Healthcare Reform and Obesity

Call the title strange, but this is a good example of the various opinions on the ideal interaction between people and their government.

Introduction
To make a generalization, liberals generally expect that the government should be trusted to provide services to the citizenry for the greater good and advancement of society. This can take the form of infrastructure growth, federal grants for college tuition, Social Security, Medicare, or anything that makes a good Reaganite cringe when spoken of in terms of hundreds of billions of dollars. Conservatives generally distrust the government in providing these services, preferring instead to hearken to individualism and the value of work ethic and perseverance in the private interest to yield the greater good and advancement of society. Now, I have a passion for history, so I know that this in no way adequately explains the complex and interwoven strands of political groups and motivations in American history and how various parties have formed to garner their loyalty around a single banner. However, it's a good foundation for addressing this facet of the health care debate.

Popular Opinion
I don't put a lot of trust in poll numbers, because the majority is not inherently right. We have this nice culturally engrained link between popular sovereignty and progress, but that's not so! Furthermore, studying statistics taught me that polls can be very unreliable to boot. Anyway, there is no doubt that most Americans are of the opinion that health care reform is needed. CBS reported in June that, in fact, 72% of Americans support a "public option" for health care. No doubt, like me, most of these respondents have very little idea about the complexities of insurance policy and don't know what they're agreeing to. But what are the implications of this popular opinion, and what can people do about it?

The Cost Debate
The first key issue about the health care debate that has bothered me is the ideological opposition to its cost. There has been a furor between the Congressional Budget Office (CBO) and the White House on the cost of reforming health care:

"The Congressional Budget Office, standing tall in the face of Democratic outrage, provided analysis that shows the President’s plan will NOT reduce government spending on health care like he said it would, and that it will substantially increase the federal deficit – despite tax increases." (Wall Street Journal 7/24/09)

Truthfully, though, health care reform should not be measured in terms of how much it costs, but how much it will save in net terms. The main principle is that the government will attempt to wrangle the growing costs of providing benefits and insurance to an aging American population reliant on specialists and prescription medication. Thus, costs will be reflected in the government, not in the private sector and consumer spending, as they have to this point. The Obama administration claims, according to the New York Times, that its plan will save both households and the nation a sum total of about $2 trillion over ten years. This is where the debate truly lies: in cost with the consideration of savings over time.

Personal Responsibility
Now there is a legitimate political argument over health care. I am inclined to support a government option if it serves to maintain the insurance industry but introduce competition in order to keep insurers honest and reduce their exploitative practices. However, there is more that one can do besides have an opinion on healthcare that will probably only have an effect on Washington if your local Congresspeople are soon up for reelection. One can have personal responsibility.

I've listened to enough oratories through high school speech and debate to know that rhetoric-based calls for social justice and populism can be tiring. I will try to avoid that. However, health care costs to a degree are a direct reflection of one's personal lifestyle. Genetics are the obvious exception, and I have no qualms saying that health care for unavoidable disorders and complications, like Multiple Sclerosis, is justified. I do not believe though, that the government should have the responsibility to insure bad lifestyles. Avoidable obesity is an instance in which the left-wing notion of government-provided services falls short and the more right-wing notion of lack of reliance on the government comes into play, striking a sort of balance.

Here are some facts from a study from the CDC released July 27th in Health Affairs:

"The annual healthcare costs of obesity could be as high as 147 billion dollars for 2008. Obesity is now responsible for 9.1 per cent of annual medical costs compared with 6.5 per cent in 1998.
The medical costs for an obese person are 42 per cent higher than for a person of normal weight. Obesity accounts for 8.5 per cent of Medicare expenditure, 11.8 per cent of Medicaid expenditure, and 12.9 per cent of private insurance expenditure."

To use the oft-quoted John F. Kennedy, "ask not what your country can do for you - ask what you can do for your country." A social contract invokes expectations from both the citizenry and the government. We must not be a complacent populace in considering the health care debate, happy to vote 72% in favor of reform while sitting idly by. Promoting healthy lifestyles and countering obesity, especially in children, can make a dent in the cost and help the savings of healthcare in the long run. This is a bipartisan issue that requires no governmental action whatsoever, but can have the result of making the costs of a change in the healthcare more palatable.

Moving Forward

In considering policy options, the temptation can be to go for the convoluted, working the tight spaces of Washington political alliances and forging an imitation of Hegelian synthesis. Ted Kennedy has been the icon of that sort of bipartisanship. Assuredly it has its place. But how about a simpler way to cut a tenth of healthcare reform costs off instead of challenges by the fiscal conservative camp to reduce costs by nickels and dimes in whatever ardent health care reformers are willing to drop? Americans can accomplish this. It just requires living up to our end of the exchange of rights and responsibilities with the government.