Saturday, October 1, 2011

Republican on Health Care

After visit to the Italian Fest in Denver - and watching people "enjoy" plenty of pizza and cannoli -I felt a slight philosophical shudder, a shift in my political center. All I need to do is go to a food festival or go to the mall or even go to the supermarket, and I feel an urgent need to "go Republican" on health care.

By that I mean, the issue of personal responsibility for health care is becoming more and more significant to me. Americans who give little thought to their diet, exercise, and health are literally costing me money. And, as cold as this may sound, I don't want to pay for their Medicare. And it may not even be about retirement - the poor eating and exercise habits of many Americans are clearly driving up my private sector premiums right now as well.

Obviously, increased demand and consumption - and advancements in technology/treatment - is what is driving up prices. And, on the national level with Medicare, it is only going to get worse. The biggest problem with our deficit is the millions of Baby Boomers who are retiring and signing up for their "all but free" health care for the next twenty or so years. And, let's face it, millions of these people are doing nothing to decrease their health care costs. They're not trying to get off their blood pressure medicine, they're not trying to decrease their risk of coronary hearth disease, they're not doing anything. And, we're going to be paying for it for decades and decades. And that really bothers me.

Now, of course, there is another side to this. I am under no illusion that this problem is entirely the fault of consumers - especially people like me and my family. Insurance companies are posting record profits, and they are jacking up premiums simply because they can. Some state governments are considering legislation that forces companies to spend a set percentage of medical services and lowering premiums. The insurance companies are certainly taking advantage of the fact that we are all terrified of getting cancer or getting in a car accident or tearing our ACL. And, so we could all get amazingly healthy, and the companies might still raise rates.

But, still. With the survival of Medicare in mind, I'm thinking, "Come on, people. Get a clue." Even conservative Bill O'Reilly has argued for years that we all have a interest in the health of others because their behavior directly affects our pocketbook. As much as a the libertarians want to whine when people seek to restrict and regulate consumption of "crap," one man's heart attack or high blood pressure or type II diabetes is certainly my business. So, lay off the fast food people. Period. Enough with the sodas. I'm serious. Stop plying your kids with processed versions of food, and get a clue about a little exercies.

Recently, after I criticized President Obama's jobs plan, I friend of mine said, "You're turning into a Republican." I laughed, knowing it's not about party for me. It's about money.

Now, go take a walk. And ask someone to go with you.


Anonymous said...

Despite the drone of the media, I don't think that the link between food that you eat and health care costs is particularly clear.

People who become obese often end up with diabetes and other less obvious problems (arthritic knees, etc). But it is really surprising to many when they learn that obesity only has a small impact on lifespan. You really should judge less.

Almost everyone does "bad" things. Kids go to loud rock concerts and drive too fast. Others smoke. Some simply don't wear their seat belts. Some ride motorcycles or enjoy hang-gliding. Some well-educated parents don't get vaccinations for their kids. The overweight are just easy pickings. You should also read the research on obesity -- for many, it's not as easy to "resist the temptation" as you seem to believe.

Also, there is no place where reasoning such as yours stops. Studies show that animals live much longer and with fewer health problems if they consume very few calories. Should we say that unless you eat less than 1250 calories a day, we won't help take care of you if you get sick?

So, two points. First, rather than look down on those of "weak mind," perhaps if we're really concerned, we could incentivize behavior that helps people -- subsidize vegetables instead of grains and meat, give people time off from work to exercise or providing incentives to employers to provide such time/facilities - there are lots of ideas for change that probably make make people happier and lead to less medical intervention.

Second, your Republicanism on the issue (cost transfer) is cold and uncaring. If someone in your family were to be stricken with a disease that required expensive and ongoing care, you would probably want treatment, and there is no reason that this treatment shouldn't be provided as long as the resources exist. People are denied health care every day because they cannot pay in the US - sounds like you want to add another limit - the number of slices of pizza you've consumed in your lifetime.

BTW - If it weren't for the demand for healthcare, aggregate demand, and the state of the economy, would probably be even worse. You seem to look at every expenditure in the world is somehow coming out of your pocket - it's not. What is money for anyway?

mmazenko said...

Oh, please. Small impact on lifespan? I guess that's a valid point if you understand that technology and pharma allow us to live for years beyond the norm if we're heavily medicated. No need to adjust diet and exercise if you can just take a pill ... or ten. It's not that it has small immpact - it's that we can very expensively stave off death - but that doesn't mean they are healthy.

Your examples of bad things are nothing but misdirection. Health has improved dramatically since smoking became so regulated and more of a social stigma. And concerts, seat belts, and hang gliding don't lead to nearly 500,000 deaths per year and billions of dollars in care.

And I am not picking on the obese. I am all too familiar with how difficult weight issues are. I understand people can't just "resist temptation." I'm not picking on the overweight, I'm also talking about thin but unhealthy people. Plenty of thin diabetics, and high blood pressure, and heart disease, and poor bone density, and strokes among the thin. And there's a difference between struggling with weight and not even trying. We all work better with incentives - and financial ones are generally pretty effective.

And I'm with you on promoting health by incentivizing it. And that's much of what I am talking about. There's a great book called Nudge which makes the same case. But time off work for exercise? Some companies actually do, and I'm for it. But you can't mandate it. The point is there is much to be said for personal responsibility.

And my term "Republican" was meant as a sarcastic play on the common criticism. For example, when President Bush felt the need to qualify the term as "compassionate conservatism," we reached an awkward moment. The GOP and conservatives are not cold and uncaring, and the origins of conservatism with Burke and Disraeli argued for a more secure society that preserved the institutions which made it strong.

Thus, most in the GOP understand the need for Medicare and access to health care. It's only the extremist voices that cloud out that basic human compassion. And seeing health care spending as a positive is rather twisted. If we didn't spend so much on health care, we might have some more money left over to fix our roads and schools. Money is not "for" health care.

And I'm not talking about being stricken with some disease or being in a random accident. I'm talking about people in their teens and twenties with Type II diabetes. That used to be called "adult-onset" because it struck in people's sixties after a lifetime of poor eating.

So, I'd say history is a pretty big indicator of the validity of my claims. We are spending far more on health care than we need precisely because we have abandoned any sense of being responsible for our health.

Anonymous said...

I don't see how you aren't picking on the overweight. What else are you claiming? What do you think people ought to do with their lives? You say that it's not about wearing seatbelts? What is it about?

People who don't have weight problems simply don't have a shared point of reference and thus judge. It's understandable and easy to do. I continue to occasionally judge despite my best efforts. Here's some more info on perhaps why we shouldn't judge.

I take back my lifespan statement, though all the studies seem to have used BMI -- a terrible measure for anything -- and as far as putting things in perspective:

"This study has shown that continuing to smoke is as dangerous as doubling your body weight, and three times as dangerous as moderate obesity."

You seem to have this attitude that says: live the way that I live and I won't have to pay for your healthcare. Seems awfully smug.

You should read
The Marmot Review Health is about much more than what you eat or if you jog a couple of miles each day.

You have to get over this idea that everything is about money. Money is simply a proxy for resource control. The idea that we can't "afford" roads because we have to provide healthcare is wrong. If doctors are available and we have asphalt and construction workers, we can do both - money or no. We let the notion of money limit our ability to do things that we can do right now, and it's tragic.

"It's only the extremist voices that cloud out that basic human compassion."

You must have not read David Brooks' latest piece.

mmazenko said...

I am criticizing unhealthy diet and exercise habits which lead to illness and higher health care costs. And, yes, I am arguing people should choose healthier options like me.

Smug? Whatever. It's no more smug than claiming I am educated and therefore other people in society should be as well because it will benefit all of us. Care to explain the difference?

If we have asphalt and doctors we can ...? Money or not? OK, I am not generally quick to resort to extreme names, but you're sounding rather Marxist. And those ideas about just building roads and doctors treating everybody regardless of money is ... utopian to say the least.

Anonymous said...

Believing that everyone should be educated - like you - as a benefit to society? I'm sorry, but this is very egotistical thinking. Believing that everyone should have to _opportunity_ to get the education that they desire - that's something completely different.

You're argument against my example is that it's Marxist? Not that it's bad, or that it's unfair or impossible or that it will harm people, but that it's Marxist? Perhaps you didn't understand my point. Perhaps I wasn't clear. In the world, there are resources - human and material. The limits of our economy in a year are what humans can do with those resources in a year. Period. Markets (and money) may help us to decide what to do with those resources, but things right now are terribly broken, as we let those resources go to waste for lack of money that can be created at will.

By the way, providing healthcare regardless of money isn't Marxist. -- It's just right.

What Marxism became (brutal Stalinism) was certainly bad for people. But one might stop and think about what Marx actually had to say and whether any of his ideas are relevant today. From the leftist rag known as The Harvard Business Review

Private Hip Replacement said...

Healthcare should come second to none. This Trust has been there for us whenever we have needed them.

mmazenko said...

I do have a hard time believing that we don't commit to health care being a basic human right - and I don't mean emergency care. Certainly, the limits to what people might want are endless, and restraint for the basic human need is imperative. But everyone should be able to go to a clinic and get medical assistance.