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Posts Tagged ‘Third party payer’

I’ve often explained that “third-party payer” is a major problem in our healthcare sector.

This occurs when consumers can buy healthcare with other people’s money. For instance, nearly half of all healthcare spending in America is directly financed by government. And a big chunk of supposedly private healthcare spending is actually the result of government policies that encourage and subsidize over-insurance (in which case, people may be buying healthcare with their own money, at least indirectly, but in a system akin to a pre-paid all-you-can-eat buffet).

Anyhow, one of the big downsides of this system is that third-party payer undermines market discipline and leads to higher prices and massive inefficiency in the health sector.

This then leads to a perverse outcome as politicians point to the higher prices and inefficiency and say this is evidence of market failure!! In a stereotypical example of “Mitchell’s Law,” they then propose more government to ostensibly deal with problems created by government (and people wonder why I have lots of gray hair).

We have the same problem in higher education, except it may be even worse if you look at these charts. Simply stated, government loans and grants have enabled colleges, schools, and universities to dramatically boost tuition and engage in massive bureaucratic featherbedding.

Interestingly, the Obama Administration has a proposal that sort of addresses this issue. The Department of Education is proposing “gainful employment” regulations that would, among other provisions, limit loans and financial aid on the basis of whether a school produces students with high student-loan debt relative to post-graduate earnings.

This sounds like it might be a good idea. After all, it would presumably lead to less government spending.

But there’s a catch. A giant catch, as explained by Brian Garst of the Center for Freedom and Prosperity.

…if it is truly needed to protect students, why are public and private non-profit universities excluded? For-profit schools only serve about 20% of all higher education students, and yet are the exclusive target of the regulation.

Yes, you read correctly. The Obama Administration is not trying to save money or impose accountability. Instead, it is seeking to undermine competition.

You may think I’m making this up, but a former senior bureaucrat at the Department of Education bragged, in a speech to a left-wing group, that the goal is to stamp out for-profit schools.

Here’s another excerpt from the folks at the Center for Freedom and Prosperity.

Former deputy undersecretary of education Robert Shireman, who initiated the Gainful Employment regulations, is currently under investigation for ethics violations and conflicts of interest relating to these effort. He has made clear through public comments that he sees eradicating private-sector colleges as his ultimate goal. In a recent speech delivered at the Center for American Progress, he said he does not believe that a business should own a college.

This fight illustrates why government intervention is so corrupting.

I don’t like any federal subsidies to education, whether for K-12 or for higher education. I don’t care whether the subsidies are for government schools, non-profit private schools, or for-profit private schools.

So I would like to cut off loans, grants, and other funds to for-profit schools, but that should happen at the same time that handouts also are being eliminated for other types of schools (Tim Carney has a very good explanation of why there are no good guys in this fight).

Let me close with an analogy.

I don’t want federal money in the healthcare system. So that means I don’t want payments of taxpayer money to private hospitals and private physicians.

But I would be even more agitated if the Obama White House said that it would “save money” by cutting off health funds, but only monies going to the private providers. The net result is that we all would be forced into VA-type treatment from government.

The moral of the story is to shrink government across the board.

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The new leftist website, Vox, has an article by Sarah Kliff on Vermont’s experiment with a single-payer healthcare system.

But I don’t really have much to say about what’s happening in the Green Mountain State, other than to declare that I much prefer healthcare experiments to occur at the state level. Indeed, we should reform Medicaid and Medicare and also fix the tax code so that Washington has no role in healthcare. Then the states can experiment and compete to see what works best.

But that’s a topic for another day. The real reason I cite Kliff’s article is that Ezra Klein tweeted this image from the article and stated that is was “The case for single payer, in one graphic.”

Vox Third-Party Payer

I don’t know if the numbers in the graphic are correct, but I have no reason to think they’re wrong.

Regardless, I certainly don’t disagree with the notion that our healthcare system is absurdly expensive and ridiculously inefficient.

In other words, the folks at Vox have accurately diagnosed a problem.

However, do these flaws prove “the case for single payer”?

It’s probably true that “single payer” has a lower monetary cost than the system we have today (assuming you don’t include the cost of substandard care and denied treatment), but that doesn’t mean it’s the ideal system.

Indeed, there is a better way to deal with the waste, inefficiency, and bureaucracy of the current system. third-party-2The answer is free markets and genuine insurance, both of which would help address the real problem of third-party payer.

Third-party payer, for those who are new to the healthcare field, is what you get when somebody other than the consumer picks up the tab. And because of government intervention, that’s what happens with about 90 percent of healthcare spending in the United States. Here’s what John Goodman had to say about this problem.

Almost everyone believes there is an enormous amount of waste and inefficiency in health care. But why is that? In a normal market, wherever there is waste, entrepreneurs are likely to be in hot pursuit — figuring out ways to profit from its elimination by cost-reducing, quality-enhancing innovations. Why isn’t this happening in health care? As it turns out, there is a lot of innovation here. But all too often, it’s the wrong kind. There has been an enormous amount of innovation in the medical marketplace regarding the organization and financing of care. And wherever health insurers are paying the bills (almost 90 percent of the market) it has been of two forms: (1) helping the supply side of the market maximize against third-party reimbursement formulas, or (2) helping the third-party payers minimize what they pay out. Of course, these developments have only a tangential relationship to the quality of care patients receive or its efficient delivery.

And here’s some analysis from a study published by the National Bureau of Economic Research.

In most industries, higher quality is associated with higher prices. That is not true in medical care, however, largely because of the public sector. …Every analysis of medical care that has been done highlights the significant waste of resources in providing care. Consider a few examples: one study found that physicians spent on average of 142 hours annually interacting with health plans, at an estimated cost to practices of $68,274 per physician (Casalino et al., 2009). Another study found that 35 percent of nurses’ time in medical/surgical units of hospitals was spent on documentation (Hendrich et al., 2008); patient care was far smaller. …In retail trade, the customer is the individual shopper. If Wal-Mart finds a way to save money, it can pass that along to consumers directly. In health care, in contrast, the situation is more complex, since patients do not pay much of the bill out-of-pocket. Rather, costs are passed from providers to insurers to employers… About one-third of medical spending is not associated with improved outcomes, significantly cutting the efficiency of the medical system and leading to enormous adverse effects.

Here’s my humble contribution to the discussion, starting with an explanation of how special tax breaks deserves some of the blame.

…how many people realize that this bureaucratic process is the result of government interference? For all intents and purposes, social engineering in the tax code created this mess. Specifically, most of us get some of our compensation in the form of health insurance policies from our employers. And because that type of income is exempt from taxation, this encourages so-called Cadillac health plans. …We have replaced (or at least agumented) insurance with pre-paid health care.

I then explain why this isn’t a good idea.

Insurance is supposed to be for unforseen major expenses, such as a heart attack. But our gold-plated health plans now mean we use insurance for routine medical costs. This means, of course, we have the paperwork issues…, but that’s just a small part of the problem. Even more problematic, our pre-paid health care system is somewhat akin to going to an all-you-can-eat restaurant. We have an incentive to over-consume since we’ve already paid. Except this analogy is insufficient. When we go to all-you-can-eat restaurants, at least we know we’re paying a certain amount of money for an unlimited amount of food. Many Americans, by contrast, have no idea how much of their compensation is being diverted to purchase health plans. Last but not least, we need to consider how this messed-up approach causes inefficiency and higher costs. We consumers don’t feel any need to be careful shoppers since we perceive that our health care is being paid by someone else. Should we be surprised, then, that normal market forces don’t seem to be working?

And I ask readers to think about the damage this approach would cause if applied in other sectors of the economy.

Imagine if auto insurance worked this way? Or homeowner’s insurance? Would it make sense to file insurance forms to get an oil change? Or to buy a new couch? That sounds crazy. The system would be needlessly bureaucratic, and costs would rise because we would act like we were spending other people’s money.  But that’s what would probably happen if government intervened in the same way it does in the health-care sector.

This is probably more than most people care to read, but it underscores the point that we don’t have a free market in health care. Not now, and not before Obamacare.

So the folks at Vox are right about the current system being a mess. But I disagree with the notion that more government is a way to solve problems created by government.

The real answer, as I’ve already noted, is to get Washington out of health care. This means entitlement reform AND tax reform.

And if you want to get a flavor of why this would generate better results, watch this Reason TV video and read these stories from Maine and North Carolina.

So how do we get there? Repealing Obamacare is a necessary but far from sufficient condition. Cato’s Adjunct Scholar, John Cochrane, has a nice roadmap of what’s really needed.

Though Vermont certainly is welcome to travel in the other direction. It’s always good to have bad examples and I wouldn’t be surprised if the “Moocher State” played that role.

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Obamacare may not be good news for taxpayers or consumers, but let’s look at the bright side. At least the law has generated some superb political humor, including funny videos.

*The head of the National Socialist Workers Party finds out he can’t keep his health plan.

*A creepy version of Uncle Sam wants to know about your sex life.

*Young people discover that they’re screwed by Obamacare.

*One of the biggest statists of the 20th century is angry that the Obamacare exchanges don’t work.

We have another addition to this amusing collection. This cartoon video employs lots of snark to expose the illogical underpinnings of Obamacare.

My one complaint with this video, though, is that it merely scratches the surface.

Yes, Obamacare is a cluster-you-know-what, but there are many other government programs and policies that cause inefficiency and high costs

Here’s some of what I wrote on this topic back in 2009, starting with an explanation of how government intervention in the tax code has distorted the insurance market and turned it into an inefficient form of pre-paid healthcare.

Insurance is supposed to be for unforseen major expenses, such as a heart attack. But our gold-plated health plans now mean we use insurance for routine medical costs. This means, of course, we have the paperwork issues discussed above, but that’s just a small part of the problem. Even more problematic, our pre-paid health care system is somewhat akin to going to an all-you-can-eat restaurant. We have an incentive to over-consume since we’ve already paid. Except this analogy is insufficient. When we go to all-you-can-eat restaurants, at least we know we’re paying a certain amount of money for an unlimited amount of food. Many Americans, by contrast, have no idea how much of their compensation is being diverted to purchase health plans.

I then ask readers to contemplate what car insurance would look like if government also intervened in that market. Or to think about the consequences if insurance for houses also was subject to government-caused distortion.

Imagine if auto insurance worked this way? Or homeowner’s insurance? Would it make sense to file insurance forms to get an oil change? Or to buy a new couch? That sounds crazy. The system would be needlessly bureaucratic, and costs would rise because we would act like we were spending other people’s money.  But that’s what would probably happen if government intervened in the same way it does in the health-care sector.

The best way of fixing the mess in health insurance, for what it’s worth, is a flat tax. This is because the “healthcare exclusion” is repealed and compensation in the form of fringe benefits is taxed at the same (low) rate as other forms of income.

This presumably will end the incentive for gold-plated Cadillac health plans since workers – once the playing field is level – will prefer a greater amount cash compensation. So health plans gradually will be scaled back so they offer genuine insurance.

This video from the Center for Freedom and Prosperity offers a good explanation.

You also should watch this Reason TV video that shows a real-world example of how prices fall and the system is more efficient when consumers are in charge of healthcare.

For the same reason, I also recommend this story from North Carolina, as well as this example of capitalism from Maine.

It’s also worth noting that there are a few tiny parts of our healthcare system where markets are allowed to operate and consumers are in charge of spending their own money, and in these areas – such as cosmetic surgery, laser eye surgery, and abortion (regardless of whether you approve or disapprove) – we find stable prices and rising quality.

Free markets work…when they’re allowed to function.

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Not counting humor-oriented pieces such as this and this, it’s been nearly a month since I’ve written about Obamacare.

To make up for this oversight, today we’re going to look at a way out of the Obamacare mess.

But the goal isn’t simply to repeal the President’s bad policy. That merely gets us back to where we were in 2009. We need to figure out how to restore market forces to healthcare, and that means undoing decades of misguided government intervention.

Fortunately, we have a roadmap thanks to John Cochrane, a Cato adjunct scholar and Professor at the University of Chicago. Writing in the Wall Street Journal, he explains how radical deregulation is the right approach.

He starts with an essential point that “settled law” doesn’t mean unchangeable law.

…proponents call it “settled law,” but as Prohibition taught us, not even a constitutional amendment is settled law—if it is dysfunctional enough, and if Americans can see a clear alternative.

And he points out that Obamacare will get worse over time.

This fall’s website fiasco and policy cancellations are only the beginning. Next spring the individual mandate is likely to unravel when we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance. The employer mandate and “accountable care organizations” will take their turns in the news. There will be scandals. There will be fraud. This will go on for years.

But the law won’t collapse on its own. Indeed, its failures will be used as excuses for even more government.

Yet opponents should not sit back and revel in dysfunction. …Without a clear alternative, we will simply patch more, subsidize more, and ignore frauds and scandals, as we do in Medicare and other programs.

So what should be done?

Professor Cochrane points out that the healthcare system isn’t a free market now and it wasn’t a free market when Obamacare was imposed.

Instead, it’s one of the most heavily government-controlled sectors of our economy.

The U.S. health-care market is dysfunctional. Obscure prices and $500 Band-Aids are legendary. The reason is simple: Health care and health insurance are strongly protected from competition. There are explicit barriers to entry, for example the laws in many states that require a “certificate of need” before one can build a new hospital. Regulatory compliance costs, approvals, nonprofit status, restrictions on foreign doctors and nurses, limits on medical residencies, and many more barriers keep prices up and competitors out. Hospitals whose main clients are uncompetitive insurers and the government cannot innovate and provide efficient cash service.

He then explains how a market could operate – if it was allowed.

A much freer market in health care and health insurance can work, can deliver high quality, technically innovative care at much lower cost, and solve the pathologies of the pre-existing system. …We’ll know we are there when prices are on hospital websites, cash customers get discounts, and new hospitals and insurers swamp your inbox with attractive offers and great service. …Only deregulation can unleash competition. And only disruptive competition, where new businesses drive out old ones, will bring efficiency, lower costs and innovation.

If this sounds familiar, it may be that you watched this video from Reason TV on market-based hospitalization. And if you haven’t, you should!

Cochrane writes that deregulation will enable the “creative destruction” that brings progress in other parts of the economy.

We need to permit the Southwest Airlines, Wal-Mart, Amazon.com and Apples of the world to bring to health care the same dramatic improvements in price, quality, variety, technology and efficiency that they brought to air travel, retail and electronics. …Health insurance should be individual, portable across jobs, states and providers; lifelong and guaranteed-renewable, meaning you have the right to continue with no unexpected increase in premiums if you get sick. Insurance should protect wealth against large, unforeseen, necessary expenses, rather than be a wildly inefficient payment plan for routine expenses. People want to buy this insurance, and companies want to sell it. It would be far cheaper, and would solve the pre-existing conditions problem. We do not have such health insurance only because it was regulated out of existence.

Needless to say, Obamacare is the opposite of a free market. It assumes that you solve government-created problems by adding additional layers of government.

The Affordable Care Act bets…that more regulation, price controls, effectiveness panels, and “accountable care” organizations will force efficiency, innovation, quality and service from the top down. Has this ever worked?

Cochrane has the right diagnosis and right cure, but that’s the easy part. The real challenge is implementing the policies that would restore a functioning market.

That requires reforms to Medicare and Medicaid, not only to save money for taxpayers, but also because those are some of the steps that are needed if we want market forces to bring down the cost of healthcare.

Health care liberalization also means a flat tax, not only for the pro-growth impact of lower tax rates, but also because it gets rid of the internal revenue code’s healthcare exclusion, thus ending the distortion that encourages over-insurance.

It means state-by-state battles to get rid of regulations, mandates, and other forms of intervention that hinder competition and markets.

They say that even long journeys begin with a single step. That’s true, but it’s also important to walk in the right direction.

That hasn’t happened in recent decades, so it’s time to scrub the slate clean. We need free markets, not more government. We need more consumer sovereignty, not more third-party payer.

Since I’m a sucker for good political humor, we’re going to close with a great Michael Ramirez cartoon. As you can see, there’s a reason why he won my political cartoonist contest. Indeed, if I ever do another contest, this could replace his award-winning “Julia” cartoon.

Pajama Boy Move Out

It’s almost enough to make you feel sorry for Pajama Boy.

Maybe somebody should fix him up with Julia. I’m guessing they wouldn’t even know how to reproduce without intervention, handouts, and subsidies, so that would be an additional way of improving the gene pool.

And it would offset the reproductive advantage of the bureaucracy.

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You know things are going poorly for the Obama White House when even the New York Times is writing about the “third world experience” of Obamacare.

Heck, it’s almost gotten to the point where I feel sorry for the President.

But I guess I must be a mean-spirited anti-government ideologue, because I can’t stop myself from mocking the President’s ill-fated healthcare scheme. Whether I’m sharing funny cartoons or sarcastic videos, I can’t resist the temptation to kick Obamacare while it’s down.

In this spirit of love and togetherness, let’s take a look at some recent news about the law.

McClatchy News has a big expose that reveals the magnitude of the President’s if-you-like-your-insurance-you-can-keep-it prevarication. Let’s review a couple of excerpts from the story, beginning with a comparison of the President’s promise and the staggering revelation that as many as 52 million Americans may have the rug pulled out from under them.

Even as President Barack Obama sold a new health care law in part by assuring Americans they would be able to keep their insurance plans, his administration knew that tens of millions of people actually could lose those their policies. …report in 2010 said that as many as 69 percent of certain employer-based insurance plans would lose that protection, meaning as many as 41 million people could lose their plans even if they wanted to keep them and would be forced into other plans. Another 11 million who bought their own insurance also could lose their plans. Combined, as many as 52 million Americans could lose or have lost old insurance plans.

Amazingly, the President continues to be truth-challenged.

Obama insisted anew Thursday that the problem is limited to people who buy their own insurance. “We’re talking about 5 percent of the population who are in what’s called the individual market. They’re out there buying health insurance on their own,” he told NBC. But a closer examination finds that the number of people who have plans changing, or have already changed, could be between 34 million to 52 million. That’s because many employer-provided insurance plans also could change, not just individually purchased insurance plans.

Now let’s examine an example of what this means. The Weekly Standard reports on what has happened to some citizens from flyover country.

McDonald's Obamacare CartoonIn North Dakota, only 30 people have so far signed up for Obamacare. Meanwhile, 35,000 people have already or will be losing their existing health insurance plans in that state alone.

But that’s not the only bad news for the President’s statist healthcare scheme.

It seems that Obamacare is a gold mine for crooks and con artists. Let’s look at parts of a New York Times story.

To the list of problems plaguing President Obama’s health care law, add one more — fraud. …State and federal authorities report a rising number of consumer complaints, ranging from deceptive sales practices to identity theft, linked to the Affordable Care Act. Obamacare Identity Theft Cartoon…Some level of fraud or abuse is predictable with any big government program… But now, the technical failures troubling the HealthCare.gov website, as well as the law’s complexity, threaten to make matters worse. …Authorities warn that in some cases the come-ons are merely a ruse to get people to divulge sensitive Medicare and banking information. …Medicare has also long been a magnet for swindlers, thanks to its sheer scale and complexity. The troubled rollout of the new health care law has amplified the problem.

By the way, this story doesn’t even mention the possibility and risk of hackers and identity thieves breaking into the massive government databases that will be created as a result of Obamacare.

And if you’ll allow me to briefly digress, the same danger exists if politicians create the huge tracking-and-monitoring database that would be necessary if state politicians get the authority to tax out-of-state Internet sales.

Returning to the topic of Obamacare, it’s also worth noting that the growing burden of taxes and spending isn’t part of the aforementioned stories. Yet can there be any doubt that the program’s failures will lead to even more spending?

Not that any of us should be surprised. That’s almost always been the case when politicians create new entitlement programs. Indeed, I would pat myself on the back for making exactly this predication about Obamacare, but anybody with a room-temperature IQ knew this would happen, so I can’t claim any special insight.

But this does give me a reason to share this new Lisa Benson cartoon.

Obamacare Cost Cartoon

Needless to say, I’m enjoying the ongoing Obamacare disaster. But not just for reasons of Schadenfreude. The cluster-you-know-what of Obamacare is good news because it increases our chances of repealing the law in a few years (just as I predicted back in April).

But not just our chance to repeal Obamacare. We may actually have a chance to deal with the larger government-caused problems in our healthcare system, all of which lead to third-party payer and undermine the efficiency and low costs that exist when there is a genuine free market.

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We have a very interesting question from a reader in Nebraska. Is Obamacare such a cluster-you-know-what that the law will self-destruct?

Well, I’ve already explained why I’m optimistic about the possibility of turning Obamacare lemons into free-market lemonade.

Simply stated, the law took a healthcare system that already was a mess because of government intervention and subsidies and it doubled down on that misguided approach!

And since it’s highly unlikely that more government is the solution to problems created by government in the first place, I think we’ll have great fun being able to highlight all the bad consequences of Obamacare and make a principled case for pro-market reform (meaning not only Medicaid reform and Medicare reform, but also tax reform to help deal with the third-party payer crisis).

That being said, I don’t think Obamacare will collapse on its own. We’re going to have to give it a push. A big push.

This is because legislation will be required to undo all the taxes and subsidies in the law. And even though we have the bizarre situation of the Obama Administration deciding to deliberately ignore a legal requirement to impose an employer mandate beginning in 2014, we’ll also need legislation to undo both the individual and the employer mandate.

In other words, the fact that the law won’t achieve any of its goals (such as lower costs and universal insurance coverage) won’t cause the bad policy to disappear.

But it will make the law even more unpopular – particularly if we do our job.

That’s why we should relentlessly highlight examples of wasteful Obamacare spending. The Washington Post, for instance, is reporting on “the extreme measures states are taking to get young people signed up for Obamacare programs.”

And when even the Washington Post thinks politicians and bureaucrats are going above and beyond in their efforts to waste money, you know it’s something especially foolish. But when you’re trying to trick young people into signing up for insurance policies designed to subsidize richer seniors, you don’t really have much choice.

Oregon might do branded coffee cups, for example, whereas Seattle is looking at doing outreach at music festivals. It only makes sense, then, that Kentucky would be doing outreach at multiple bourbon festivals across the state.

From a big picture perspective, this type of waste in just a penny or two on the dollar, but it’s very symbolic of a law that is poorly designed and unworkable.

I also think political cartoonists are very helpful allies since they’re so effective at illustrating some of the worst parts of Obamacare. So let’s wrap up this post with a new batch of cartoons.

We’ll start with a couple that skirt the edge of appropriateness by playing off the recent airline crash in San Francisco. The first one is by Steve Breen.

Obamacare Cartoon July 15 1

And the second one is by Eric Allie.

Obamacare Cartoon July 15 2

The donkey pilot blaming the elephant passenger is a good touch, and you find that theme in this Gary Varvel gem.

Obamacare Cartoon July 15 3

Let’s close with a great Rick McKee cartoon that focuses on exploding costs, a message near and dear to my heart.

Obamacare Cartoon July 15 4

One final warning. We’re not guaranteed of victory simply because Obamacare is leading to bad results. The statists are going to try and seize control of the narrative by asserting that the higher costs and greater inefficiencies could be fixed by squandering more money in the short run and imposing a single-payer system in the long run.

That’s a very perverse example of Mitchell’s Law and it surely doesn’t make sense to normal people. But it’s an approach that plays to the worst instincts of politicians, many of who will grab any excuse to increase the size and scope of Washington.

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Last year, I showed an image of evolutionary stages that was so accurate that it would earn approval even from many strict creationists.

Here’s a new image of evolutionary stages that sets the stage for today’s discussion. Simply stated, Americans are becoming bigger. In some cases, a lot bigger.

Is this trend toward greater obesity a bad thing? As a reader asks, is it something that requires a government response?

The answer is yes…and no.

Libertarians believe people should be free to make their own decisions so long as they’re not infringing on the rights of others. And that includes the right to eat too much and exercise too little.

But the “yes” part of the answer is that we can think obesity is unfortunate and we can encourage our friends and family members to live healthier lifestyles. And if we’re willing to be pests and to run the risk of being told to mind our own business, we can even encourage strangers to shape up.

The “no” part of the answer refers to whether the government somehow should get involved. I shared a great video from Reason TV several years ago that explained why paternalistic anti-obesity programs don’t work. And just this week, one of my colleagues at the Cato Institute, Michael Tanner, addressed this issue. Here’s some of what he wrote for National Review.

Recently the American Medical Association declared that it will consider obesity a disease. …the AMA’s move is a symptom of a disease that is seriously troubling our society: the abdication of personal responsibility and an invitation to government meddling. …the AMA’s move is actually a way for its members to receive more federal dollars, by getting obesity treatments covered under government health plans. A bipartisan group of congressmen has already seized on the AMA declaration as they push for Medicare coverage of diet drugs. Observers also expect an effort to expand Medicare reimbursement for bariatric surgery, a.k.a. stomach stapling. And there will almost certainly be pressure to mandate coverage for these things by private insurance carriers, under both state laws and the Affordable Care Act. …After the AMA decision, John Morton, treasurer of the American Society for Metabolic and Bariatric Surgery, was almost giddy, calling the AMA decision a “tipping point” and adding that “now coverage policy must catch up to that consensus.” Since a typical bariatric surgery costs as much as $40,000, that could be interpreted as a warning for all of us to get out our wallets. In the end, we will be paying more, through either taxes or higher premiums.

And don’t forget that the price of treatments such as surgery almost surely will climb as there’s more “third-party payer,” so our taxes and premiums will climb by a lot more than what it cost to provide these services today.

But that’s only part of the story. Since government is picking up the tab, that gives politicians a green light (at least in their minds) to pass laws and rules designed to control and influence our behavior.

…expanded Medicare and insurance coverage socialize the cost of treating obesity, thereby inviting all manner of government mischief. After all, if being fat is not our fault, the blame must lie with food companies, advertising, or other things that need to be regulated. And if you and I have to pay for the food and exercise choices of others, we should have a say in those choices. Already, Harold Goldstein, executive director of the California Center for Public Health Advocacy, has cited the AMA declaration to boost his group’s efforts to ban junk food and tax soft drinks. …The nanny state can now claim medical backing.

Mayor Bloomberg doubtlessly thinks this is a wonderful idea. Maybe he can ban snack food as well as 17 oz. sodas.

Heck, why not have a cop in every house to make sure we consume 5 servings of fruits and vegetables every day? Actually, I shouldn’t say that too loud. Given the Supreme Court’s Obamacare decision, there’s apparently no limit to the federal government’s power to control our behavior through the tax code, so I’d hate to give politicians any more crazy ideas.

If you think I’m engaging in a bit of hyperbole, just remember that New York City already has gone after bake sales for peddling sweets.

So what’s the big picture? Mike nails it, explaining that the medicalization of obesity is symptomatic of the effort to undermine individual responsibility.

Much of public policy these days seems designed to eliminate personal responsibility. Take efforts to reduce poverty, for example. How much of poverty is due to poor lifestyle choices? We don’t want to blame the poor, nor should we forget that there are those, especially children, trapped in poverty by circumstances beyond their control. But we also know the keys to getting out of or staying out of poverty: (1) finish school; (2) do not get pregnant outside marriage; and (3) get a job, any job, and stick with it. Unfortunately, much of the welfare state we have constructed is perversely designed in ways that end up encouraging destructive behaviors.

In other words, the welfare state hurts the poor, as Thomas Sowell explained the other day. Though I suppose fairness requires me to admit that there are those who benefit from all the various income-redistribution programs. A vast army of bureaucrats get very comfortable salaries to administer these program, and these poverty pimps, as Walter Williams describes them, enjoy much higher levels of compensation than they could earn in the economy’s productive sector.

But I’m guilty, once again, of digressing. Let’s get to the rest of Mike’s final point.

Big government reduces all of us to the status of children. We have no responsibility for anything in our lives; therefore, government must take care of us. All we have to do, like children, is give up the freedom to make our own choices — good or bad.

Amen. A “good choice” isn’t good if it’s the result of coercion. Paternalists sometime have admirable goals, but they err when they want to turn big government into big daddy and big mommy.

P.S. Several readers have noticed that I’m now writing one post a day instead of two and have asked whether this is a permanent change. The answer is yes. With all the other things I’m trying to juggle – researching and writing, dealing with Capitol Hill, talking to the press, giving speeches, etc – this seems like the best way to allocate my time. Particularly now that my posts tend to be a lot longer and more substantive than when I began blogging.

P.P.S. Since we’re on the topic of obesity, it goes without saying that our real problem is bloated government, not bloated people. Which is why I always enjoy cartoons that portray DC as the true home of gluttony. For good examples, see here, here, hereherehere, here, here, here and here.

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