The Problem With the Health-care Debate
With all the debate going on in the US about ‘Obamacare’ and health reform it is hard for Americans to not make comparisons to other systems. The Canadian system has been used as an example by both the GOP and the Dems as an example of what we shouldn’t or should do. Naturally, as a Canadian I am willing to blindly defend our health-care are being the best in the world; after all, that’s what our politicians have been telling us for eons, right?
Today, the Conference Board of Canada released a report ranking the health-care outcomes of 16 developed countries. Of course, the US received a D came last (but we expected that, it was written by a Canadian group after all). Canada received a B and came 10th out of the 16 while the US received a D and 16th. Those damn Europeans always seem to beat us out. Gasp! Say it ain’t so!
Our egos were stroked enough by beating the US so handily that we failed to see what the report was truly trying to tell us. Go back and read what the rankings were looking at again. They were looking at health-care outcomes not systems. Obama and Congress are trying to find the ‘best’ system, not the ‘best American system’. The terms of the US debate on health-care centre around how much the Feds should be involved in the health-care system (a public/private debate) instead of focusing on the real issue: How can we make more Americans healthier? If the debate was refocused, some tangible results would likely result.
Rising rates of diabetes are a great place to start. Canada and the US came 14th and 15th respectively on mortality due to diabetes. Japan came out on top. I’m going to go out on a limb and say that the differences in diabetes mortality rates between the three countries isn’t a result of different health-care systems (Canada and the US have dramatically different systems and come in right next to each other). It is more likely a result of the differences in overall lifestyle. Over several decades Japan has encouraged a culture of activity in its society. We’ve all seen videos of crazy Japanese companies leading afternoon exercises with all of their employees.
This culture seemed to have worked. A 2003 OECD report shows that 24.9% of Japanese are overweight (BMI>25kg/m) and only 3.2% are obese (BMI>30kg/m). Compare that to the US where 65.7% are overweight and 30.6% are obese and the problem is clear. Americans are fat and Japanese aren’t. It isn’t a genetic thing either, Japan gave us sumo wrestling remember.
Whats wrong with being fat? It leads to Type 2 diabetes for one. 95% of people suffering from diabetes are Type 2 ‘adult onset’ diabetics. Increases in these diabetics can be attributed to “aging population, rising obesity rates, increasingly sedentary lifestyles, and higher risk for diabetes for Aboriginal people” (source). It no wonder then that as we (Canadians and Americas) are getting fatter, we get less healthy.
Second, diabetics are expensive.
- People with diabetes incur medical costs that are two to three times higher than those without diabetes. A person with diabetes can face direct costs for medication and supplies ranging from $1,000 to $15,000 a year.
- By 2010, it’s estimated that diabetes will cost the Canadian health-care system $15.6 billion a year and that number will rise to $19.2 billion by 2020.
Its no wonder that the Canadian system is running short on cash or American insurers charge exorbitant premiums. Fat people make health care expensive for all of us.
Despite this, all of the talk in the US around health-care reform has centered around a ‘public option’. Why not drop the ideological part of the battle (which is the causing the deadlock) and find easy ways to make American’s healthier. Building more community centres where people can work out, aiding youth athletics programs, and helping at risk kids get into sports for life. It can’t stop there though, staying active throughout your whole life will make you healthier, is free (or nearly free), and will make your government/insurer happy.
It isn’t hard to start either:
In a large study, people at risk of type 2 diabetes were able to reduce that risk by 58% by exercising moderately for 30 minutes a day and by losing 5 to 7% of their body weight. In people over age 60, the risk was cut by almost 71%. Other large studies have shown similar results in reducing risk. (Source)
Besides which, I’d much prefer to see Obama pump money into programs that directly affect change in the US than fill the pockets of an inevitably inefficient bureaucracy.
With all the money he’ll save we can afford some extra twinkies apples. One of them a day could keep a public health-care battle at bay.
(1 votes, average: 5.00 out of 5)
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Hmmm, sparks an idea, I think insurance rates should be tied directly to obesity. The fatter you are, the more you pay. Hey, if a longer, happier life with lower risk of disease does not convince people to be healthy, maybe a monetary incentive will…
If overall health outcomes were the only consideration you might have a point, but there’s more to it than that. 18 percent of Americans under 65 have NO HEALTH INSURANCE. That means if they break their arm they have to choose between getting that treated or paying rent next month. Cultural influences on health outcomes aside, no one should have to make that choice.
As for the popular conservative bogeyman, it’s amazing to me how often we are told to fear the “inevitably inefficient bureaucracy” without this ever being substantiated by fact. Total public and private expenditure per capita on healthcare is double in America what it is in Canada or Great Britain. No matter how many times conservatives and libertarians trot out the supposed efficiency of the all-power free market, doesn’t make it any more true it reality.
Lest I me mistaken: I still hate fat people as much as the next guy.
But why are people fat? I don’t think it is just out of laziness….I believe most people are fat because they can not afford to be healthy!! When you have no money would you go buy 2 Big Macs for $3 (in the US) or pay a lot more to eat something healthy?… Healthy food needs to be cheaper…
Can/US & Japan differ beyond simply a culture of active lifestyle (ZOMG!) and that needs to be controlled for when looking at diabetes rates in those countries. Yes, many cultural ethnic groups have a much higher susceptibility to type II diabetes like Aboriginals which Canada and the US both have much higher proportions of than homogeneous Japan. Of course, Aboriginals alone make up a minority of North Americans but you’d have to compare within ethnic group in Japan and North America to really tease out lifestyle differences. Moreover, keep in mind that Japan is extremely inbred while North America is founded on a dozen generations of immigrants, many who suffered blight before reaching America for which diabetes susceptibility may have concomitant protection from which is now in higher proportions in today’s North America. But regardless, lifestyle and perspectives are big factors.
Naite, part of the problem is that there is view for people to get the most food (i.e. calories)/$ when the amount of relatively healthy food you get for $3 is less though more than sufficient for sustenance.
Bon travail mon ami,
Je pense que tes idées sont interessant et tu es mon blog favorite!
Mais je veux manger twinkies tous la temps, et je veux la gouvernement a payer pour mon médication au diabète. Es ceci un problème?
Merci pour ton temps, et tes idées.
Au Revoir Geoff Costeloe.
Programs that focus on healthier lifestyles are great, but people are often very slow to change cultural habits. For example, the Canadian government has had to work for years towards decreasing smoking in the population. Smokers are another huge tax on the healthcare system that relates solely back to lifestyle. However, there is no doubt that if programs like these can be implemented effectively, they can lead to better preventative care and less strain on medical resources.
But when talking about healthcare systems, rather than outcomes, it gets tricky talking about lifestyle related diseases. Are people not as deserving of treatment because they haven’t lived a model life? There are a lot of other issues at play here, for example, obesity in America is often linked to poverty, and poverty is also linked to a whole range of other indicators of health. There are definitely ways to solve these issues but they need to be addressed from a community/ cultural level and not from an individual level. “You’re fat, its your fault” isn’t the whole story…
Naite said:
“I believe most people are fat because they can not afford to be healthy!! When you have no money would you go buy 2 Big Macs for $3 (in the US) or pay a lot more to eat something healthy?… Healthy food needs to be cheaper…”
I am adamant that this is a ridiculous statement. The food you eat is a lifestyle choice in the US and not a problem based on money. People who say this are just being lazy and want an excuse to eat their hamburger from McDonalds. Vegetables are amongst the cheapest food you can buy and guess what: they are extremely healthy. Every Monday I make a giant stew of lentils, chickpeas, and an assortment of veggies and spices. It costs $5 and I have food for the entire week (at least 12 meals). This works out to be less than 50 cents a meal. It is cost efficient, time efficient and one of the healthiest things you can eat. It even tastes pretty good.
There is a lack of values placed on healthy eating. It is a societal problem. People like to eat their junk food and have no desire to exercise. Change those values and you will fix the problem.
Geoff! How could you!
There is no doubt about the need for better health programs rather than just treatment; however, where would my health be today without either of my knee surgeries?
I wouldn’t be able to walk simply because I was being an active young adult. As my walking abilities deteriorate pre-surgery, it led to back and hip problems. My painkillers were taken twice/day for months until I received my surgeries. I couldn’t work in that state…..etc
Your article leads to a very accurate analysis for one avenue of which I am in support, but the final conclusion is, in my belief, misled due to the heavy weight given.
cheers,
-J
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Naite said:
But why are people fat? I don’t think it is just out of laziness….I believe most people are fat because they can not afford to be healthy!! When you have no money would you go buy 2 Big Macs for $3 (in the US) or pay a lot more to eat something healthy?… Healthy food needs to be cheaper…
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PS. I agree whole-heartedly… If you want support, spend some time in the Arctic region of Canada and try and tell me that isn’t true. It’s straight up market-forces at work (that’s for you Geoff, you young conservative whipper-snapper!)
The collapse of traditional community lifestyles due in large part to residential schools (the last one was closed less than 15 years ago for all those who say that it was a long time ago) has eroded their previously healthier and sustainable lifestyles.
I walked the streets of Inuvik a lot this summer and a majority of the families you see of low-middle income are obese. Those who can afford the expensive vegetables are not, but when there’s a Pizza Hut and KFC for way cheaper than everything else, what the hell they supposed to do? Well the NWT government is realizing this and sinking a bunch of money into public health education surrounding diet, but it’s definitely a task………
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