Carole Carson

Shape Up or Pay Up!

We all know that medical costs are rising at an alarming rate. Many factors are causing this spike, but among the most identifiable is the increase in obesity. Two-thirds of us are overweight, and given the trend, this number is expected to reach 75 percent in the next few years.

As researchers have repeatedly documented, being overweight leads to a host of medical problems: gallbladder disease, stroke, coronary diseases, certain cancers, diabetes and others too numerous to list. And these medical conditions lead to a host of medical expenses.

Who will foot the bill?

Certainly families are aware of the worrisome increase in costs when they write checks for their medical expenses. Their awareness, however, is matched by the concern of their employers. While the cost of employee healthcare premiums rises, the pressure to provide coverage to the uninsured also rises—a double whammy.

So what’s an employer to do? Some benefit administrators are employing the “stick” motivational technique by deducting money from the paychecks of employees who don’t meet certain health requirements. According to an article in the Los Angeles Times, one Indiana-based company will deduct $30 every two weeks from the paychecks off those who fail to meet weight, cholesterol and blood pressure guidelines.

Other companies are giving “carrots.” That is, the employer reduce the amount of the insurance deductible as an incentive to get and stay trim. Instead of paying the first $5,000 in medical expenses each year, for example, the employee who gets and stays trim may have the deductible reduced to $2,500.

The courts will ultimately decide whether such actions violate employment laws, including the Americans with Disabilities Act. But one thing is certain. For the first time, Americans recognize the need to address the issue of obesity. According to a Harris Poll, 83 percent of Americans say obesity is “very harmful,” compared to 79 percent who consider smoking “very harmful” (the second leading contender). Obesity is now the number one health issue.

What can you and I do? As employees or retirees—whatever our station in life—we must set an example.

Others will follow our lead if we step up and challenge ourselves to lose weight and get fit. To misquote President Roosevelt, we have nothing to lose but pounds themselves.

And what we have to gain is invaluable. We can regain the self-respect and financial viability that comes from living a disciplined, purposeful life. Is that too much to ask of ourselves? And can we afford to do anything less?

Survival of the Fittest?

Medical care costs continue to rise. This fact has implications for all of us, but especially for persons of retirement age.

Financial experts at Fidelity Investments advise retirees to set aside nearly $250,000 to cover medical expenses during their senior years. According to Fidelity’s analysis, projected medical costs have risen 50 percent over the past seven years. Equally troubling is the observation that the trend upward shows no sign of abating, and the Medicare trust fund is expected to be insolvent by 2019.

Will these worrisome costs trigger changes in lifestyle? Will we decide to become fit to reduce medical expenses? Or will only the fittest survive?

A significant percent (some experts place the estimate at 80 percent) of the medical expenses we incur are a function of lifestyle choices such as eating too much, smoking, not exercising consistently and abusing drugs and alcohol. The implication is clear: we can prevent the majority of medical illnesses and associated costs by adopting healthful lifestyles.

If we can no longer afford expensive care or prescription drugs to deal with our medical conditions, we certainly will have a strong incentive to stay as fit as possible.

Before I decided to lose weight and get fit, my medical insurer had a file on me that was at least five inches thick. Much of what I was treated for, whether it was gallbladder surgery or chest pain, was a function of lifestyle. I ate too much, so I weighed too much. I seldom exercised, and I enjoyed nightly cocktails. One overnight stay in the hospital for chest pain cost several thousand dollars.

Today, I keep my weight in the normal range, I exercise each day and I limit alcohol to an occasional glass of wine. As a consequence, except for an occasional sinus infection, my medical expenses are minimal. I want to keep them this way, partly to preserve my good health but also to preserve my nest egg. As medical care costs continue to rise, survival of the fittest may take on a new meaning.

"A man who dares to waste one hour of time has not discovered the value of life."                    Charles Darwin

Escalating Medical Care Costs: Who Will Be Our Brother’s Keeper?

Medical care costs reached $ 2.3 trillion in 2008 and are expected to rise indefinitely at an annual rate of 9 to 10 percent.

 

In addition to the uninsured, middle-class Americans with insurance are feeling the pinch as the costs outstrip increases in income. In response to the growing financial burden, President-Elect Obama has made accessible and affordable medical care a top priority.

 

Yet 70 percent of medical care costs, or $ 1.61 trillion, is attributed to unhealthy lifestyle choices (smoking, poor eating habits and lack of exercise). This raises a compelling question: who will foot the bill?

 

A report by the Vitality Group, a provider of employer health and wellness programs, highlights the disconnect between personal responsibility for maintaining one’s health and financial responsibility for medical consequences. While 82 percent of those surveyed felt they were personally responsible for the state of their health, only 44 percent felt they had a financial responsibility for the cost of medical care.

 

Over half of those surveyed felt that employers and government should absorb the financial consequences of unhealthful lifestyle behaviors, rather than the individuals who engaged in the behaviors. Researchers also reported that the participants were reluctant to pay for wellness programs designed to teach healthful habits.

 

Spotlighting the disconnect between lifestyle choices and financial consequences provides useful insight for policymakers and employers seeking to reduce medical care costs. Even with the availability of sophisticated technological tools, social engineering is an imprecise mix of science and guesswork. Consequently, a variety of experiments are likely to be undertaken with the hope that one or more will be successful in reducing unhealthful lifestyle behaviors.

One approach is taxing unhealthful behaviors. Alabama’s fat tax falls in this category. Beginning in January 2009, obese state workers will risk a monthly increase of $25 in insurance costs if they fail to reduce their weight.

Equally controversial is the approach being proposed by New York Governor David Patterson—an 18 percent sales tax on sugary drinks and sodas. Governor Patterson estimates that this tax, if approved, would generate an estimated $400 million in revenue to offset rising medical care costs resulting from obesity.

 

His model is based on the success of the anti-tobacco campaign. Certainly anti-smoking advertisements have contributed to a decline in smoking; however, researchers have also found a clear correlation between the increased cost of cigarettes and a reduction in the number of smokers. According to statistics cited by Drs. Tom Farley and Deborah Cohen in their book, Prescription for a Healthy Nation, every 10 percent price increase on cigarettes reduced sales by about 3 percent.

 

Whether smokers connected the cost of their behavior with the cost of treating smoking-related ailments was irrelevant. Some quit smoking because of the expense. Those who continued were forced to offset some of the medical costs associated with smoking. (Even so, a $7 tax would be required to fully cover the additional costs of medical care associated with smoking.)

 

In Governor Patterson’s model, sugary drinks are the equivalent of cigarettes. Americans consume one-third of their calories from sugar; half of those come from sugary drinks that nutritionists consider empty calories—the drink is high in calories and low on nutrition. In addition, sugary drinks fail to satisfy hunger. Consequently, the surplus calories in the sugary drinks are added to the calories consumed in food. For these reasons, many experts consider sugary drinks to be the most significant factor in the rise of obesity.

 

If Governor Patterson’s tax initiative passes, public health officials believe they will see a correlation in reduction of the number of overweight or obese individuals, similar to the decline in the number of cigarette smokers.

 

According to Art Carlos, chief executive officer of the Vitality Group, “The increasing need for health care arises from the treatment of illnesses and medical problems that are preventable through more healthful lifestyle choices. Despite advances in medicine, physicians cannot undo the damage resulting from long term abuse of our bodies and are limited in their ability to reverse a lifetime of unhealthful habits. The solution will emerge when we are required to take personal accountability for the way we choose to live.”

 

We spend twice as much as other industrialized nations for medical care, yet we are losing ground on the health front. In the near future, rising medical costs will force us to answer the question: who will be our brother’s keeper?

"Am I my brother's keeper?"                    Bible, Genesis, chapter 4, verse 9

Political Promises, Healthcare and Our Big Fat American Deficit

On September 11, 2008, the U.S. budget deficit reached an all-time high of $9,682,116,996,293.84. Servicing this debt requires around $500 billion annually, give or take a few billion. And like the addict who needs another fix, we continue to spend. This year, experts estimate that an additional $410 billion will be added to the big fat American deficit. Moreover, because of the rocky economy, less revenue from taxes may cause these numbers to rise.

The United States is currently spending 16 percent of its gross domestic product on healthcare. This figure will probably expand in tandem with the expanding waistlines of overweight and obese Americans, whose numbers now total two-thirds of adults and one-third of our offspring. Surplus weight results in health problems that translate into additional medical costs. Consequently, the direct and indirect economic costs of the rising numbers on the bathroom scale are sobering. Individuals, insurers, employers, government programs (including Medicaid and Medicare) and county, state and federal governments pay for direct costs. And as most individuals and employers know too well, insurance premiums are rising. The average annual premium for a family of four is over $12,000.

Indirect costs are harder to measure yet just as real. They reflect the loss of income resulting from absenteeism, sick days, restricted activity and premature death.

I wrote about this issue in an article titled "Political Promises, Healthcare And Our Big Fat American Diet" that appeared September 3, 2008 on basilandspice.com and included a summary of the solutions to the healthcare dilemma proposed by the two presidential candidates. Go here for the full article.

McCain proposes a $5,000 tax credit to help uninsured families afford coverage. He also proposes taxing employer-subsidized medical insurance. McCain believes that improved management of the healthcare system will trim costs.

In contrast, Obama’s priority is obtaining coverage for the 45 million uninsured Americans at an estimated annual cost of $65 billion. Like McCain, Obama assures voters that better management of the healthcare system and cost controls can lower the annual insurance premiums to an affordable level of $2,500 for a family of four.

Both of these candidates agree that the healthcare system needs attention. Although they disagree on the means, both want citizens to have access to affordable healthcare. Without being drawn into the merits of either candidate’s proposals, we can focus on three fixes that can help us become more fiscally and physically fit (FIT):

F: Fix the medical model. Instead of reimbursing physicians and hospitals $250,000 for a single heart surgery, fund wellness and prevention programs for 1,000 people at $250 each. That’s the perspective of Dr. Nick Yphantides, author of My Big Fat Greek Diet and the poster child for what an individual can achieve when lifestyle changes occur. Once a big man (he weighed nearly 500 pounds) with an even bigger heart, Dr. Yphantides now weighs 237 pounds. He uses his personal example with his patients and members of the community to promote healthy lifestyles even though it would be more lucrative to focus on the treatment of medical problems arising from lifestyle choices.

I: Intervene in the lives of individuals to cut through denial. Alabama is experimenting with a stick rather than a carrot. State employees will be fined $25 if they fail to make lifestyle changes that address health and weight issues. Although most of us prefer a carrot to a stick, some of us may need the sting of a stick to wake us up.

T: Tackle the issue of fitness as a community. We need to change the environmental cues that encourage us to overeat and underexercise into ones that encourage us to eat more healthfully and exercise regularly.

Communities can adopt successful group weight-loss programs such as the Nevada County Meltdown, where over 1,000 people lost nearly four tons in eight weeks. Or communities can introduce Dr. David Sabgir’s model, the Walk with a Doc program in Lewis Center, Ohio. Each Saturday at 8:30 a.m., Dr. Sabgir and other physicians and medical-care providers walk with about 175 to 200 patients, family and friends.

How I cast my ballot once inside the voting booth this November is a private matter. Publicly, however, I have no problem sharing my ideas on how we can enhance the health and well-being of friends, family and neighbors. As a by-product, we can reduce the cost of healthcare and help lower the national debt.

My own medical cost-containment program is to lead a healthful lifestyle to render expensive medical care and prescription drugs unnecessary. And my tongue-in-cheek goal is to die a natural death without the help of a doctor.

Can You Afford to Be Overweight and Out of Shape?

In the future, our wealth may depend upon our health. That’s because one of the unfortunate by-products of being overweight and out of shape is the risk of increased medical expenses. According to the Centers for Disease Control and Prevention, the most common medical problems (heart disease, diabetes, stroke and some forms of cancer) are linked with excess weight and lack of fitness.

As the numbers on the scale climb, so do the numbers of medically uninsured people. Today, experts estimate that 47 million adults out of 300 million U.S. citizens lack medical insurance. Moreover, a disproportionate number of the uninsured are young adults (aged 19 to 29). While young adults make up 17 percent of the total population, they represent 30 percent of the uninsured.

According to census data through 2006, nearly 14 million people aged 19 to 29 had no health insurance. This number represents an increase of 400,000 in one year (from 2005 to 2006). By extrapolating the trend through 2009, we can assume that the number of uninsured is approaching or has exceeded 15 million.

While seniors have their advocacy groups and others are sensitive to children’s needs, young adults have no advocates in the healthcare system or in the government. Moreover, we can’t assume that youth protects these young adults from requiring medical care; indeed, their medical needs are not inconsequential. Obesity, which has documented medical consequences, increased by 70 percent in this age group in the last 20 years. Plus, there are 3.5 million pregnancies among females in this age group each year.

Uninsured young adults are living without medical care, including doctor visits, prescriptions and needed treatments. When young adults have to choose between paying the rent and buying food or receiving medical care, medical care is bypassed. Without a regular doctor, young adults don’t receive ongoing medical supervision, and minor problems left untreated become more threatening and expensive to address.

Since I lost weight and renovated my lifestyle, I’ve voluntarily undertaken the task of encouraging everyone—independent of age—to adopt healthy habits. Sometimes I appeal to people’s vanity—I encourage individuals to think how much better they will feel and look if they lose weight and exercise regularly.

Increasingly, though, the economics of healthcare makes the most compelling argument: we can’t afford the option of not being fit. The medical costs associated with disease and illness are simply beyond the reach of millions of us. In the face of that difficult reality, to enhance our wealth, we must preserve our health.