Time for common-sense health care changes
Three things about health care are universally true:
It ranks near the top of “important” issues. It’s really expensive. Damn near no one understands it.
The combination of ignorance and health care’s ever-expanding complexities has resulted in a history of bad policy, where premiums have skyrocketed and coverage has declined. Obamacare, passed in 2009 and upheld by the Supreme Court, was supposed to change that by providing affordable care to every American. It didn’t. Despite promises to the contrary, many were unable to retain their preferred physician, experienced unacceptable wait times, and often did not receive the medical care to which they had been accustomed. And instead of physicians primarily focusing on patients – the very reason they chose the medical profession – too many were forced to deal with mountains of bureaucratic paperwork, decimating the personal doctor-patient relationship. Salt in the wound was watching premiums and deductibles continue to climb while health care became ever more labyrinthine.
Despite the broken system, Obamacare ruled the day and reform wasn’t an option. But all that changed with Donald Trump’s surprise victory. Now, repealing Obamacare is legitimately on the table. Or is it?
So as to not put this column’s readers to sleep more than normal, we won’t delve into the technical minutiae of health-care legislation, but instead look at the major areas where reform can, and must, be achieved.
But first, let’s address the white elephant that no one else is: There is no true solution to reforming health care so that it’s affordable for all Americans. None. There are many reasons for this, from our entitlement mentality to costs that simply cannot be controlled. But like our nation’s $20 trillion debt, it is a house of cards that will eventually implode. The best we can hope to achieve is slowing the inevitable and preparing a better system for when the current one collapses.
Two plus two always equals four – whether people choose to believe it. And the hard truth is that America simply cannot afford its astronomical health care costs. Most tragic is that, while everyone talks a great game about “protecting future generations,” so few walk the walk, preferring to “get theirs” as much as possible, to the detriment of our children and grandchildren.
For the last seven years, Republican leaders vowed, above all, to “repeal and replace Obamacare.” When the opportunity finally presented itself, the GOP found itself in complete disarray, with nothing to show but contentiousness within its ranks. Leaders somehow caught offguard were forced to cobble together legislation that has unflatteringly been labeled “Obamacare-lite,” and which the Congressional Budget Office stated will cost significantly more than Obamacare.
One would have thought that, with so much time, the Republican Party’s best and brightest would have already crafted a bill of common-sense reforms that the whole caucus supported. But they didn’t, and, frankly, still don’t, as the current bill faces stiff opposition on several fronts. And it doesn’t help that President Trump is saddled with an approval rating of just 37 percent – a situation entirely of his own making. Squandering so much political capital in the first 60 days is not a recipe for success.
That said, here are several reforms that would inject market forces into the system to improve care and slow the meteoric rise in costs.
By far, the number one issue that must be on the table is addressing the obesity epidemic. And “epidemic” is exactly what it is, as 36 percent of Americans are obese, and an additional 34 percent are categorized as overweight. It is the largest factor in the spiraling costs that continue to devour ever larger slices of the health care pie. To get our arms around this, consider that more than $200 billion per year – yes, staggeringly, that’s per year – is spent on obesity-related, preventable chronic diseases. In other words, by the next presidential election, we will have spent a trillion dollars just on obesity costs alone. Chew the fat on that, because not even America’s economy can absorb such a monstrosity. And it will get considerably worse as more Baby Boomers – the most overweight generation on record – enters the period where health issues are most prevalent.
Obesity has already caused a massive upswing in cancers, heart disease, diabetes, stroke, high blood pressure, bone issues and arthritis, just to name a few. Vaccines are not as effective in the obese, which compounds health care costs and increases risk to the general population. And obesity results in not just high rates of job absenteeism, but “presenteeism” – lower work productivity when employees do show up. In just a decade, the cost for this decreased and lost productivity is estimated to be upwards of $500 billion annually.
There are a host of other negative effects costing billions more – wider seats and doors in stadiums, amusement parks, and public transportation; larger and stronger toilets in hospitals and buildings; airline lawsuits and countersuits over whether the obese should be required to purchase two seats; and yes, even costs associated with building larger coffins. Perhaps most startling, a study found that one billion gallons of fuel are wasted every year (1 percent of the nation’s total) just to haul Americans’ extra pounds. Given that the average American weighs 24 more pounds than in 1960, airlines are using roughly 175 million more gallons of jet fuel per year just to accommodate our mass. From creating more carbon emissions, which in turn causes more health problems, to increasing business costs, the price of obesity is simply unacceptable.
Taxing foods and sugary drinks is not the answer, as that hurts manufacturers, businesses and employees, while penalizing healthy consumers.
So how do we cut the fat from these massive obesity outlays? For starters, since obese individuals incur 42 percent more health care costs than healthier people, they should bear the bulk of those costs.
This author does not typically favor government mandates, since they often lead to a “governmentknows-best” nanny state.
However, a mandate that insurers must screen every individual, every year, to gain health assessments and establish baselines, makes sense. With that information, premiums can be adjusted so that those with self-induced obesity conditions pay more. And that is only fair, since healthier Americans are now mandated to subsidize the unhealthy behavior of the obese. Without incentives to become healthier, the problem will continue to expand faster than America’s waistline.
Some will call this a bigoted “fat tax,” while accusing this author of fat shaming. Wrong.
The obese can have their cake and eat it, too. They’d just pay more to do so. In reality, this wouldn’t be a tax at all, but a reduction in the taxpayer subsidy that they currently receive. How is that any different from life insurers making smokers pay more? Or auto insurers charging young drivers higher rates? Higher risk behavior begets higher premiums.
Those who become healthier by hitting reasonable benchmarks would earn a premium decrease, while those who choose to continue an obese lifestyle would be forced to put more skin in the game. No one is mandating what they can and can’t do, but no longer would their lifestyle choices – notwithstanding the “99 percent” who claim it’s a “thyroid problem” – be swallowed by taxpayers hungry for health care premium relief.
Take a bite out of the trillion-dollar obesity epidemic, and the rest is gravy.
Part Two will focus on other common-sense reforms.