If ever there was reason to reconsider the wisdom of having our healthcare and insurance under employment or government mandate, the "war on obesity" is it.
The surge of employer-based health insurance, which didn't happen in other insurance markets such as automobile and life insurance, and the creation of federal-based Medicare and Medicaid insurance in 1965, has contributed to skyrocketing medical costs and insurance rates for everyone, according to a just-released analysis by Robert B. Helms, director of health policy studies at the American Enterprise Institute. Receiving health insurance through employers removed the competitive marketplace which would have encouraged providers and insurance companies to keep costs down. It's also resulted in a plethora of untaxed health benefits, which at first glance seemed a good thing for recipients, and employers didn't mind since they could deduct benefits as a business expense. But it's also mostly benefited higher-income people with employer-provided perks, according to Helms, while meaning greater costs to our wallets, freedoms and choices.
Lawmakers have also played a significant role in raising costs of healthcare. State legislatures have passed more than 1,800 mandated health insurance "benefits," with 295 new mandates introduced in January of last year alone, according to a new report by the Council for Affordable Health Insurance. "For almost every health care product or service, there is someone who wants insurance to cover it so that those who sell the products and services get more business," they explain. Lawmakers justify their support by asserting that mandates won't cost much or that they'll save money, but "we have overwhelming evidence mandates virtually always cost money rather than save it," CAHI says. They estimate mandated benefits increase the cost for basic health insurance for all consumers by 20% to more than 50%, depending on the state. Worse, a number of these cost-raising, mandated covered treatments are frivolous, fraudulent or alternative -- unsound, ineffective, unproven or potentially dangerous.
One of the most problematic, covered by both employer and federal health insurers, is weight loss "treatments." The "costs of obesity" are cited as justification for such mandates, as well as a plethora of government public health, anti-obesity programs. But the profit motives and special interests, rather than science, behind such initiatives are undeniable. Instrumental in getting coverage and tax deductions for weight loss treatments is the American Obesity Association, a lobbying organization for obesity-related businesses, whose sponsors include bariatric surgical groups, pharmaceutical companies, and weight loss programs like Weight Watchers and Jenny Craig. Among the most vocal advocates of employer anti-obesity "wellness programs," as well as higher insurance premiums for fat people, are groups such as the as the National Business Group on Health and its Institute on the Costs and Health Effects of Obesity, representing the interests of large corporations supplying their employees with health insurance. NBGH Board members also include the country's largest insurance companies, pharmaceutical companies, weight loss programs, bariatric surgical suppliers, Health and Human Services officials, and other obesity-related interests.*
Consumers generally assume that healthcare policies and insurance rates are made by unbiased experts and have science behind them. But as Dr. Henry Miller of Hoover Institution noted in a recent TCS article, government health officials have made one bad decision after another that squander valuable resources and place consumers at added risk.
And fat people have proven highly lucrative profit centers as weight is medicalized and money can be made on weight loss "treatments" -- which get piled onto those "costs of obesity." Never mind that weight loss interventions have long-term failure rates of nearly 99%, and directly cost the public an estimated $64 million, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Never mind that the diets and other weight loss measures actually put health in greater jeopardy, leaving people fatter and at higher risks for heart disease, cancers, osteoporosis and type 2 diabetes. We're also seeing more providers turn "to various kinds of managed care plans that attempt to produce better value through disease management, patient education, and utilization controls," notes Helms. In this case, fat people are being increasingly pressured to participate in corporate and government weight loss "wellness programs," whether they want to or not.
While claiming a health imperative, going after all of those deemed fat -- which is now two-thirds of us -- isn't really about health. While the fattest in our population -- elderly, minorities, poor and women -- may correlate with groups needing greater healthcare dollars, blaming fatness is a red herring. There's been an effective media blackout on the facts that the "costs of obesity" are gross exaggerations and bad science being hyped mostly by those trying to sell weight loss or obesity-related treatments and those making money on insurance.
It's not politically popular to address the facts that most, nearly 70%, of the growth in health care spending is due to increased costs per treated case chiefly because of more expensive drugs and technologies, rather than rising numbers of cases, as research by Emory University economist Kenneth Thorpe and colleagues reported in the journal Health Affairs. They found very little change in the number of people treated for heart disease and most of the top medical conditions since 1987. While the population is fatter, people are living longer and "dramatically" healthier lives than ever, as even the CDC's Health United States 2002 report acknowledged.
As the costs of healthcare and insurance have climbed; and the government, employers and insurance providers face an aging population and potential greater outlays of healthcare dollars to care for them; they're looking for more ways to improve their bottom lines. It is logical that insurers would try to find a way to raise premiums without garnering public scrutiny and wrath. Blaming obesity and claiming people are fat because of bad behavior is just the ticket -- they can charge higher premiums to them while making it appear their own choice.
Blaming obesity also makes it easier to ignore the larger issues behind rising healthcare costs and the more difficult decisions that allocating public healthcare expenditures most prudently would entail. We mustn't let the facts get in the way. It wouldn't be popular to acknowledge that "being male is now the single largest demographic risk factor for early mortality in developed countries," according to Daniel Kruger, a social psychologist at the University of Michigan Institute for Social Research, in research published last June in Evolutionary Psychology. Even the most morbidly obese women have longer life expectancies than "normal" weight men, according to obesity researcher Paul Ernsberger at Case Western Reserve School of Medicine, Cleveland, Ohio. Yet no one is concerned about a catastrophe of maleness and calling for the eradication of men.
Instead of addressing more difficult public health issues, employer-group insurers offer benefits like coverage for cosmetic procedures, teeth whitening and floral arrangements that are most enjoyed by those in higher income brackets benefit, which explains the political popularity of maintaining the current state of affairs, according to Helms. A recent analysis in Health Affairs found that those with family incomes over $50,000 also enjoyed 71.5% of the value of federal tax health expenditures last year, while those with income below $20,000 got only 3.4%. The vast public anti-obesity initiatives being promoted, while unproven and unsound, cost taxpayers hundreds of millions of dollars a year.... all the while, ways public healthcare dollars might be better spent if saving more lives was really the goal are ignored. Dr. Steven H. Woolf, professor of family medicine, preventive medicine and community health at Virginia Commonwealth University, Richmond, reported ending racial disparities in health care could save five times more lives -- nearly 900,000 African Americans during the 1990s alone -- than more drugs or technological advances.
These are all uncomfortable issues to confront, but look them squarely in the face we must if we are to make the soundest decisions, create the most efficient health care system, and preserve our freedoms. It's in everyone's best interests to encourage a thriving business climate, but when the marketplace has become so distorted by governmental interference; and government agencies, insurers and employers have become entangled with special interests and thrown sound science out the window in favor of political expediency and their own benefit, all of us have good reason to want them all out of our healthcare choices and call for a serious re-examination of our priorities.
Part Two: In Feeding Frenzy, we'll expose how the government, our schools and employers have become institutions for social engineering and how our freedom of choice about what we do on our own time and in our own homes are being taken away.
* Editor's note: An earlier version of this article claimed: "NBGH member attorney John Banzhaf supported a proposal to allow 'employers, schools, insurers and other similar institutions to discriminate against any person who is obese.' He said: 'Make them pay...and pay. Fat people are leeches.'" These assertions were in error. Prof. Banzhaf is not affiliated with NBGH and he never said "fat people are leeches." TCS regrets the error and apologizes to Prof. Banzhaf.