Healthier Lifestyles Now Looking Budget Healthy
An apple a day keeps the doctor away, but what does it do to the budget deficit?
There’s been some long-running debate in the community over whether or not having people adopt healthy lifestyles would actually reduce health care costs as opposed to just making people healthier. After all, getting crushed by a an anvil at age 45 is terrible for your life expectancy, but not particularly costly compared to letting you live 20 more years before getting a cancer diagnosis. But via Ezra Klein and Tom Laskaway some indication that the research on obesity is now looking to indicate that it will save money:
Health economists once made the harsh financial calculation that the obese would save money by dying sooner. But more recent research instead suggests that better treatments are keeping them alive nearly as long – but they’re much sicker for longer, requiring such costly interventions as knee replacements and diabetes care and dialysis. Medicare spends anywhere from $1,400 to $6,000 more annually on health care for an obese senior than for the non-obese, Levi said.
This is basically good news, since the sort of measures that could create more opportunities for healthy diet and exercise habits are themselves relatively cheap compared to the delivery of health care services. But it’s long been a bit unclear as to whether or not cost-effective measures along those lines would actually pay for themselves in terms of reduced medical costs down the road. Insofar as that does seem to be the case, it further strengthens the argument that we can afford to build a healthier society. I don’t actually think it makes a ton of sense to argue that we should promote wellness in order to save money. Rather, we should promote wellness in order to produce healthier, longer-lived, happier people. But if such measures are cost-negative, that strengthens the case for taking the necessary steps.
29 Responses to “Healthier Lifestyles Now Looking Budget Healthy”
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July 7th, 2009 at 11:40 am
Good post. As I would put it, the policy world is full of otherwise good ideas we can’t afford to implement, so showing the net costs of a particular good idea are low to negative is actually quite significant.
So, I will look forward to my government-supplied treadmill that spits out coupons for vegetables.
July 7th, 2009 at 11:42 am
I’ll say the same thing here that I have said in many other threads. Refined carbohydrates are killing America.
July 7th, 2009 at 11:49 am
You’re going to make me eat fruit? Goddamn socialists.
July 7th, 2009 at 11:49 am
I have two points:
1) It would be nice if the overweight and obesity classification were tied more directly to actual negative health consequences. As it currently stands, you are better off, on average, being overweight than ‘normal’.
2) It would be even better if they could start finding and publishing behaviors that lead to health problems. I imagine you would then discover what is suggested by BradyB. There are a lot of non obese people out there whose behavior is just as deleterious to their long term health, I’d imagine.
July 7th, 2009 at 11:58 am
Yeah, my understanding is that weight per se (or BMI or whatever) isn’t really a good health measure. In fact, a doctor friend of mine suggested his overarching conclusion was actually quite simple: if you eat a lot of vegetables, get regular exercise, don’t smoke, drink only in moderation, and avoid unnecessarily risky situations (e.g., drinking and driving), odds are you have done almost everything you can with respect to behavior to optimize your health outcomes. And he wasn’t convinced that tracking weight, cholesterol, blood pressure, or so on was doing much to add to that conversation–bad results on such measures might lead to medication, but they weren’t changing his lifestyle advice, which remained the same for just about everyone.
July 7th, 2009 at 11:58 am
I don’t actually think it makes a ton of sense to argue that we should promote wellness in order to save money. Rather, we should promote wellness in order to produce healthier, longer-lived, happier people.
In a perfect world, I’d agree with you, Matt. But you know the government will only promote wellness at the margins to produce healthier, longer-lived people.
However, if there are cost savings to be had, it seriously ratchets up what sort of wellness promotion the government can justify.
Imagine the government buying up all the tobacco producers and importers, for instance – and running them as before, except for cutting their advertising and promotional budgets to zero. It would probably roughly break even, but the big justification would be the cost savings from fewer people trying tobacco, and getting hooked, in the first place.
Or imagine crop subsidies being shifted from corn to leafy green vegetables.
Or imagine partly justifying mass transit subsidies because their use inevitably involves walking.
If a healthier population uses significantly fewer health care dollars, there’s a whole big range of health-fostering programs that can be justified that would never otherwise pass muster.
July 7th, 2009 at 12:01 pm
I don’t understand the quote at all. Maybe I’m suffering from dementia.
I’ve highlighted the word “instead,” which suggests that newer research is contrary to the initial supposition of the health economists. But the rest of the paragraph seems to confirm that initial supposition. And the phrase “better treatments are keeping them alive nearly as long” makes no sense–nearly as long as what comparison group–non-obese people?
July 7th, 2009 at 12:05 pm
So what exactly do you mean by “promoting healthier lifestyles”? I presume you mean “taxing the shit out of people who refuse to comply.” And when that doesn’t work, prohibiting the offending action/substance.
The narrower the gap between “progressive” and “lifestyle police” becomes, the creepier it gets.
July 7th, 2009 at 12:05 pm
As it currently stands, you are better off, on average, being overweight than ‘normal’.
I should note that this is somewhat misleading, at least as applied to the population as a whole. The prevailing view on the “obesity paradox” (i.e., the repeated finding that people in the “overweight” BMI classification live longer) is that once you reach a certain age, it is probably better to be a little heavy so that you can better deal with future illnesses that cause weight loss. Prior to that point, it’s better to be in the normal category.
So if you are in your 60s or 70s, yes, it’s better to be a little fat. If you are in your 20s or 30s or 40s or 50s, not so much.
July 7th, 2009 at 12:08 pm
And this is posted by someone who is still obese, correct?
July 7th, 2009 at 12:12 pm
So what exactly do you mean by “promoting healthier lifestyles”? I presume you mean “taxing the shit out of people who refuse to comply.” And when that doesn’t work, prohibiting the offending action/substance.
This is just insane. The vast majority of proposals to “promote healthier lifestyles” involve reducing subsidies to unhealthy crops like corn and soy*, or planning development to accommodate walking and biking.
July 7th, 2009 at 12:13 pm
* Yes, corn and soy can be healthy if eaten as, well, corn or tofu or edamame. But most of it is grown in this country to make high fructose corn syrup or hydrogenized soybean oil, which aren’t healthy.
July 7th, 2009 at 12:17 pm
Rich in PA,
What the new research is finding is that obese people aren’t actually dying soon enough on average for there to be cost savings. So while it remains true that IF they died soon enough on average there would be a cost savings, in practice that condition isn’t being met.
And yes, the finding is that obese people are living nearly as long as non-obese people. But that isn’t really the important finding from an economics perspective: the important finding is they are living past the switchover point, meaning the point past which the increased costs of serving their health needs while alive outweighs the savings from dying earlier.
July 7th, 2009 at 12:19 pm
Isn’t this actually another argument for a public program? If everyone is in the same risk pool, the long-term savings will accrue to the pool. Traditional insurers resist covering “wellness” because people change coverage so frequently (job change, employer shifts in coverage, etc) that they don’t see a benefit in paying today for prevention if the value will only be recognized 10 years down the road. Only in “universal” programs (like Medicare) would you be able to see this benefit in downstream savings for near-term expenditures.
July 7th, 2009 at 12:37 pm
DTM @13: Thanks for your message. I think the word “instead” there is ill-chosen, because the health economists (according to the quote) weren’t claiming that the obese were actually dying sooner, but that they would save money *if* they died sooner. So the later findings don’t counter that–they’re about something else entirely, the actual life expectancy of obese people, and their incidental point tends to confirm the initial speculation. I think Ezra needed an editor on this one.
July 7th, 2009 at 12:42 pm
I think the word “instead” there is ill-chosen, because the health economists (according to the quote) weren’t claiming that the obese were actually dying sooner, but that they would save money *if* they died sooner.
The claim, “Health economists once made the harsh financial calculation that the obese would save money by dying sooner,” doesn’t necessarily imply a conditional. And in fact if I recall correctly, at least some people did in fact predict this would actually happen.
July 7th, 2009 at 12:46 pm
@12 Joe
I think you will find that Soy is going to go down as one of the more dangerous foods ever mass-injected into our food market. The only function for Soy should be estrogen-replacement therapy.
July 7th, 2009 at 12:54 pm
“The vast majority of proposals to “promote healthier lifestyles” involve reducing subsidies to unhealthy crops like corn and soy*, or planning development to accommodate walking and biking.”
Oh, right! Like MY’s plan to reduce drinking by building a bike path to places where people don’t drink.
Wait. No. His plan was to put an additional tax on alcohol.
July 7th, 2009 at 1:11 pm
This could explain some of the differences between health-care delivery and outcomes in other welathy countries compared to the United States, but I probably would not leap to conclusions of “A-HA!!! Now any crackpot public health scheme will lower health care delivery costs too!” (Of course, you are not at all saying this. It’s just important to remember.)
July 7th, 2009 at 1:25 pm
Wait. No. His plan was to put an additional tax on alcohol.
As I recall, Matt’s primary justification for supporting an increased alcohol tax was the perceived need to generate revenue. The fact that it would likely improve health a bit was just a secondary justification, meaning a reason for preferring it over some other possible means of generating revenue.
July 7th, 2009 at 1:30 pm
MY “After all, getting crushed by a an anvil at age 45 is terrible for your life expectancy”
Matt, only three people in the history of the world have ever been crushed by an anvil, and in all three cases the anvil was being wielded by a hyper-crazed blacksmith.
You are 3,545 times more likely to be crushed by a marauding circus elephant than an anvil. Approximately.
July 7th, 2009 at 1:40 pm
I demand a free-gym-membership-and-locally-grown-vegetables stimulus.
July 7th, 2009 at 1:58 pm
Wrong! The only argument that has a chance is “We should promote wellness in order to increase corporate profits.”
Your error, Matt, reflects a common misconception about a fundamental truth of our political system.
July 7th, 2009 at 2:49 pm
DTM,
Correct, at least to some extent, depending on which post of his you read. At one stage, a few months back, complaining about some post from Paul Campos, MY said that his rationale for taxes on public health hazards did not depend “at all” on the public health argument. Later, he seemed to lean away from that a bit. See here:
http://yglesias.thinkprogress.org/archives/2009/01/the_case_for_booze_taxes.php
Either way, as soon as you start allowing the “but it also stops people from doing things I consider idiotic” to become part of the decision matrix… creepiness ensues.
Besides, for a progressive to rely on the “it raises revenue” argument seems even stranger with regard to booze and cigarette taxes. Because, you know, poor people smoke and drink a lot.
So either justification seems bizarre coming form these quarters. “I support sin taxes because they allow me to control what other people do” is an odd progressive argument. As is, “I support sin taxes because they allow me to raise a ton of revenue, which happens to come largely from poor people.” But in the end, I think the REALLY strange progressive argument is, “I support sin taxes because they allow me to control what other people do AND they allow me to raise money from poor people.”
What’s the opposite of a liberaltarian?
July 7th, 2009 at 2:53 pm
You say: “I don’t actually think it makes a ton of sense to argue that we should promote wellness in order to save money.”
One thing I’ve been wondering though–what is the loss of economic productivity caused by the cohort of obese-people-with-constant-health-complications? It seems you could also justify “healthy lifestyle” measures as a way to boost productivity of the workforce.
July 7th, 2009 at 3:19 pm
Either way, as soon as you start allowing the “but it also stops people from doing things I consider idiotic” to become part of the decision matrix . . . creepiness ensues.
But that’s not really the argument, at least from people like Matt–his argument is more of the form that the activity imposes net negative externalities, so it is appropriate to price in those externalities through taxation.
Besides, for a progressive to rely on the “it raises revenue” argument seems even stranger with regard to booze and cigarette taxes. Because, you know, poor people smoke and drink a lot.
Matt doesn’t seem to care much if any given tax proposal is regressive. Citing one graph with a crappy fit, his theory is that the progressive effects of increased government spending systematically outweigh the regressive effects of taxation, so the case-by-case details don’t matter. I personally think that is a terrible argument, and have said as much in these comments several times, but in any event that is how Matt shrugs off this concern.
What’s the opposite of a liberaltarian?
A “compassionate conservative”.
July 7th, 2009 at 3:36 pm
A lot of these analyses that claim life extension treatments don’t save money miss an important point. They don’t look at the GDP that a person generates directly and indirectly and the tax revenue that would follow.
A lot of people in their 60s and 70s who remain healthy, continue working, so their survival should contribute directly to GDP growth and tax revenue. Beyond that, there are indirect benefits to older relatives. For example, many grandparents take responsibility for raising children, providing free childcare and guidance. This should indirectly have a positive effect on current and future GDP as well.
It is no coincidence that we call death “a loss”. IMO, the only way one can conclude that life extension is not cost effective is by improperly accounting for the beneficial externalities of the life.
July 7th, 2009 at 6:25 pm
Obese /= overweight.
I am not convinced that being overweight is much of a health issue (all other things, like exercize, diet, alcohol use etc, being equal). In fact, I wonder if what we call “overweight: is not in fact the normal weight for humans in times of non-food scarcity since that is what evolution has programmed us for. Simply because our standards of beauty prefer wraith-thin does not make it healthy or natural for us. However I do believe there are good stats on the dangers of obesity.
July 7th, 2009 at 8:17 pm
“his argument is more of the form that the activity imposes net negative externalities”
the externalities might be part of it. But not all of it. He also takes into account “benefits” to the corrected individual.
He has discussed this at length, particularly with regard to smoking, which he sees as having fewer negative externalities than drinking.
Smoking, he tells us, is basically bad for you “fron the first puff.” And still, the best he has been able to muster is some sort of phrase like, “I am not sure where I stand on these kinds of paternalistic measures.”
But it seems he is pretty clear, insofar as he supports them.
Look, I can say, “I support a tax on people of Norwegian heritage, because we need revenue.”
And then, “And hey, by the way, another great thing about this tax is that it will really hammer people of Norwegian heritage, and i don’t really like them much.”
And later, I could say, “But hey, this is not about hating Norwegians. Like i said, It’s REALLY about raising money.”
I think people would connect the dots.