Americans Changing Their Behavior to Lessen Healthcare Costs

If Senator O’Bama and his socialistic ilk are able to bring about a National Health Care system two factors, which they may not have considered in their equation for determining the cost of that new system of health care delivery, need to be factored in; namely the deleterious effects of smoking and the nationwide epidemic of obesity. Each of those negative impacts on one’s general health will dramatically increase the cost of medical care as the years go by unless there is some positive incentive for changing one’s life style and destructive behavior. Free medical care is no incentive.

During the past 24 years there has been a dramatic increase in the incidence of obesity in the United States. Data from two surveys reported by the Atlanta based Center for Disease Control and Prevention (CDC) show that among adults aged 20–74 years the prevalence of obesity increased from 15.0% (in a 1980 survey) to 32.9% (in the survey conducted in 2004 ). Obesity of every degree is a serious health concern, not only for adults but also, increasingly, for children and adolescents. Data from the same surveys (1980 and 2004) demonstrated that the pervasiveness of obesity is mounting in young folks as well. For children aged 2–5 years the prevalence grew from 5.0% (in 1980) to 13.9% (in 2004), for those aged 6–11 years it increased from 6.5% to 18.8%; and for those aged 12–19 years the incidence of obesity was inflated from 5.0% to 17.4%. There are several reasons for this increase, but the bottom line is that Americans eat too much junk food and get far too little exercise. Children no longer go out doors to play, unless they are engaged in structured, seasonal sporting activities via little league basketball, baseball, football and/or soccer organizations. Too many young folks merely sit around in their rooms playing video or computer games or text messaging friends. The July 16, 2008 addition of the Journal of the American Medical Association (JAMA) reported on the results of a 6 year study (2000-2006) wherein the exercise habits of 1000 of our country’s young people were tracked. The results demonstrated that while 90 % of youths at age 9 got about two hours of exercise on most days, fewer that 3% of the teens who were followed at age 15 got any exercise at all; the time when little league sports usually ends.

Obesity is the leading cause of preventable death and disease in the United States; now tied with cigarette smoking. It is associated with hypertension (high blood pressure), osteoarthritis (a degeneration of cartilage and the underlying bone within a joint), dyslipidemias (increased levels of cholesterol or triglycerides), type 2 diabetes, coronary heart disease (the nation’s number one killer), stroke, gallbladder disease (especially gall stones), sleep apnea and other respiratory problems, gastro-esophageal reflux (GERD) and some cancers (particularly those associated with estrogen production such as malignancies in endometrial lining of the uterus, as well as breast and ovarian cancers). There is also a higher prevalence of colon CA in obese people. Every one of those diseases will become an increasingly greater problem if the current trends in obesity are not brought under control. With someone else paying the bill for the care of those diseases, there is little motivation for behavioral alterations such as following prudent diets and engaging in increased amounts of exercise. Imagine what will happen to the over all health of our nation’s citizens if the next 24 years brings another 15% rise in the incidence of obese adults, as it did between 1980 and 2004. The proposed National Health Care system will neither encourage changes in behavior nor will it be able to sustain the exorbitant cost of medical care of that large number of people apart from drastic increases in taxation or rationing the accessibility of services.

Obesity is defined as having a body mass index (BMI) greater that 30. Morbid obesity is further identified by attaining a BMI greater than 40. A BMI between 25 to 29 is considered being over weight. One can calculate one’s BMI by taking one’s height in inches, squaring that number (I.e. 68 times 68 if one is 5 ft 8 in. tall) and dividing that figure into one’s weight in pounds. That figure (a fraction) is then multiplied by a standard 703. The figure thus produced is then one’s BMI. For example a 5 ft 8 in tall person who weighs 160 lbs would compute his/her a BMI as follows: 68 x 68=4,624. 160 divided by 4,624=.035. .035 x 703 = 24.6. Thus that person is considered to be of a maximum normal weight for height.

The prevalence of morbid obesity was 4.7 percent in the year 2000, according to the latest published figures from the Center for Disease Control; up from 2.9 percent observed in a national data set obtained from 1994. From 2000 to 2005, the prevalence of obesity (BMI over 30 but less than 40) increased by 24%. However, the prevalence of a BMI over 40 (morbid obesity) increased by 50% and the prevalence of a BMI over 50 increased by 75%, two and three times faster respectively, than simple obesity. Given those trends and the numerous diseases and disabilities that result there from, one can readily see that a national healthcare system, where people are not responsible for paying the bills for their expensive medical care, will result in taxations that will markedly alter the current life styles of the citizens of middle America. This is not going to be just a “tax the rich” scenario.

In 2006, 20.8% (45.3 million) of U.S. teens and adults were then admittedly cigarette smokers; of those, 80.1% (36.3 million) smoked every day, and 19.9% (9.0 million) smoked some days. The prevalence of cigarette smoking further varied substantially among population subgroups. By sex, prevalence was higher among men (23.9%) than women (18.0%). Among racial/ethnic groups, Asians had the lowest prevalence (10.4%). Hispanics had a significantly lower prevalence of smoking (15.2%) than American Indians (32.4%), as well as non-Hispanic blacks (23.0%), and non-Hispanic whites (21.9%). Smoking prevalence also varied by level of education. Smoking pervasiveness was highest among adults who had only earned a General Educational Development (GED) diploma (46.0%) and those with 9 to11 years of education (35.4%); overall, smoking popularity was found to be inversely proportional to one‘s years of post high school education. By age differential, adults aged 18 to 24 years and 25 to 44 years had the highest incidence of smoking (23.9% and 23.5%, respectively). The inevitability of current smoking was higher among adults living below the federal poverty level (30.6%) than among those at or above this level (20.4%). At a cost of approximately $4.00 per pack, that can only be defined as abject foolishness. Cigarette smoking causes cancer of the lung, mouth, kidney, bladder and other regions as well. It is the main cause of emphysema (95%) and a major risk factor in peripheral vascular disease, heart attacks and stroke. With the ill effects of second hand smoke, even non-smokers who live with those who smoke will suffer from certain tobacco related conditions that will also add to the cost of the federal budget’s national health care bill.

The bad habits and destructive life styles in which some American’s have chosen to engage themselves, and the costly diseases that result from those habits are factored into the price that the rest of us pay in our insurance premiums. If we have HSA’s and catastrophic insurance (as suggested in a previous article), the premiums for which are based upon the risks imposed by smoking and obesity, those with destructive behaviors will have to pay for their choices. As Americans we are free to choose but for too long now we have failed to teach the hard, but axiomatic lesson that bad choices also incur bad consequences.

If we once again become a nation that uses the consumer driven, free enterprise system of health care, as it had been practiced before Medicare was instituted in 1965, then eventually people will see that their physically destructive behavior can affect their Health Savings Accounts (HSA) in a negative way. Those who smoke a pack per day could instead contribute the $120 per month spent on tobacco to their HSA, thus enabling it to grow that much higher; and by stopping smoking the need for expending the HSA monies will also drop off precipitously because of the lowering of the incidence of tobacco related disease. Fewer stops at fast food facilities basis will likewise assist in shrinking one’s waste line, thus ceasing its growth and instead adding to the growth of their health savings bank account.