The number of uninsured and underinsured needs fixing too. And there’s absolutely nothing food-related that can fix that. That needs to be fixed by single payer or the public option.

In a recent blog post over at FoodPolitics.com, Marion Nestle summed it up best. Recently released CDC stats show that the percentage of Americans engaged in physical activity is remaining stable, while obesity and diabetes rates are rising in tandem with one another. Our problem is food. And given the fact that the problem is getting worse, we’ve gotta do something about it. Not just for our wallets, but for our quality of life.

Problematic Health Care Costs Other Than Obesity

As for healthcare costs, some of the problem is the high cost of overhead for the insurance companies, no doubt. All of their marketing, lobbying, corporate jets, paper pushing, etc, adds to the bottom line. Then there’s the pressure to increase profits every quarter. That’s another culprit along with obesity in our rising costs.

For-profit insurers also cause increased costs to hospitals, who devote time (and thus money) to trying to work with each of the different insurers to get reimbursed for their services. For example, the doctors’ time spent on the phone with the insurance to get a needed procedure approved, or the time spent figuring out which drug is in the insurance plan’s formulary so the patient won’t have to pay the full price out of pocket.

While some of the stuff hospitals and clinics need to do to get reimbursed applies to Medicare as well as to private insurers, it’s easiest when there are one set of rules (Medicare’s) and not a zillion different sets of rules that you need to keep track of (one per insurance payor and plan).

Then there are the added costs from little problems that become big problems, like trips to the emergency room for uninsured patients who could have prevented the big problem by going for routine preventative care instead. Sometimes the patients pay these bills, and sometimes the hospitals get stuck with the tab when the patient can’t pay. Either way, it all goes into the big pot of health care costs in the U.S.

In theory, a good bill from Congress can fix many of these things. They might be able to take away some of the ability of the insurance to set tricks and traps in the rules, making less hoops for hospitals to jump through. Hopefully, they will give us a system where all of us can get the preventative care we need, as well as trips to the doctor for little problems that come up, so we can treat them before they come expensive big problems.

But, assuming we do all of that and we do it really well, we still have the costs associated with preventable health problems caused by lifestyle (smoking, exercise, stress, sleep, and diet) and those problems are getting worse.

The Increased Costs of Increased Waistlines

I think it’s overly simplifying the problem to call it “obesity.” The problem is crappy lifestyles, largely crappy diets. You can be thin with a crappy diet, and you might be fat with a healthy diet. If nothing else, calling the problem “obesity” is definitely ignoring all of the thin people who eat absolute garbage. I’m sure everyone knows one of those people – the ones you hate who can eat anything and still fit in a size 4. Skinny doesn’t equal healthy.

That said, obesity is easy to measure, far easier to measure than quality of diet. There’s the problem that it’s hard to tell what people ate. (There are two methods… disappearance data, i.e. what food was produced or imported that was presumably either eaten or thrown away, and asking people what they ate, which typically underestimates the amount eaten. How much people actually ate falls in between those numbers.) Then there’s the problem of agreeing on what constitutes a good diet, which I talk about below.

When I worked in health care, my job was to go into clinics for various specialties and find out what the top diagnoses, procedures, medications, reasons for visit, etc were. Usually I’d work in primary care (internal med, family med, and pediatrics). Pediatrics was the only specialty where most of the problems are things like ear infections (i.e. not chronic, lifestyle-related problems) and an enormous chunk of the appointments were physicals, so the patients in those cases weren’t even sick.

(for the remainder of this article and its graph, go here.)