Insurance reform?

I have been frustrated by the whole health care reform debate. Now that health care reform is "over" perhaps it is time to reflect a little. It seems to me that the debate was not so much about reform as about insurance. To reform the system would be to change the basic structure of how care is provided and what is paid for. Clearly we are not ready for that! When talk of looking at end of life issues conjures up discussion of "death panels" and adjustments of insurance coverage are defined as massive reform, I don't think either side gets it. As long as we do more and more complex procedures for more and more people who (by virtue of what we are doing) live longer and longer, costs cannot go DOWN. Now if we actually focus on prevention, keeping those same people from getting sick initially, THEN maybe costs can go down.

I believe insurance is the wrong model for health care. I have fire insurance on my house, collision insurance on my car, but I really do not want to use either of them. I don't know the statistics, but I'm sure almost everyone who has health insurance uses it every year. This is not insurance but pre-payment. To be sure, few of use could afford a serious medical evaluation without insurance, but why do we want it to cover everything? All we are doing is offering to pay someone else for for giving our own money back to us (less a substantial fee!). Can you imagine loaning money to the bank and they paying them to keep it for you? With the exception of catastrophic coverage, that is essentially what we are doing.

As a physician, I recognize that fewer people would see me if they had to pay out of pocket, and that is indeed one of the struggles of a primarily wellness business. the ones who do, however, are motivated to transform their lives. This is true health reform.

Tortoise and the Hare

You know the old story of the tortoise and the hare. The hare starts out fast, gets over confident and loses the race to the slow but steady tortoise. For many this seems to be the case in weight loss. It has always been alleged that fast weight loss is unhealthy. Although I have lost the reference, there as a recent study showing that actually rapid weight loss may be more beneficial in achieving both greater and more lasting results. This is only one study and hardly enough to draw conclusions. Nevertheless, rapid weight loss is not unhealthy per se. Unmonitored rapid weight loss and unhealthy eating is risky for sure. There have been many documented deaths from starvation diets, unwise use of over the counter appetite suppressants and the like. It should be noted there are far more deaths attributable to obesity and inactivity, but we all know that.

As a bariatric physician, it is my experience that rapid weight loss under supervision is quite beneficial. We observe our clients who get off to a good start are more likely to keep up their losses and less likely to drop out. getting up a full head of steam right out of the gate does help in my opinion.

Overall, my bet is on the hare, as long as we can keep him directed and not overconfident!

Too fat to fight!

A recent article on our bariatric society web site quoted top military officials as complaining about obesity in the 17-24 age range. Currently about 27% are too overweight to join the military. As an "old guy" from the Vietnam War era, I never even knew this could be a reason for rejection! I took my chances with the lottery and fortunatly did not get drafted due to a favorable number. How times have changed. The pedicatric obesity problem has gotten a lot of press as has the general population problem, but I'm not sure this particular age group ha gotten much press. This is the age where folks should be in their prime. This is the time to look back on when our health begins to fail: "If I were only 21 again!"

How can we help people see the course they have set for themselves? Children are dependent on parents, adolescents heavily influenced by peers, but this group is in the process of maturing fully. As a society we need to find ways to help with positive body image, mature patterns of eating and activity, and a sense that life is to be lived fully, not just observed on a screen. Yes, the business of life gets in the way, but all the more reason focus on staying healthy.