Saturday, June 05, 2004

Apparently one of Dr. Parker's favorite tourist spots has played host to a nanny-state conference on obesity the past few days. Radley Balko has been covering it in TechCentralStation posts here, here, and here. As well as at the Cato Institute and his own blog. From what the Surgeon-General has to say, Mr. McBride should be very afraid:

If you check out the website for the Obesity Summit, you'll notice on the homepage the quote the summit's organizers have chosen to set the tone for three day event. It's from U.S. Surgeon General Richard Carmona:

"As we look to the future and where childhood obesity will be in 20 years... it is every bit as threatening to us as is the terrorist threat we face today. It is the threat from within."

The U.S. government's spokesperson on medical issues says obesity is every bit as threatening as terrorism. Given that the war on terror has spawned the largest federal bureaucracy in the history of the country, questionable trespasses on our civil liberties, and is costing U.S. taxpayers tens of billions of dollars, that's an awfully scary thing for a high-ranking government official to say. And that conference organizers chose to place Carmona's quote front and center ought to give some sort of indication of the starting point from which this debate's about to kick off."

So I guess that means the deck is stacked already. The third TCS article is an excellent analysis of the myth that medical underwriting is illegal:

When I was originally asked to write the designated dissent piece for TIME's special issue on obesity, I went back and forth with a fact-checker over my assertion that state and federal governments prevented health insurers from tying health insurance premiums to risk -- the same way car and life insurers do. Charging everyone within a group plan the same amount for health insurance removes an important financial incentive to stay healthy, and forces fit people to subsidize health care for the not-so-fit. Allowing folks who keep the weight off and the blood pressure and cholesterol down to pay less for health insurance (and allowing health insurers to provide it to them) would also strike a needed blow for personal responsibility in the obesity debate.

The problem is that though several health care policy experts told me they were certain health insurers were barred from such "medical underwriting," no one could say exactly why. In fact, I talked to several health insurance companies themselves, and none could point to any specific law, regulation, or case law laying out the prohibition. I even called tort king John Banzhaf, who -- believe it or not -- is actually on record supporting lower premiums for fit health care consumes, though only as it applies to obesity and blood pressure.....I called the general counsel's office at HHS. Deputy General Counsel Paula Stannard walked me through every possible federal barrier to medical underwriting, and explained why they don't apply.

In fact, in 2001 the Depts. of HHS, Labor and the Treasury (in predictable federal bureaucratic confusion, the three agencies share jurisdiction over the issue) proposed a regulation (66 Fed. Reg. 1421) insisting that the convoluted HIPAA (Health Insurance Portability and Accountability Act) regulations be interpreted to allow health insurance companies to underwrite risks......So HHS, the EEOC, the Departments of Labor and Treasury, and the courts have all said our health insurers should be free to assign risk in the same manner car and life insurers do.

Yet the health insurers, for whatever reason, still seem to think they can't.

What Mr. Balko doesn't point out is that under the current system the individual is insulated from their health care costs. To provide the proper incentive such a system of "medical underwriting" would have to exist in a MSA-type program where the individual bore a realistic share of the cost. Another strike against it is the increased prevalence of obesity in individuals with lower socio-economic status could label such a plan as "economic discrimination".

In a nutshell from Mr. Balko's blog TheAgitator

Whodda' thunk that twenty or ten or even five years ago that a major news magazine could pose a question like "are you responsible for your own weight" and not only would there be actual debate on the question, but the "no" side would start the debate with the upper hand?

It's crazy. If you aren't responsible for what you put into your mouth, chew and swallow, what's left that you are you responsible for?

What indeed?
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