Is obesity good?

Megan McArdle has some thoughts on obesity, both compassionate and pragmatic, at her blog, Asymmetrical Information:

It seems like they're taking a true statement--"society shouldn't assume that the overweight are simply lazy slobs with remarkably little willpower"--and extrapolating it to a ridiculous result: "which means that seriously overweight people shouldn't try to lose the extra weight". Even if we shouldn't judge obese people, that doesn't mean we shouldn't try to encourage them to do something they find very, very hard. Most people find quitting smoking or giving up sugar really, really hard, but we don't tell them not to bother treating their diabetes because it's not their fault their pancreas isn't pumping out any insulin. Fair just isn't very relevant. It isn't fair that every cold I ever get goes straight to my lungs and hangs out there for a month, and I have to carry an inhaler with me everywhere I go, because otherwise I could die. It's certainly not fair that I could go blind in my eighties like my grandmother. Nature doesn't care about fair. That's why it's called natural selection, not natural distribution.

Do read the whole thing.

Health care and capitalism

A while back I listened to this podcast interview from the Glenn & Helen Show, about health care. They spoke to Dr. David Gratzer, who is the author of The Cure: How Capitalism Can Save American Health Care. I thought it sounded interesting, so I bought the book and it just arrived in the mail. Some of the author's arguments are summarised in an editorial he wrote for the Washington Post:

How to employ market reforms? Here are five simple steps.

• Make health insurance more like other types of insurance. Health savings accounts, which passed as part of the Medicare reforms of 2003, were an important first step, separating smaller expenses from high-deductible insurance, for catastrophic events. However, the legislation is overly rigid. Congress must expand and revise the structure of HSAs, and level the tax playing field for those not covered by an employer plan.
• Foster competition. American health care is the most regulated sector in the economy. The result? A health insurance policy for a 30-year old man costs four times more in New York than in neighboring Connecticut because of the multitude of regulations in the Empire State. Americans can shop out-of-state for a mortgage; they should be able to do so for health insurance. Likewise, many laws intended to promote fairness end up reducing competition and thus innovation. Congress should reconsider such laws, beginning with the federal Emergency Medical Treatment and Active Labor Act (EMTALA).
• Reform Medicaid, using welfare reform as the template. Medicaid spending is spiraling up, now consuming more dollars at the state level than K-12 education. Like the old Aid to Families with Dependent Children, part of the problem stems from the fact that the program is shared between both the federal and state government -- and is thus owned by neither. Congress should fund Medicaid with block grants to the states, and let them innovate.
• Revisit Medicare. Back in the late 1990s, a bipartisan commission approved a reasonable starting point for Medicare -- junking the price controls, and using the Federal Employees Health Benefits Plan as a model. Elderly Americans would then have a choice among competing private plans. Given that the unfunded liability of Medicare is four times greater than that of social security, the time is right to experiment with this idea.
• Address prescription drug prices by pruning the size and scope of the FDA. It costs nearly a billion dollars for a prescription drug to reach the market, and roughly 40% of that is due to safety requirements. This is effectively a massive tax on pharmaceuticals. With new technology and focus, it would be possible to update the FDA, drawing from President George H. W. Bush's experiments with contracting out certain approval steps to private organizations, which boasted lower costs and faster approval times.

None of these steps would be dramatic but all are important. Congress also slowly needs to weigh bigger issues: how to shore up Medicare, create portability of health insurance, and foster a market for medical innovation.

I highly recommend the podcast. During the interview Helen makes an interesting point: most sick people would prefer the timeliness and quality of treatment available in the US, so it almost seems that state-run systems are popular mostly because a strong majority of people are healthy (and it gives them a fuzzy feeling that "everyone gets taken care of"). In other words, in most Western countries the healthy majority imposes socialized medicine - which is notably fraught with rationing and forcing old and sick people to wait for even the most basic care - on everyone (other than those who can afford to sidestep the sometimes fatal queues: see here, for instance).
Another point Dr. Gratzer makes in the podcast (and I presume in the book) is that health care (which in the US is often part of the benefits offered by one's employer) should be decoupled from employment. In this regard, I recently saw an interesting article in Fortune which proposes a way to underline the problem:

In 2003, back when Continental Airlines (Charts) was losing its shirt, Gordon Bethune, its salty CEO, got sick of hearing that upstarts like JetBlue had created a new business model that would bury the industry's dinosaurs. So he had his CFO recompute Continental's earnings assuming the company had (like JetBlue) a much younger workforce - and thus much lower health, pension and related costs.
Presto: Earnings went from a reported $388 million loss to a $420 million profit, a swing of $800 million. "It was all bull," Bethune says now of the idea that the economic laws of air travel had been repealed. "If we could fire all our workers every five years, we'd look good too." Though Bethune cooked up what I call "age-adjusted earnings" simply to fend off attacks on Continental, the mammoth profit swing his analysis unearthed has big policy implications.
To most of us, the idea that a firm's success could depend so greatly on the youth of its employees feels crazy. Yes, GM and its ilk may have gotten themselves into trouble with generous giveaways when the good times rolled. But a sane nation would assess business performance separately from some socially determined sense of what makes for decent health and pension coverage for citizens.
[...]
A small but surprisingly powerful way to enlist business in this conversation would be for the Dems to turn Bethune's creative bookkeeping into a new rule for public companies: In addition to the usual earnings reports, require firms to issue an "age-adjusted" income statement that shows what earnings would be if the company had, say, average-aged workers.
Why would this break through the clutter? Unlike (sensible) new accounting rules that will force firms to put health and pension liabilities on their balance sheets, age-adjusted earnings would create a media hook that becomes part of every quarterly release. Imagine if TV anchors were saying things like "Today search giant Google reported fourth-quarter earnings of $600 million - though on an age-adjusted basis it was $150 million less."

The columnist's goal is actually to generate the necessary political capital to implement state-run health care, but it seems like a useful tool to me regardless of what the intended goal is: maybe it would even help to instigate more market-oriented reforms.
For further reading on health care, see this series of posts at Asymmetrical Information.

Dead Meat

A lot of Europeans often go on and on about how much better healthcare systems are around here: they are so much more equitable as they are free and universal, while in the US, which is barbaric and inhumane, people die on the street and are turned away from emergency rooms if they do not have a credit card.
That's clearly a load of tosh. European healthcare systems are obviously not free, and as far as I know people are not turned away from emergency rooms in the US. Additionally European-style socialized systems also tend to be extremely inefficient. This creates somewhat hidden discrimination in two respects:

• If you are relatively healthy you get all the care you need but as soon as something serious crops up things often go pear-shaped, and at that point,
• If you are rich you can afford to go private (either at home or abroad), but if you're not you are as likely as not going to be stuck in a sometimes fatal waiting list.

I don't doubt that the US system needs to be reformed, but at least the inequalities of the US system (which are much less pronounced than what most Europeans would like to think) are transparent and recognize a reality which Europe has simply swept under the carpet.
For instance a while back, in Italy, my 83-year-old grandmother was diagnosed with colon cancer (after various misdiagnoses), and was put on a waiting list of several months to get the operation needed to remove the tumor. The wait would in all probability have been fatal. As she could afford it she paid for the necessary procedure and did it immediately as a private patient, and now, thank God, it seems the issue has been resolved conclusively. In this respect I highly recommend watching a tragi-comic preview of an upcoming documentary, entitled Dead Meat. The producers say:

Dead Meat is a 25 minute short film which shows the reality of health care under Canada's socialized medical system: Canadians wait ... and wait ... and wait. ... And sometimes they die while waiting for free government health care.

The filmmakers are currently in production on a feature-length film addressing health care in the U.S. and Canada slated for release in late 2006. As an interim offering, they have produced this short film which debuted at the Liberty Film Festival in West Hollywood, CA on Oct 21, 2005.
[...]
Many Canadians who have never been really sick are supportive of their system. In fact, the system caters to the healthy majority with free primary care doctor appointments, flu shots, etc. while depriving the truly sick - often the elderly - of timely medical treatment that is often more expensive. Political expediency dictates that health care dollars are spent where the votes are: the healthy majority - while across Canada, hundreds of thousands of sick and disabled people quietly languish in pain in their homes on long waiting lists for treatment.
[...]
Certainly there are pockets of excellence in the Canadian health care system - and not everyone waits. If a person is in the process of having a heart attack, they get immediate treatment. However, any treatment deemed 'elective' - meaning that possible death is not imminent - often entails a wait. Cancer biopsies, MRI scans, heart bypasses, cataract operations, and hip replacements all involve lengthy waits for many Canadians.

Please watch it! It is truly compelling. Incredibly there are still people who find something to brag about when comparing universal public healthcare to the US system. I wonder what these people would consider a failure...