OT: HR3200 - you may read the health care reform bill as it develops

The really frightening part of the ongoing debate over health care is that since the majority of people are either overweight or obese, as a voting bloc they will inevitably control the outcome - and that outcome will no doubt end with those that opt for a healthy lifestyle subsidizing those that don't.

The cause and effect relationships are well-documented and largely indisputable.

Many studies show people with so called lifestyle-related health issues actually spend fewer health care dollars over the course of their lives than healthy people, because of decreased longevity. Here's a link to one such study:

"...The study found that although annual health-care costs are highest for obese people earlier in life (until age 56 years), and are highest for smokers at older ages, the ultimate lifetime costs are highest for the healthy (nonsmoking, nonobese) people. Hence the authors argue that medical costs will not be saved by preventing obesity.

Their results tell us that that life expectancy from age 20 is reduced by 5 years for obese people and 7 for smokers. The consequence is that healthy people live to incur greater medical expenditure subsequently on average, more than compensating for the earlier excess expenditure related to obesity or smoking..."

[www.plosmedicine.org]

And from the same website [www.plosmedicine.org] comes this:

"In a sense, Van Baal and colleagues' study is a useful antidote to current concerns. But let us be clear: it does not attenuate them. Obese people cost less because individuals die younger and hence with less chronic morbidity associated with old age. This is a useful thing to know, but how might it affect public health strategies for obesity? In particular, does it mean that concerns about increasing population obesity are misplaced, as least as far as health-service costs are concerned?

Sadly not. Examine an obese population and a lean population of the same age and sex distribution, and the former will incur far greater health-care costs throughout the life course. Much more diabetes, and more cardiovascular disease and cancer will occur amongst the obese—even amongst the older obese [3]. Compare health-care costs now with those thirty years ago, and—holding everything but obesity constant—the current population costs much more to the health sector than it did then [4]. Moreover, quite apart from health-care costs, the other costs to society from obesity are also greater because of absences from work due to illness and employment difficulties; these costs amount to considerably more than health-care costs [5]. It is not clear that these extra costs are intrinsically related to health-care costs, but they are currently estimated to be around four times as great in obese than in lean people [5].

But is it worth knowing that obese individuals are cheaper than lean ones for the health sector in the long run? What does that mean for clinical or public health practice? Unless taxpayers take their cue and eat too much and exercise too little in order to reduce their tax burden, it has no particular implications. And the study may reinforce the cynical view that governments may be reluctant to intervene when doing so implies greater health expenditure on each individual through their life. We have to be clear, therefore, about the distinction between lower lifetime health costs associated with obese individuals and higher costs of obese populations.""

Certainly obesity has costs, but you claimed that in terms of health care costs, the non-obese were "subsidizing" the lifestyles of the obese, and even the section you quoted clearly states, "obese individuals are cheaper than lean ones for the health sector in the long run."

He's just a chubby hater. And to be fair to be obese you must have a BMI of 30 or 100lbs overweight. Most people are merely overweight. More in the 20 to 50lb range. And if they're active its not going to lead to anything.

Certainly obesity has costs, but you claimed that in terms of health care costs, the non-obese were "subsidizing" the lifestyles of the obese, and even the section you quoted clearly states, "obese individuals are cheaper than lean ones for the health sector in the long run."

You're conveniently ignoring the next paragraph where the author states: "Examine an obese population and a lean population of the same age and sex distribution, and the former will incur far greater health-care costs throughout the life course. Much more diabetes, and more cardiovascular disease and cancer will occur amongst the obese—even amongst the older obese [3]. "

What is also conviently lost in the study that claims to demonstrate that fat people and smokers cost less in the long run is the sweeping categorization of healthy being anyone who isn't overweight and doesn't smoke.

Just to be clear, my argument is for making people responsible for their lifestyle choices. Obesity and smokers are an obvious target because it's clear that overweight people consume too many calories per calories expended (exercise). Simply stated, those who make the effort by routinely exercising and consuming a healthy diet should incur lower health care premiums - much in the same way that safe and accident-free drivers pay less in car insurance.

Consider the comments made in an interview this week by Victor R. Fuchs, a Stanford University Health Policy core faculty member and the Henry J. Kaiser, Jr., professor of economics and of health research and policy, emeritus.

"Cost shifting doesn’t do anything about the real cost of health care…People say the employers should pay some, the government should pay some…It’s families and individuals who end up paying for it…either in foregone wages or in higher prices on what business sells or…in higher taxes. It's just us out there. The name of the game in Washington is to try to hide who is bearing the cost.

Take the idea that insurance companies shouldn’t charge different premiums [based on health status]...From the point of view of equity, that has a lot of appeal. Why should a person who is sick have to pay more? But it’s an example of cost shifting, … healthy people will end up paying more."
[ http://www.kaiserhealthnews.org/Checking-In-With/Fuchs.aspx ]

So should adults with AIDS be put in the category of paying more like obese & smokers should? What about drug addicts & alcoholics who are put in treatment centers? Where does this end?

When hate does. Apparently there are a lot of perfect people out there that never get sick and never make bad choices that are more deserving of health care.

Yep!

lol....well this will go along with the mj conspiracy theories on the other thread....perhaps when you go to the doctor and they take your height and weight to see if you even deserve to be seen. 😉

"Lifestyle choices"? Surely you are aware that not every obese person is fat because of poor eating habits. How do you intend to measure the degree to which unchosen factors contribute to obesity? How about those who contract HIV -- should the cost of insurance distinguish between people who are infected with HIV through transfusion and those infected through sex? The truth is that our health care problem has nothing to do with the medical costs of being fat or infected with HIV, and everything to do with the costs of medical malpractice insurance and pharmaceuticals. I may not be the most empathetic person around, but whenever I hear someone promote the "lifestyle choice" perspective I am at least able to understand the motivation behind their view:

"But why do the rest of us care so much? What is it about fat people that makes us so mad? As it turns out, we kind of like it. "People actually enjoy feeling angry," says Ryan Martin, associate professor of psychology at the University of Wisconsin, Green Bay, who cites studies done on people's emotions. "It makes them feel powerful, it makes them feel greater control, and they appreciate it for that reason." And with fat people designated as acceptable targets of rage—and with the prevalence of fat people in our lives, both in the malls and on the news—it's easy to find a target for some soul-clearing, ego-boosting ranting."

http://www.newsweek.com/id/213646

So should adults with AIDS be put in the category of paying more like obese & smokers should? What about drug addicts & alcoholics who are put in treatment centers? Where does this end?

When hate does. Apparently there are a lot of perfect people out there that never get sick and never make bad choices that are more deserving of health care.

One thing you can almost always count on is for one or more people to pull out the strawman argument in lieu of reasonable debate.

Using your logic car insurance companies would refuse to give safe-driver discounts to people who wear glasses or contacts. I mean, you can't always count on people to remember to put on their glasses or put in their contacts can you?

Or what about home insurance discounts to people who have fire and burglary alarms installed? How dare you discrimminate against people who can't afford to install such systems!

Sigh....

ok so can we get back on topic with this thread,has anyone ever even read the 5 different bills in subcommittee being debated right now as far as i know there is no "bill" before the congress right now because they are all still in subcommittee

http://www.aarpmagazine.org/health/8_myths_about_health_care_reform.html?CMP=KNC-360I-YAHOO-ATM&HBX_OU=51&HBX_PK=health_care_reform_myths

WASHINGTON (Reuters) – The Congressional Budget Office may be missing potential savings from various health reform proposals by not looking at efforts to manage or prevent expensive, chronic conditions such as diabetes and heart disease, researchers said in a study released on Tuesday.

The study, published in the Tuesday edition of the Health Affairs journal, comes as members of the U.S. Congress prepare to return to Washington next week and again take up legislation to revamp the U.S. healthcare system.

President Barack Obama has made the overhaul a top priority this year, but debate has swelled in both parties in part over the CBO's early projections the Democratic plan could cost nearly $1 trillion.

Obama and other Democrats have argued the CBO does not factor in how improvements to care such as primary doctor visits, although costly at first, could improve people's health and lower costs over time.

The nonpartisan CBO, charged by Congress to estimate the cost of various programs, now uses a 10-year forecast that cannot look at the cost of programs aimed at diseases that can last for decades, researchers at the University of Chicago said.

Instead, the CBO should use methods that would weigh savings from earlier treatment and other intervention that could help reduce costly complications from conditions that arise when left untreated or improperly treated, they said.

Lawmakers need cost estimates that look at a period of 25 years for healthcare legislation, they said in their study, which was sponsored by diabetes drug maker Novo Nordisk A/S and looked at a scientific model to help estimate such costs for long-term diseases.

"Although this would not be necessary for the vast majority of cost estimates produced by the CBO, it would improve the information available when Congress considers health legislation with implications for the treatment of a relatively small number of costly chronic illnesses," they wrote.

In the study, researchers at the University of Chicago's National Opinion Research Center said new longer-term estimates would also help legislators and others estimate how having healthier, longer-living patients would affect costs.

In their model, the researchers used the example of diabetes, which affects nearly 8 percent of the U.S. population, or 24 million Americans, and factored in the costs of complications such as blindness, kidney failure and stroke.

They projected the disease would cost $336 billion a year 25 years from now. They then factored in the costs of prevention programs that would include medication and routine testing and how they could save money over time.

While such methods would need to be adjusted as treatments change, it could provide the CBO a starting point to look more long term, they said.

(Reporting by Susan Heavey; Editing by Peter Cooney)

Here is how we solve two problems at once. There are plenty of Mexicans trying to move to the US for employement. Now there are plenty of Norte Americanos who want to move to Mexico for health care. Let's come up with an exchange program.

Article on Mexico health care.
http://www.usatoday.com/news/world/2009-08-31-mexico-health-care_N.htm?poe=HFMostPopular&loc=interstitialskip

lol rotor,how about israel or france,i'd go there ok maybe veracruz

WASHINGTON – President Barack Obama, faced with falling approval ratings and increasingly impatient with Senate negotiations over health care, is weighing a shift in strategy that would offer more details of his goals for overhauling the nation's health care system.

The president is considering a speech in the next week or so in which he would be "more prescriptive" about what he feels Congress must include in a bill, top adviser David Axelrod said Tuesday in an interview. The speech might occur before the Sept. 15 deadline the White House gave to Senate negotiators to seek a bipartisan bill, Axelrod said. He suggested that two key Republicans have not bargained in good faith.

Congress reconvenes next Tuesday after an August recess in which critics of Obama's health proposals dominated many public forums.

Some Obama allies, watching his approval ratings tumble in polls along with support for a health care overhaul, have urged the president to take a more hands-on approach. They feel he gave too much leeway to Congress, where one bill has passed three House committees, another has passed a Senate committee and a third has been bogged down in protracted negotiations in the Senate Finance Committee.

Axelrod indicated that Obama would not offer new proposals but would be more specific about his top priorities.

"The ideas are all there on the table," Axelrod said. "Now we are in a new phase, and it's time to pull the strands of these together."

He said there is serious discussion in the White House of Obama "giving a speech that lays out in specific ways what he thinks" about the essential elements of a health care bill.

Axelrod said it was possible that the speech could occur before a planned Sept. 15 Obama address on health care in Pittsburgh.

Obama has called for innovations such as a public health insurance plan to compete with private insurers, but he has not insisted on it. It was not clear Tuesday the degree to which he might press for various proposals in a new speech.

Obama also plans to meet with Democratic congressional leaders on Tuesday.

Axelrod condemned recent comments by two chief Senate Republican negotiators — Charles Grassley of Iowa and Mike Enzi of Wyoming — who have sharply criticized key elements of Democrats' health care plans even as they insisted that a workable bipartisan plan was possible.

Their remarks, Axelrod said, "were not exactly consistent with good-faith negotiations."

In an August fundraising letter, Grassley asked people for "support in helping me defeat Obama-care." He said Democratic-drafted bills would be "a pathway to a government takeover of the health care system."

Enzi, in a radio address Saturday, said Democratic proposals would restrict medical choices and make the country's "finances sicker without saving you money."

The two men are part of a six-senator, bipartisan negotiating team that also includes GOP Sen. Olympia Snowe of Maine. Hopes for a workable bipartisan plan have dimmed in recent weeks, and Axelrod's comments were the most dismissive yet from a White House official.

Congress' August recess was brutal for Obama and his allies, as lawmakers faced raucous crowds denouncing Democrats' health proposals. When Congress reconvenes Tuesday, Democratic leaders hope to change the dynamic by holding quiet, closed-door sessions with nervous colleagues and arguing that far-reaching health care changes can be good politics as well as good policy.

They also hope GOP-led opposition has peaked. But that's far from clear, and Republicans are eager to hand Obama his first major defeat.

A new CNN/Opinion Research poll found that 53 percent of Americans disapproved of Obama's handling of health care, while 44 percent approved. In March, far more people had approved than disapproved.

In a Kaiser Health Tracking Poll in August, 40 percent said they favored passing some sort of health care revision this year, a dramatic drop from 62 percent in June.

Liberal groups have held hundreds of events in a bid to show that a robust overhaul is more popular than August's news reports would suggest.

The message lawmakers will hear when they return to Washington "will be very different than what they heard when August started," said Jacki Schechner of Health Care for America Now. One idea her group will stress, she said, is that the politically smart vote, even in toss-up districts, will support widespread changes meant to expand health insurance coverage and options.

Nervous Democratic lawmakers need to be told, "you got elected to do something," she said. "And you might get re-elected if you actually do something."

Many first- and second-term House Democrats believe the noisiest protesters at town hall forums do not represent most of their constituents, said Rep. Chris Van Hollen, D-Md., who is tasked with getting his colleagues re-elected. Democratic leaders will try to build on that point, he said, listening to members' concerns and emphasizing the political and societal risks of doing nothing.

Some Democrats say Republicans blundered by basing so much of the opposition on demonstrably untrue claims, such as assertions that the House legislation would lead to "death panels" for elderly patients. In the Capitol's cool, calm setting, party leaders hope to persuade lawmakers that such claims are easily denied.

Democrats also are portraying top Republicans, including Grassley and Enzi, as cynics who pretend to want a bipartisan accord while never intending to compromise in any meaningful way. Liberals now want Congress and Obama to push for full-blown health care changes, saying there's no need for Democrats to compromise when, with their substantial majorities in both the House and Senate, they are the game's only players.

Republicans approach Labor Day feeling upbeat about the ground they gained during the August recess. Some are confident that no amount of closed-door hand-holding of nervous Democratic lawmakers will reverse the momentum.

"After a disastrous month at home, the fact that Democrats' new health care strategy is to hide in Washington from the people who elected them to get health care passed shows what bad shape they're in," said Antonia Ferrier, spokeswoman for House Republican leader John Boehner of Ohio.

The GOP's most effective attacks, many Democrats say, deal with Obama's questionable claim that the nation can significantly expand health coverage without increasing the deficit over 10 years. The nonpartisan Congressional Budget Office says none of the pending health plans would control long-term spending, and that ones with the elements Obama wants would expand the deficit by about $1 trillion over the next decade.

Some Democrats say the congressional leaders will have to trim more costs from the health bills that have cleared one Senate committee and three House panels, even though it would antagonize liberals and make it harder to cover uninsured people, one of Obama's top goals.

___

Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.

ttp://www.post-gazette.com/pg/09245/994806-154.stm

I thought some of you might enjoy the following:

"Dear Mr. President: I am writing you today because I am outraged at the notion of involving government in healthcare decisions like they do in other countries...So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company's list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company's claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company's crack cost-review and retroactive cancellation and denial squads, my insurance company's executives and board of directors, my insurance company's profit requirements, the shareholders, my employer, and my doctor.

Anything else would be insulting." -Kos

The entire letter to the president can be found here: http://www.dailykos.com/storyonly/2009/7/25/756972/-Dear-Mr.-President

the first election i voted in was 1980 for reagan, since then i've grown up and realized it's not all about me, when hiv/aids first hit this country reagan ignored it for YEARS after all it was only gays and haitians getting it(disposable people you know), it wasn't until rock hudson died that reagan started to invest in research, the way i see it republicans will do nothing about anything until it hits them in the head,democrats at least try to do stuff before it reaches crisis point

I don't think it's a democrat/republican issue. I think people support things for which they have empathy, and empathy tends to come from personal experience. Those with lower incomes often support social programs, because they are more likely to use them, and those with higher incomes often rebel, because they will pay for a larger share of those programs, programs they will not use. Outliers, like wealthier people who support social programs, tend to be people who come from a lower income backgrounds, or have family members or friends who would benefit from social programs. Support for causes, including taxpayer funded policy, correlates directly with personal experiences, and the extent to which people believe the circumstance their taxes aid "could be me, or someone I love." After all, you seem much more angry about HIV policy than cervical cancer screening policy. 😀

lol i had the male exam for hpv and trust me it was not a pleasant thing, think toilet brushes and you should know by now i am pro woman everything, republicans too me seem to be pro birth but not pro life

Interesting article, "How Obama Can Make Healthcare Better Without Congress"

http://www.americanthinker.com/2009/09/how_obama_can_make_healthcare.html

very interesting article! thanks for posting it. as this shakes out, i wonder if he is aware of this...

Sounds like he isn`t doing his job, he would have made a great Virgin Islander!

Sounds like he isn`t doing his job, he would have made a great Virgin Islander!

*ooohhh, that's ice cold....*:-o