I Might Have Been Wrong About Obesity…

I frequently make a big deal about obesity – how it’s probably one of the primary reasons Americans have comparatively low life expectancies, and how it contributes largely (no-pun intended) to our skyrocketing health care costs.  My generalizations are imprecise at best…just plain wrong at worst. 

Check out this Q and A with health economist Eric Finkelstein, author of The Fattening of America, on my favorite blog – the Freakonomics blog.  The Freakonomics “movement,” led by Steven Levitt and Stephen Dubner, is great at finding the unintended economic consequences of certain endeavors.  Some of the major points from the interview:

• Yes, obesity does cost us money – about $93 billion per year…not a drop in the bucket.  But obesity is “cheaper” than it has ever been, and it continues to become less costly.  Compare this number to the $350 billion cited by McKinsey (previous blog posting) for collection and billing costs in health care, and you start to see that the creative thinking needs to be focused on health care markets and administration, rather than keeping people thin.  
• Obesity is not a sign of market failure, but a sign of market success.  We are incentivised to be fat.  Food is relatively cheap and getting more so.  Innovations as benign as power windows in automobiles are too numerous to account for, and incrimentally reduce the number of calories Americans must burn to produce the same economic output.  30 years ago, power windows were an expensive optional extra.  Today, even the cheapest cars have them.  Same with microwaves –faster food preparation means more time for work with less energy (calories) exerted.  Additionally, we have such fantastic pharmaceuticals and medical procedures that obesity (to an extent – BMI lower than 35) doesn’t lower life expectancy significantly.   Why? Today’s obese people have better lipid profiles and lower blood pressure than skinny people 40 years ago. 
• Perhaps the most interesting point made by Finkelstein was this:  it isn’t economically viable to spend money to prevent obesity.   As discussed above, obesity is partially an outcome of market success – meaning the best way to fight obesity is to make life harder.  We could all live like Amish people but it would cost trillions in lost productivity…we would be skinnier, but have similar or shorter life expectancies.  Plus it presents interesting philosophical issues.  What is our purpose?  It seems to be to survive, reproduce and make life easier and more rewarding for ourselves.  Maslow’s pyramid.  We would never back-out all the efficiencies American’s have integrated into their lives – it wouldn’t be worth it.  Obesity is a sign of economic success – this is why it correlates very closely with an industrialized country’s wealth.  So why institute expensive, paternalistic government programs to prevent obesity if everything else we are doing as a society, consistent with generalized notions of “progress,” is contributing to it?  
• Comparing obese people with smokers is not fair economically.  Obesity does exhibit a cost on America – the $93 billion mentioned above accounts the extra food, pills, medical procedures an obese person will consume while having the same length of life as a skinny person.  The most interesting fact here is that smokers only exhibit a cost on society because of the collateral damage of second hand smoke. But they may pay for it themselves.  Smokers pay billions in cigarette taxes and die before they collect much of their social security.  This is one of the few cases I can think of where a tax has been implimented efficiently…that is, it ends up costing the country less overall – it saves money.  Finkelstein mentions that if the government were truly dedicated to reducing health care costs – the easiest way would be to hand out free cigarettes.  People would die long before they would have to be treated for the chronic diseases associated with old age – the most expensive segment of health care. 
• Obese people who work extremely hard, create a lot of value, and don’t have time to exercise are an interesting bunch given these statistics.  Reducing their labor productivity by 1.5 hours per day (they start going to the gym) would have a dramatic negative effect on their overall lifetime productivity – but yield little positive benefit: they pay for their own health insurance, and they live nearly as long.  

Yes, obesity does exert a cost on society…but it’s an incrementally shrinking cost.  The key to reducing health care costs lies in the efficiencies in the system itself.  And let’s not forget – America is one of wealthiest nations in the world.  This is why we have the highest health care cost per person, we are willing to pay for it…never mind that many of the expensive bells and whistles don’t necessarily help us.

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It’s Not All or Nothing…

When we make snap judgments based on race, creed, religion, or gender, we are bigots.  When a Wall Street trader makes a snap judgment, he can either make or lose a lot of money.  The latter probably more closely resembles the original reason for the adaptation.  Long ago in our development, making judgments that amount to generalizations when presented with simple, yet ambiguous circumstances, probably saved our lives.  But it’s not always necessary and certainly not always appropriate.  Especially when the systems encountered by modern humans are seldom “simple” and certainly not linear.
When people discuss health care (myself included) we sometimes exhibit that all-too-human behavior in the form of putting things into nice clean packages….whether they fit or not.  Most of the time they don’t fit.  In happens in American politics all the time: you hear somebody weigh in on one issue, or you look at the style of their clothing, and you’ve made your decision: liberal or conservative…Democrat or Republican.

I tend to do this with when comparing and contrasting free-market health care ideas with government-based, socialized systems.  The truth is, nearly every developed country’s system is combination of both.  America has a developed form of socialized health care – Medicare and Medicaid.  And while I won’t argue that the government is an efficient administrator, I do agree that some basic level of care for all citizens and legal aliens is a right.  I hate to agree with Michael Moore, but we really do need to take the best aspects of every system and integrate into a package that will work with American’s unique problems.  Of course, I disagree with Michael Moore’s conclusions, most of the time…

Let’s take England’s health care system out of its neat, tidy, “socialized medicine” box for a moment, and remember that United Kingdom’s “socialized” system, isn’t.  Yes, they have a more developed government-based system that we do, but there is a market-driven, private sector as well.  People who can afford to buy supplemental private health insurance.  Here’s a quote from comment 24, on Stephen J. Dubner’s post, entitled “The Health Care Mess: A Brief History,” on the Freakonomics blog.
“I lived in the U.K. for 3 yrs as a US citizen working for a multi-national company so I like to share my experience with anyone who is stuck in either the “single payer” or “choice” camp. My family went to our local GP (same one every time…he really got to know our family and our health history) any time we wanted, for any reason, never saw a bill, never saw a this-is-not-a-bill. We didn’t abus[e] it, but it was nice to know you could go when you felt you needed to. Although I was also covered (as a priviledged yank) by private health insurance, I never felt compelled to use it. Until one day……. My kids started getting ear infections, despite having tubes (”grommets” as they called them) and our GP said “these infections are occurring too frequently” and referred us to an ENT. The ENT said we should have their adnoids removed. Despite my hesitation, we ultimately agreed. When we asked about scheduling, it was going to be something like 2 months and we said “ohhh,” whereupon he said, “of course, if you have private insurance, I can see you next week.” Huh? Hey – that’s right – we do! we said, and promptly filled out the paperwork and gotter’done. So apparently you can still pay to get faster service, which perhaps isn’t all bad.”

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