7 ms·

A new report clarifies some misconceptions about the U.S. medical system

55 points by austenallred 13y ago

melling 13y ago
Gotta wonder if the sedentary lives that many of us have isn't going to lead to health problems. Throw in the long hours and there has to be a health downside.
ghouse 13y ago
And by the transitive property, subsidized processed food, including corn syrup, is making healtcare expensive.
siculars 13y ago
My brother is a doctor. I work in a university hospital in medical informatics and I'm friends with literally dozens of doctors across a spectrum of specialties. Every single one of them will put obesity at the top of the "what's wrong with healthcare/the population/people" list. Just stop being fat.
- rhizome 13y ago
  Have you seen the profiles of Congresspeople lately?
- old-gregg 13y ago
  Successful "healthcare service providers", not obesity is what is making healthcare expensive. Ask a Porsche salesman who his clients are. Obesity doesn't explain a $800 knee MRI or $4K ambulance ride. A californian hospital billed us at $3.7 per second for a broken wrist. Your brother, not fat people, is making healthcare expensive. This is so freaking obvious I'm starting to veer into conspiracy theories territory failing to explain this craziness: they'll start suspecting "mongolians and puerto-ricans" as factors before they'll notice this enormous elephant in the room. Every US city has a neighborhood where "doctors live". It's sickening. Also, ask your brother what he thinks. I have a few friends in healthcare and they're very open about it (it's hard to deny if you know their lifestyles)
  - carbocation 13y ago
    Obesity (or, possibly better put, the behaviors that lead to obesity) is what makes (many) people sick. Cost is explained by a great variety of factors, some of which you have identified, but many of which are much more subtle.
  - pfraze 13y ago
    Doctors should cost a lot. They undergo almost a decade of (debt-incurring) training to provide extremely valuable services, often at absurd hours. You ever hear of being "on-call?" Anybody that works ER shifts doesn't have a job -- they have a life in medicine. So you're going to have to work hard to convince me doctors should be paid less. We're already facing a downturn in the number of people entering the medical career (to the extent that nurses are now being trained to handle more of the job -- good in some ways, but difficult in others). Regarding other facets of healthcare costs, some kinds of medicine and equipment are just flat-out expensive. Figuring out what costs are largesse and what costs are justified is tough, and made somewhat more difficult by distortions to the market by insurance and medicare. I'm not saying insurance or medicare are not the best solution (I don't really know) but I do know it affects the market pricing mechanisms. Cost-controlling is a huge topic in the healthcare industry right now. Nobody disagrees that the costs are too high, but some things are worth paying for more than others. I think there are other places to look before the docs.
    - ninguem2 13y ago
      That's because the supply of doctors is kept artificially low and the cost of training is not borne out by society. There are other countries in the world, you know. You can just look at what they do.
    - old-gregg 13y ago
      Your entire answer is basically what TV tells you to think of doctors after watching numerous sitcoms about them. Doctors exist in other countries, they manage to learn the same amount and some are apparently better than their US counterparts [1] Moreover, I said "heathcare providers", not "doctors". Every piece of medical equipment, from an artificial joint to a scalpel, goes through a lengthy list of middlemen each making a healthy margin. Walk into the oncology clinic (the same ones who accept donations from various "X to cure cancer!" events) and take a look at price of the hardwood they put in. That's your "cure cancer" money and it has nothing to do with "doctors should cost a lot". Healthcare lobbyists is the problem, but I'm just pointing out the easiest signs everyone can see. It's not rocket science: if you think obesity is the problem, look at the cost of giving birth. If you think insurance companies are the problem, try to get an MRI independently. If you think cost of education is the problem, look at the degree a jet-owning medical equipment salesman holds. [1] http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems http://en.wikipedia.org/wiki/World_Health_Organization_ranki...
- deleted 13y ago
  [deleted]
- auctiontheory 13y ago
  Every single one of them will put obesity at the top of the "what's wrong with healthcare (1) Have you actually asked them? (2) So you're saying that they'll blame someone else, rather than blame their own bureaucracy and inflated salaries.
  - siculars 13y ago
    1. Yes. Obesity as a problem comes up often when talking candidly with doctors. 2. I can agree with you on the bureaucracy thing but when you get sick you're gonna want the best doctors working on you. I don't begrudge doctors a single penny they honorably and legitimately earn. 14 years of school and hundreds of thousands in debt? Ya, you do that and get back to me.
    - auctiontheory 13y ago
      I don't begrudge doctors a single penny they honorably and legitimately earn. Your answer begs the question. Also, US doctors earn a higher multiple of the average salary than doctors in other Western countries do, while not providing measurably better patient outcomes.
- DanBC 13y ago
  Any of them work in ER? What about alcohol or mental health? EDIT (after question was answered) I do agree that obesity is the leading problem with healthcare! I'm just curious about the problems of alcohol or MH in emergency care settings. They're significant in the UK.
  - siculars 13y ago
    ER, Neuro, OB, Radiology, Psych, GI, Cardio, Optho, Family, Peds, Nursing. I'm sure I'm skipping a few. Honestly, obesity is a root cause for so many preventable illnesses. All it takes is moderate diet and exercise and you'll be set.
- whyenot 13y ago
  > Just stop being fat. Unfortunately, as we learn more about obesity, it's becoming increasingly clear that once you are fat, it is very difficult to ever lose the weight and keep it off for a significant amount of time[1]. I don't know what the solution is, but being overweight, especially "on the way up" is something that should be taken much more seriously. 1. http://www.nytimes.com/2011/10/27/health/biological-changes-thwart-weight-loss-efforts-study-finds.html http://www.nytimes.com/2011/10/27/health/biological-changes-...
  - pfraze 13y ago
    It may seem distasteful in some ways, but stomach-stapling is a fairly effective solution to consider for the morbidly obese. If you've not heard of this (a gastric bypass) I recommend googling. It's not the end solution, but boy does it work.
    - whyenot 13y ago
      It's a solution that does work, but it seems to me like a last resort and also a solution that doesn't scale very well. 35.9% of the US population over age 20 is obese[1]. 1. http://www.cdc.gov/nchs/fastats/overwt.htm http://www.cdc.gov/nchs/fastats/overwt.htm
- znowi 13y ago
  I know a few obese people and they require almost an ongoing medical attention. Starting from diabetes and on to various complications with deteriorating prospects. They can't participate in many activities feeling alienated or wear trendy clothes their like - which adds to emotional stress and psychological issues on top of it. But really, it's quite easy to stay fit, if you want it. First thing you do is eat less (can't emphasize it enough). Second, eat home food and cut all the junk. And lastly, stay active: bike, swim, hike, whatever. No need for fancy diet programs.
alexeisadeski3 13y ago
Is it possible that more than one factor is making healthcare expensive? The US gov't itself already spends more (per capita) than does the Canadian gov't. Is the US obesity rate much higher than Canada's? Have a look: http://en.wikipedia.org/wiki/Obesity_in_the_United_States http://en.wikipedia.org/wiki/Obesity_in_the_United_States
transfire 13y ago
Insurance companies make healthcare expensive. Pass a law that requires all payers to pay the same rate for the same service, be it an insurance company or an individual paying out of pocket and the system would get fixed in short order.
- jackschultz 13y ago
  I'm gonna go ahead and say it's not as simple as just "passing a law".
- zdw 13y ago
  This. Middlemen always push the prices up and they exist to get a cut, nothing more. In many cases, the insurance agent who sells the policy gets paid the roughly the same amount as a primary care physician for looking after a patient. Only one party here is actually doing needed work...
- ahomescu1 13y ago
  One scenario of how this plays out is that everyone winds up paying the maximum rate, not the minimum (best case, everyone winds up paying the average the old rates). Passing a law like this means the poorest insured will pay more, while the richest might pay less (or the same).
- ars 13y ago
  The higher paying people subsidize the lower paying. If you did what you suggest then medicare would have to pay more (probably 50-100% more), which would necessarily increase taxes. This is not necessarily a bad thing, just keep in mind all the unintended consequences.
- Zigurd 13y ago
  A big step in the right direction, but, upstream of the insurance companies, the health care service and product providers have much greater supplier strength than in single-payer systems. There is still of lot of complexity inside that box but "Supplier strength in pricing" is much closer to the cost TL;DR than fat people.
__pThrow 13y ago
What a horrible headline in the original article! Headline: Obesity, not old people, is making healthcare expensive Article: contains no occurrences of the word obesity
nostrademons 13y ago
I've long thought that the most effective action the government could take to fix health care (and a variety of other problems) would be to eliminate corn subsidies. That one government action has ripple effects throughout the economy and almost all of them are negative. It concentrates economic power in big agribusiness instead of farmers, because it means that chemical/bioengineering companies like Monsanto can wield huge economies of scale across the one crop that is most economically viable in the U.S. (because it's subsidized by the government). It drives local farmers out of business because they can't compete with the giant agribusinesses. It makes the U.S. agricultural system less resilient to drought and blight, and more dependent upon petrochemical fertilizers. And then it also makes it far more economical to make food products with high fructose corn syrup, corn-fed chicken & beef, cornmeal, and corn starch, all of which are phenomenally unhealthy for you. This is why poor people eat at McDonalds; because of the subsidies, corn-fed beef & chicken and soda made from high-fructose corn syrup are much cheaper than healthier alternatives, and so that is all poor people can afford. Then they get fat, and the rest of society bears the burden for their medical and lost productivity costs.
- DanBC 13y ago
  Soda made from regular sugar is going to be as cheap as soda made from HFCS. Obese people will still be able to drink 64 ounce "cups" of sugar water. Fat people do not need HFCS to become fat. They need calories. Some people suggest that HFCS may make those calories less satiating than calories from fat, but they don't mention other types of sugar. Any sugar when eaten in excess is harmful. Sugar from honey or sugar beets or sugar cane is going to cause harm if you're drinking six litres of soda a day. The Economist puts a UK Big Mac as cheaper than a US Big mac. What are our subsidies that make the burgers so cheap, if we don't have cheap HFCS? http://www.economist.com/content/big-mac-index http://www.economist.com/content/big-mac-index
  - Chestofdraw 13y ago
    Possibly the beef subsidies? According to the site linked below the price for a big mac meal is cheaper in the US, so they have a more expensive burger but cheaper sides. http://www.humuch.com/prices/McDonalds-Big-Mac-Meal/______/518 http://www.humuch.com/prices/McDonalds-Big-Mac-Meal/______/5...
npsimons 13y ago
As others have pointed out, there are many factors that contribute to high cost healthcare. And while I think that BMI is almost completely worthless, and I've never been really fat, I can say that exercise and losing weight are some of the best things (and best feeling things) I've ever done. Sure, fix the costs (especially with IT/technology in general, as those on this board can probably have the biggest effect on that), fix the insurance industry, and let's have a serious look at the food industry while were at it - but on an individual level, giving exercise a try will probably reduce our health costs in the long run and make us feel better in the short run.
DanBC 13y ago
> Actually, chronic diseases, such as heart disease and diabetes, among people younger than 65 drives two-thirds of medical spending. About 85 percent of medical costs are spent on people younger than 65, though people do spend more on healthcare as they age. I thought this might be because the US system has much more support for people over the age of 65, and thus pushes prices down, but later on in the article they say > Though it often may feel like out-of-pocket expenses are growing disproportionately to the cost of healthcare, Medicare, Medicaid, and federal employee plans have actually picked up an increasingly larger share of the tab. The article makes some assumptions. > The patient wants to see the best doctors and get the best treatments available, Not necessarily. Many patients don't want the best, they just want protection from the worst and they want "good" or "excellent", but they'll include other things. "How convenient is the hospital for people to visit or for me to get after care?" is one example. The article title is annoying. The article doesn't explain why obesity is driving up costs, and doesn't do a good job of showing that obesity is driving up costs. The abstract doesn't mention obesity, but says: > Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources of information, and self-management software.
LizVerano 13y ago
Just stop being fat. Control what you eat.
streptomycin 13y ago
This says otherwise http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050029 http://www.plosmedicine.org/article/info:doi/10.1371/journal... Who do I believe, a blogger from The Atlantic who seems to be misinterpreting the data he cites, or a peer-reviewed scientific publication?
- MaysonL 13y ago
  Well, what that report says is that fat people cost more per year then non-fat, but since they die quicker, they don't cost as much over their lifetime. It would be interesting to see what discount rate would equalize the costs.
ScottBurson 13y ago
My personal bizarre pet idea for bringing down healthcare costs: mandatory minimum copays. The problem, by one analysis, is that patients have no incentive to weigh costs against benefits. That's a tough task in any case, and pushing it off to the insurers makes it harder, as the insurer has less information than either the patient or their doctor about their individual case. The result is that neither patients nor (often) doctors know what the services cost. In fact price information has been so effectively removed from the system that in some cases nobody knows what the service really costs. tptacek posted a great example: http://news.ycombinator.com/item?id=4465845 http://news.ycombinator.com/item?id=4465845 The purpose of the mandatory minimum copay is to force price information back into the system. When patients have to pay some part of the price of every service, they will therefore have to know what those prices are. All that said, there are obviously some questions and problems to be dealt with. For starters, what's the formula for how much people have to pay? On the large end, I would suggest something like (price in dollars) ^ 0.7. This means for a $10k service, the copay would be about $600; for a $100k service, about $3000; and for a $1M service, around $16k. Those numbers feel reasonable to me: big enough to make most people think twice about choosing a six-figure intervention, but not an absolute barrier if there's a good medical reason. On the small end, though, that formula produces numbers that are arguably too large. A $200 service (if there is such a thing? maybe in lower-income rural areas) would have a $40 copay by that formula. This risks discouraging people from getting preventative and urgent care that they need. To correct for this we could simply subtract some fixed number from the result of the above formula. I'm not sure what the right number is, but somewhere in the $40 - $80 range, I would guess. (This provision could also be subject to means testing.) Probably when I say "mandatory" what I really mean is "the government provides incentives to make plans with this property significantly cheaper than those without". I don't care that rich people will circumvent the rule if they want; I just care that most people are on plans with this property, so that, as I say, price information is forced to flow again.
- DanBC 13y ago
  Patients are the wrong people to drive costs down. "Why are you re-canularising me? Why am I being charged for this extra un-needed canula procedure? Just leave the old one in" etc. Doctors can assess the research, and can decide whether the risk of infection from old canulas balances the risks of new canulas, and whether the cost is worth it or not. Here's a radio programme (no longer available from the BBC website, but may be somewhere else on the Internet?) about an Indian hospital that does a lot of work to drive down costs. http://www.bbc.co.uk/programmes/b039yz53 http://www.bbc.co.uk/programmes/b039yz53 http://www.bbc.co.uk/news/health-10837726 http://www.bbc.co.uk/news/health-10837726 > "We believe that the only way is to build large hospitals - 100 or 200 beds are not going to be the solution for the current world health problem. We need to build large hospitals where hundreds of operations are carried out every day." > And here in Bangalore, the theory appears to work. Despite the huge volume of operations, mortality rates are comparable with or better than those in Britain and the US, and costs are much lower.
kimonos 13y ago
True! Many people nowadays are suffering obesity and sometimes are unaware that their health are at risk.
jes5199 13y ago
It's NOT a trivial problem, though. There's evidence that other mammal species are also experiencing obesity epidemics, even though their diets haven't changed: http://www.aeonmagazine.com/being-human/david-berreby-obesity-era/ http://www.aeonmagazine.com/being-human/david-berreby-obesit...
slt555q 13y ago
Hmmm...I guess all those other academic papers showing that the greatest percentage of healthcare dollars go to end of life care defined as final 2 years but especially final 6 months. I am also pleased to see this analysis was in part conducted by, "we'll tell you what you want to hear as long as you pay us" BCG. Or as I know them BSG. Healthcare costs are skyrocketing because people are making a lot of money. Look back to '76 or so when the people who pushed for changes to the laws allowing for the creation of HMOs and promised enormous savings. That didn't happen. Any time you have a major consulting company telling you how to reduce healthcare costs the sound your actually hearing is money dropping in their pockets. It would be fun to skewer the article point by point but not worth the time.
slt555q 13y ago
PS Ask my friend in Canada who is waiting 16 months for a hip replacement how happy he is.
- HarryHirsch 13y ago
  This very issue is known in Britain as the "little old lady problem". Resources are limited, and society needs to decide who gets care first. There are many life-threatening conditions, but arthritis in the hips and knees isn't one of them. Consequently, if you can pay, you get to the front of the line, and if you can't you'll get one eventually, but you won't die. They always roll out the little old ladies in wheelchairs when it comes to healthcare reform.
  - slr555 13y ago
    "Consequently, if you can pay, you get to the front of the line, and if you can't you'll get one eventually, but you won't die." That's such a great comfort when you are in excruciating pain and can't walk. I think that should be the motto of the NHS "at least you won't die". Aim high. Actually it's not the little old lady problem. I did a documentary on healthcare in the UK. One of the patients suffered from severe rheumatoid arthritis, a serious autoimmune disorder, she was told it would take 6 months to see a rheumatologist. She had the means to pay for private care and saw the same doctor within a week. You see arthritis which you probably don't have and obviously don't understand comes in many for from the less complex osteoarthritis to forms that have many nasty sequelae such as lupus or psoriatic arthritis. I have worked in healthcare for 20 years and my wife about the same but she has worked more internationally. In countries with state run healthcare many times newer treatments such as cancer drugs are not available. Flawed though it may be I will stick with US medicine.
    - HarryHirsch 13y ago
      One of the patients suffered from severe rheumatoid arthritis, a serious autoimmune disorder, she was told it would take 6 months to see a rheumatologist Again: rheumatoid arthritis does not kill you. many times newer treatments such as cancer drugs are not available Good that you say that. In many countries to gain approval the manufacturer needs to show a benefit over what is already on the market. Whatever was there was new, but it didn't prolong survival or improve quality of life. Why should the public pay for something very expensive (because it's still under patent) when something equally good is available for much less as a generic?
tpainton 13y ago
the societal move to destigmatize obesity is the culprit. It's now okay to be big and beautiful.
- stefan_kendall 13y ago
  I think you may have cause and effect backward here. Suppose a bunch of people get fat. What are the chances that they, after the fact, convince themselves that fat is okay?
  - npsimons 13y ago
    Not to mention that stigmatizing obesity is not going to solve the problem. What is this, grade school? "haha, fatty-fatty-fatty!" Maybe some empathy and support would go much further in helping the obese to conquer their problems.
youngtaff 13y ago
I'm not even sure the headline actually represents the original article faithfully (http://jama.jamanetwork.com/article.aspx?articleID=1769890 http://jama.jamanetwork.com/article.aspx?articleID=1769890) One thing to note is that there are many organisations who represent the elderly and they have political power - certainly in the UK, older people vote so you see laws that benefit them sometimes to the detriment on the young.

55 points by austenallred 13y ago

Gotta wonder if the sedentary lives that many of us have isn't going to lead to health problems. Throw in the long hours and there has to be a health downside.

ghouse 13y ago

And by the transitive property, subsidized processed food, including corn syrup, is making healtcare expensive.

siculars 13y ago

My brother is a doctor. I work in a university hospital in medical informatics and I'm friends with literally dozens of doctors across a spectrum of specialties. Every single one of them will put obesity at the top of the "what's wrong with healthcare/the population/people" list. Just stop being fat.

rhizome 13y ago
Have you seen the profiles of Congresspeople lately?
old-gregg 13y ago
Successful "healthcare service providers", not obesity is what is making healthcare expensive. Ask a Porsche salesman who his clients are. Obesity doesn't explain a $800 knee MRI or $4K ambulance ride. A californian hospital billed us at $3.7 per second for a broken wrist. Your brother, not fat people, is making healthcare expensive. This is so freaking obvious I'm starting to veer into conspiracy theories territory failing to explain this craziness: they'll start suspecting "mongolians and puerto-ricans" as factors before they'll notice this enormous elephant in the room. Every US city has a neighborhood where "doctors live". It's sickening. Also, ask your brother what he thinks. I have a few friends in healthcare and they're very open about it (it's hard to deny if you know their lifestyles)
- carbocation 13y ago
  Obesity (or, possibly better put, the behaviors that lead to obesity) is what makes (many) people sick. Cost is explained by a great variety of factors, some of which you have identified, but many of which are much more subtle.
- pfraze 13y ago
  Doctors should cost a lot. They undergo almost a decade of (debt-incurring) training to provide extremely valuable services, often at absurd hours. You ever hear of being "on-call?" Anybody that works ER shifts doesn't have a job -- they have a life in medicine. So you're going to have to work hard to convince me doctors should be paid less. We're already facing a downturn in the number of people entering the medical career (to the extent that nurses are now being trained to handle more of the job -- good in some ways, but difficult in others). Regarding other facets of healthcare costs, some kinds of medicine and equipment are just flat-out expensive. Figuring out what costs are largesse and what costs are justified is tough, and made somewhat more difficult by distortions to the market by insurance and medicare. I'm not saying insurance or medicare are not the best solution (I don't really know) but I do know it affects the market pricing mechanisms. Cost-controlling is a huge topic in the healthcare industry right now. Nobody disagrees that the costs are too high, but some things are worth paying for more than others. I think there are other places to look before the docs.
  - ninguem2 13y ago
    That's because the supply of doctors is kept artificially low and the cost of training is not borne out by society. There are other countries in the world, you know. You can just look at what they do.
  - old-gregg 13y ago
    Your entire answer is basically what TV tells you to think of doctors after watching numerous sitcoms about them. Doctors exist in other countries, they manage to learn the same amount and some are apparently better than their US counterparts [1] Moreover, I said "heathcare providers", not "doctors". Every piece of medical equipment, from an artificial joint to a scalpel, goes through a lengthy list of middlemen each making a healthy margin. Walk into the oncology clinic (the same ones who accept donations from various "X to cure cancer!" events) and take a look at price of the hardwood they put in. That's your "cure cancer" money and it has nothing to do with "doctors should cost a lot". Healthcare lobbyists is the problem, but I'm just pointing out the easiest signs everyone can see. It's not rocket science: if you think obesity is the problem, look at the cost of giving birth. If you think insurance companies are the problem, try to get an MRI independently. If you think cost of education is the problem, look at the degree a jet-owning medical equipment salesman holds. [1] http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems http://en.wikipedia.org/wiki/World_Health_Organization_ranki...
deleted 13y ago
[deleted]
auctiontheory 13y ago
Every single one of them will put obesity at the top of the "what's wrong with healthcare (1) Have you actually asked them? (2) So you're saying that they'll blame someone else, rather than blame their own bureaucracy and inflated salaries.
- siculars 13y ago
  1. Yes. Obesity as a problem comes up often when talking candidly with doctors. 2. I can agree with you on the bureaucracy thing but when you get sick you're gonna want the best doctors working on you. I don't begrudge doctors a single penny they honorably and legitimately earn. 14 years of school and hundreds of thousands in debt? Ya, you do that and get back to me.
  - auctiontheory 13y ago
    I don't begrudge doctors a single penny they honorably and legitimately earn. Your answer begs the question. Also, US doctors earn a higher multiple of the average salary than doctors in other Western countries do, while not providing measurably better patient outcomes.
DanBC 13y ago
Any of them work in ER? What about alcohol or mental health? EDIT (after question was answered) I do agree that obesity is the leading problem with healthcare! I'm just curious about the problems of alcohol or MH in emergency care settings. They're significant in the UK.
- siculars 13y ago
  ER, Neuro, OB, Radiology, Psych, GI, Cardio, Optho, Family, Peds, Nursing. I'm sure I'm skipping a few. Honestly, obesity is a root cause for so many preventable illnesses. All it takes is moderate diet and exercise and you'll be set.
whyenot 13y ago
> Just stop being fat. Unfortunately, as we learn more about obesity, it's becoming increasingly clear that once you are fat, it is very difficult to ever lose the weight and keep it off for a significant amount of time[1]. I don't know what the solution is, but being overweight, especially "on the way up" is something that should be taken much more seriously. 1. http://www.nytimes.com/2011/10/27/health/biological-changes-thwart-weight-loss-efforts-study-finds.html http://www.nytimes.com/2011/10/27/health/biological-changes-...
- pfraze 13y ago
  It may seem distasteful in some ways, but stomach-stapling is a fairly effective solution to consider for the morbidly obese. If you've not heard of this (a gastric bypass) I recommend googling. It's not the end solution, but boy does it work.
  - whyenot 13y ago
    It's a solution that does work, but it seems to me like a last resort and also a solution that doesn't scale very well. 35.9% of the US population over age 20 is obese[1]. 1. http://www.cdc.gov/nchs/fastats/overwt.htm http://www.cdc.gov/nchs/fastats/overwt.htm
znowi 13y ago
I know a few obese people and they require almost an ongoing medical attention. Starting from diabetes and on to various complications with deteriorating prospects. They can't participate in many activities feeling alienated or wear trendy clothes their like - which adds to emotional stress and psychological issues on top of it. But really, it's quite easy to stay fit, if you want it. First thing you do is eat less (can't emphasize it enough). Second, eat home food and cut all the junk. And lastly, stay active: bike, swim, hike, whatever. No need for fancy diet programs.

alexeisadeski3 13y ago

Is it possible that more than one factor is making healthcare expensive? The US gov't itself already spends more (per capita) than does the Canadian gov't. Is the US obesity rate much higher than Canada's? Have a look: http://en.wikipedia.org/wiki/Obesity_in_the_United_States http://en.wikipedia.org/wiki/Obesity_in_the_United_States

transfire 13y ago

Insurance companies make healthcare expensive. Pass a law that requires all payers to pay the same rate for the same service, be it an insurance company or an individual paying out of pocket and the system would get fixed in short order.

jackschultz 13y ago
I'm gonna go ahead and say it's not as simple as just "passing a law".
zdw 13y ago
This. Middlemen always push the prices up and they exist to get a cut, nothing more. In many cases, the insurance agent who sells the policy gets paid the roughly the same amount as a primary care physician for looking after a patient. Only one party here is actually doing needed work...
ahomescu1 13y ago
One scenario of how this plays out is that everyone winds up paying the maximum rate, not the minimum (best case, everyone winds up paying the average the old rates). Passing a law like this means the poorest insured will pay more, while the richest might pay less (or the same).
ars 13y ago
The higher paying people subsidize the lower paying. If you did what you suggest then medicare would have to pay more (probably 50-100% more), which would necessarily increase taxes. This is not necessarily a bad thing, just keep in mind all the unintended consequences.
Zigurd 13y ago
A big step in the right direction, but, upstream of the insurance companies, the health care service and product providers have much greater supplier strength than in single-payer systems. There is still of lot of complexity inside that box but "Supplier strength in pricing" is much closer to the cost TL;DR than fat people.

__pThrow 13y ago

What a horrible headline in the original article! Headline: Obesity, not old people, is making healthcare expensive Article: contains no occurrences of the word obesity

nostrademons 13y ago

I've long thought that the most effective action the government could take to fix health care (and a variety of other problems) would be to eliminate corn subsidies. That one government action has ripple effects throughout the economy and almost all of them are negative. It concentrates economic power in big agribusiness instead of farmers, because it means that chemical/bioengineering companies like Monsanto can wield huge economies of scale across the one crop that is most economically viable in the U.S. (because it's subsidized by the government). It drives local farmers out of business because they can't compete with the giant agribusinesses. It makes the U.S. agricultural system less resilient to drought and blight, and more dependent upon petrochemical fertilizers. And then it also makes it far more economical to make food products with high fructose corn syrup, corn-fed chicken & beef, cornmeal, and corn starch, all of which are phenomenally unhealthy for you. This is why poor people eat at McDonalds; because of the subsidies, corn-fed beef & chicken and soda made from high-fructose corn syrup are much cheaper than healthier alternatives, and so that is all poor people can afford. Then they get fat, and the rest of society bears the burden for their medical and lost productivity costs.

DanBC 13y ago
Soda made from regular sugar is going to be as cheap as soda made from HFCS. Obese people will still be able to drink 64 ounce "cups" of sugar water. Fat people do not need HFCS to become fat. They need calories. Some people suggest that HFCS may make those calories less satiating than calories from fat, but they don't mention other types of sugar. Any sugar when eaten in excess is harmful. Sugar from honey or sugar beets or sugar cane is going to cause harm if you're drinking six litres of soda a day. The Economist puts a UK Big Mac as cheaper than a US Big mac. What are our subsidies that make the burgers so cheap, if we don't have cheap HFCS? http://www.economist.com/content/big-mac-index http://www.economist.com/content/big-mac-index
- Chestofdraw 13y ago
  Possibly the beef subsidies? According to the site linked below the price for a big mac meal is cheaper in the US, so they have a more expensive burger but cheaper sides. http://www.humuch.com/prices/McDonalds-Big-Mac-Meal/______/518 http://www.humuch.com/prices/McDonalds-Big-Mac-Meal/______/5...

npsimons 13y ago

As others have pointed out, there are many factors that contribute to high cost healthcare. And while I think that BMI is almost completely worthless, and I've never been really fat, I can say that exercise and losing weight are some of the best things (and best feeling things) I've ever done. Sure, fix the costs (especially with IT/technology in general, as those on this board can probably have the biggest effect on that), fix the insurance industry, and let's have a serious look at the food industry while were at it - but on an individual level, giving exercise a try will probably reduce our health costs in the long run and make us feel better in the short run.

DanBC 13y ago

> Actually, chronic diseases, such as heart disease and diabetes, among people younger than 65 drives two-thirds of medical spending. About 85 percent of medical costs are spent on people younger than 65, though people do spend more on healthcare as they age. I thought this might be because the US system has much more support for people over the age of 65, and thus pushes prices down, but later on in the article they say > Though it often may feel like out-of-pocket expenses are growing disproportionately to the cost of healthcare, Medicare, Medicaid, and federal employee plans have actually picked up an increasingly larger share of the tab. The article makes some assumptions. > The patient wants to see the best doctors and get the best treatments available, Not necessarily. Many patients don't want the best, they just want protection from the worst and they want "good" or "excellent", but they'll include other things. "How convenient is the hospital for people to visit or for me to get after care?" is one example. The article title is annoying. The article doesn't explain why obesity is driving up costs, and doesn't do a good job of showing that obesity is driving up costs. The abstract doesn't mention obesity, but says: > Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources of information, and self-management software.

LizVerano 13y ago

Just stop being fat. Control what you eat.

streptomycin 13y ago

This says otherwise http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050029 http://www.plosmedicine.org/article/info:doi/10.1371/journal... Who do I believe, a blogger from The Atlantic who seems to be misinterpreting the data he cites, or a peer-reviewed scientific publication?

MaysonL 13y ago
Well, what that report says is that fat people cost more per year then non-fat, but since they die quicker, they don't cost as much over their lifetime. It would be interesting to see what discount rate would equalize the costs.

ScottBurson 13y ago

My personal bizarre pet idea for bringing down healthcare costs: mandatory minimum copays. The problem, by one analysis, is that patients have no incentive to weigh costs against benefits. That's a tough task in any case, and pushing it off to the insurers makes it harder, as the insurer has less information than either the patient or their doctor about their individual case. The result is that neither patients nor (often) doctors know what the services cost. In fact price information has been so effectively removed from the system that in some cases nobody knows what the service really costs. tptacek posted a great example: http://news.ycombinator.com/item?id=4465845 http://news.ycombinator.com/item?id=4465845 The purpose of the mandatory minimum copay is to force price information back into the system. When patients have to pay some part of the price of every service, they will therefore have to know what those prices are. All that said, there are obviously some questions and problems to be dealt with. For starters, what's the formula for how much people have to pay? On the large end, I would suggest something like (price in dollars) ^ 0.7. This means for a $10k service, the copay would be about $600; for a $100k service, about $3000; and for a $1M service, around $16k. Those numbers feel reasonable to me: big enough to make most people think twice about choosing a six-figure intervention, but not an absolute barrier if there's a good medical reason. On the small end, though, that formula produces numbers that are arguably too large. A $200 service (if there is such a thing? maybe in lower-income rural areas) would have a $40 copay by that formula. This risks discouraging people from getting preventative and urgent care that they need. To correct for this we could simply subtract some fixed number from the result of the above formula. I'm not sure what the right number is, but somewhere in the $40 - $80 range, I would guess. (This provision could also be subject to means testing.) Probably when I say "mandatory" what I really mean is "the government provides incentives to make plans with this property significantly cheaper than those without". I don't care that rich people will circumvent the rule if they want; I just care that most people are on plans with this property, so that, as I say, price information is forced to flow again.

DanBC 13y ago
Patients are the wrong people to drive costs down. "Why are you re-canularising me? Why am I being charged for this extra un-needed canula procedure? Just leave the old one in" etc. Doctors can assess the research, and can decide whether the risk of infection from old canulas balances the risks of new canulas, and whether the cost is worth it or not. Here's a radio programme (no longer available from the BBC website, but may be somewhere else on the Internet?) about an Indian hospital that does a lot of work to drive down costs. http://www.bbc.co.uk/programmes/b039yz53 http://www.bbc.co.uk/programmes/b039yz53 http://www.bbc.co.uk/news/health-10837726 http://www.bbc.co.uk/news/health-10837726 > "We believe that the only way is to build large hospitals - 100 or 200 beds are not going to be the solution for the current world health problem. We need to build large hospitals where hundreds of operations are carried out every day." > And here in Bangalore, the theory appears to work. Despite the huge volume of operations, mortality rates are comparable with or better than those in Britain and the US, and costs are much lower.

kimonos 13y ago

True! Many people nowadays are suffering obesity and sometimes are unaware that their health are at risk.

jes5199 13y ago

It's NOT a trivial problem, though. There's evidence that other mammal species are also experiencing obesity epidemics, even though their diets haven't changed: http://www.aeonmagazine.com/being-human/david-berreby-obesity-era/ http://www.aeonmagazine.com/being-human/david-berreby-obesit...

slt555q 13y ago

Hmmm...I guess all those other academic papers showing that the greatest percentage of healthcare dollars go to end of life care defined as final 2 years but especially final 6 months. I am also pleased to see this analysis was in part conducted by, "we'll tell you what you want to hear as long as you pay us" BCG. Or as I know them BSG. Healthcare costs are skyrocketing because people are making a lot of money. Look back to '76 or so when the people who pushed for changes to the laws allowing for the creation of HMOs and promised enormous savings. That didn't happen. Any time you have a major consulting company telling you how to reduce healthcare costs the sound your actually hearing is money dropping in their pockets. It would be fun to skewer the article point by point but not worth the time.

slt555q 13y ago

PS Ask my friend in Canada who is waiting 16 months for a hip replacement how happy he is.

HarryHirsch 13y ago
This very issue is known in Britain as the "little old lady problem". Resources are limited, and society needs to decide who gets care first. There are many life-threatening conditions, but arthritis in the hips and knees isn't one of them. Consequently, if you can pay, you get to the front of the line, and if you can't you'll get one eventually, but you won't die. They always roll out the little old ladies in wheelchairs when it comes to healthcare reform.
- slr555 13y ago
  "Consequently, if you can pay, you get to the front of the line, and if you can't you'll get one eventually, but you won't die." That's such a great comfort when you are in excruciating pain and can't walk. I think that should be the motto of the NHS "at least you won't die". Aim high. Actually it's not the little old lady problem. I did a documentary on healthcare in the UK. One of the patients suffered from severe rheumatoid arthritis, a serious autoimmune disorder, she was told it would take 6 months to see a rheumatologist. She had the means to pay for private care and saw the same doctor within a week. You see arthritis which you probably don't have and obviously don't understand comes in many for from the less complex osteoarthritis to forms that have many nasty sequelae such as lupus or psoriatic arthritis. I have worked in healthcare for 20 years and my wife about the same but she has worked more internationally. In countries with state run healthcare many times newer treatments such as cancer drugs are not available. Flawed though it may be I will stick with US medicine.
  - HarryHirsch 13y ago
    One of the patients suffered from severe rheumatoid arthritis, a serious autoimmune disorder, she was told it would take 6 months to see a rheumatologist Again: rheumatoid arthritis does not kill you. many times newer treatments such as cancer drugs are not available Good that you say that. In many countries to gain approval the manufacturer needs to show a benefit over what is already on the market. Whatever was there was new, but it didn't prolong survival or improve quality of life. Why should the public pay for something very expensive (because it's still under patent) when something equally good is available for much less as a generic?

tpainton 13y ago

the societal move to destigmatize obesity is the culprit. It's now okay to be big and beautiful.

stefan_kendall 13y ago
I think you may have cause and effect backward here. Suppose a bunch of people get fat. What are the chances that they, after the fact, convince themselves that fat is okay?
- npsimons 13y ago
  Not to mention that stigmatizing obesity is not going to solve the problem. What is this, grade school? "haha, fatty-fatty-fatty!" Maybe some empathy and support would go much further in helping the obese to conquer their problems.

youngtaff 13y ago

I'm not even sure the headline actually represents the original article faithfully (http://jama.jamanetwork.com/article.aspx?articleID=1769890 http://jama.jamanetwork.com/article.aspx?articleID=1769890) One thing to note is that there are many organisations who represent the elderly and they have political power - certainly in the UK, older people vote so you see laws that benefit them sometimes to the detriment on the young.