Wednesday, August 4, 2010

Missouri's health-care dilemma

Yesterday, by a 3-to-1 margin, Missouri voters passed Proposition C: "No law or rule shall compel, directly or indirectly, any person, employer, or health care provider to participate in any health care system."

From the New York Times:
“This really wasn’t an effort to poke the president in the eye,” said State Senator Jim Lembke, a Republican. “First and foremost, this was about defining the role of state government and the role of federal government."
On the same day that Missouri voted against mandatory health insurance, the Center for Disease Control released a study listing Missouri  among the most obese states in the union. From the Wall Street Journal:
Ten years ago, 28 states had obesity rates of below 20% of their adult population, the CDC report said. In the latest survey, Colorado is the only state, along with Washington, D.C., that fits that description. Also, no state had an obesity rate above 30% in 2000, whereas nine states are above that threshold today, the report said. Those states are Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and West Virginia.
Obesity is often a sign of ill health, and our country's increasing obesity rates go hand-in-hand with increasing medical costs. Here is some date from a report released last month from advocacy organization Trust for America's Health, “F as in Fat: How Obesity Threatens America’s Future 2010,” page 107:
  • Obesity-related medical costs total $147 billion a year, or nearly 10 percent of all annual medical spending (based on 2006 data).
  • Of the $147 billion, Medicare and Medicaid are responsible for $61.8 billion. Medicare and Medicaid spending would be 8.5 percent and 11.8 percent lower, respectively, in the absence of obesity.
  • Obese people spend 42 percent more on health care costs than healthy-weight people.
 Ironically, when you compare obesity rates by state with how states voted in the 2008 presidential election, you discover that all nine states with over 30% obesity rates voted Republican. By contrast, eight of the nine states or districts with the lowest obesity rates (Colorado, District of Columbia, Connecticut, Massachusetts, Hawaii, Vermont, Oregon, Montana, New Jersey) voted Democratic. Does this mean that the states most likely to try to opt out of the federal health-care program are the states most likely to have high medical costs? And if so, what does that mean for those states' budgets - or the health of their residents?

This is no time for people in blue states to crow, however. Here's more grim news. The CDC report says that "in 2000, [alarmed by our nation's obesity rate of 19.8%,] a Healthy People 2010 objective was established to reduce the prevalence of obesity among adults in the United States to 15%." Instead, we gained more weight. Lots more.

Not one state achieved the goal of a less-than-15% obesity rate by 2010. Whereas in 2000 28 states had an obesity rate of  less than 20%, in 2009 only Colorado and the District of Columbia had a rate that low. In 2000, no states had an obesity rate of more than 30%; in 2009, nine states do.

When all the states are put together, our average obesity rate is 26.7% - almost 7 percentage points higher (and about 27 million more people) than nine years earlier. And since weight and height were self-reported in the study, many analysts believe our true obesity rate is even higher than the study indicates (be honest now: is the weight on your driver's license entirely accurate?).

With or without federal insurance mandates, we are seriously weighing down our nation's health-care system. If Missouri successfully challenges parts of the Patient Protection and Affordable Health Care Act - and it may not, because federal courts are likely to disagree with their election results - then Missouri lawmakers had better start thinking about what to do with their citizens who are too rich for Medicaid but too poor, too optimistic, too negligent, or too stubborn to pay for health-care insurance.


Barb said...

hmmm, so if I could just move to Oregon . . .

Anonymous said...

The rise in obesity is a complicated phenomenon, not understood by our best medical minds. America is not the only country in the world to have obese poor people: obesity seems to be a side effect of emerging markets. We who are presently unafflicted tend to blame the victims and/or the system-- government, corporations. Meanwhile, wanting to do good in this world, we face dilemmas. Should we support a broad based universal health care system that funds bariatric surgery as the solution to obesity, with a reasonable expectation that doing that will bankrupt our economy? Are we doing good when we donate processed foods to the hungry? Does that at least benefit them financially, since it's what they would be buying because of their means and preferences?
I'm on the board of a social services organization, struggling with how to use our resources, which have shrunk in this economy. Do we continue an initiative towards organic unprocessed local foods and nutrition classes, with our own accompanying debt? Or does such a "teach a man to fish" ideal threaten our mission (and our needy constituents), by reducing our ability to provide as much of what is cheap & easy & available now? We have radically different views on these questions, depending upon our own anticipated consequences, and sometimes upon our own weight. No one really knows whether obesity+diabetes+other dire health threats is preferable to Third-World starvation, (tho Americans know which of these they'd pick). But the debate is muddied by even casting it solely as a poverty, lack-of-education dilemma, when the technically obese label increasingly includes most of us.