Health Care thoughts: Really, Really Bad Idea (?)
by Tom aka Rusty Rustbelt
Health Care: Really, Really Bad Idea(?)
The Food and Drug Administration has approved a proposal to liberalize the guidelines for lap band weight loss surgery (much to the delight of the company making lap bans).
Previous guidelines required a very high level of severe obesity OR severe obesity combined with hypertension or diabetes or etc.
New guidelines will likely double the number of persons qualifying for the surgery. (If i had high blood pressure I would qualify, and I’m not that fluffy).
POLITICAL INCORRECTNESS ALERT:
Physicians are supposed to screen such candidates after exercise and diet have failed, or proceed when collateral medical conditions are very serious, this will potentially cause of rush of surgeries by patients who would be better off with fork control and more exercise. Many health providers think so, but aren’t likely to say so loudly in public.
The surgery does have side effects, and every surgery has infections risks.
And there is a significant cost for each surgery. There is no cost in driving past Krispy Creme.
When in LA I saw many billboards adverts for lap band surgery, and appeared to be more than any other product. Big bucks for a niche.
Just so we don’t wander off into a fantasy analysis in which control over one’s weight is merely a matter of better behavior – weight control is not just a matter of better behavior. Driving past the donut shop doesn’t go very far to make you weigh less. Walking past might help a bit more.
I speak from experience, which is a bad thing. We all tend to think our own experience is “reality” and all that data is just bunk. But still, my experience and the data tend to agree in this case. I have spent my life, since around 4 years of age anyhow, eating far more than any human needs. If behavior were the controling factor in body weight, I would be obese. I’m pretty much normal, despite my behavior. Oh, and just in case anybody thinks I mean I gorged on celery and bell pepper – nope. Pastries, pie and pig meat.
Obesity is progressive and seems to be more a process than a set of behaviors that can be permanently altered. In 10 years, people can go to overweight to morbidly obese and with the industrially designed diets most people eat today, it seems almost inevitable.
I wish people could do what they should. But, I would prefer they not become diabetic, lose their sight, suffer progressive peripheral neuropathies, and the like. The operation is cheaper seen in the light of total lifetime care. I agree that surgeries or medication are no substitute for exercise and diet. But, many people just can’t afford a good diet and don’t have the means/time for exercise, even walking. Two jobs will do that. That’s one reason that obestity and poverty go hand in hand. Nancy Ortiz
“There is no cost in driving past Krispy Creme.”
Oh, there’s a cost, Danny Boy. There is most definitely a cost. You may not be able to measure it in dollars and cents, but it’s there all the same.
In both the economic sense, and I think the physological sense, surgery is a substitute for diet and exercise. In neither case is it a perfect substitute. Exercise is good for us separate from its effect on body weight. But as a way of controlling weight, surgery is a substitute. In fact, in some cases, it is the superior choice.
I spent a lot of my work life trying to help diabetics get through the SS Disability claims process. Some surprisingly young people died before their claims could be paid because they couldn’t afford the medication that would have saved their lives. Obesity and diabetes are epidemic in this country. The surgery will keep people alive and healthier longer. And, who knows, maybe some attention can be paid to the underlying processes that create both obesity and diabetes. Surgery can control weight. But, what we really need is a better understanding of diabetes and how to prevent/cure it. NancyO
Sometimes genetics is kind – enjoy.
The increase in obesity and morbid obesity in just my career span (30 years) has been startling.
It is now impacting most phases of health care delivery, from ambulance gurneys to surgical tables to nursing home procedures (I recently toured a new nursing home and the lifting equipment was rated at 450 pounds).
Are the surgeons and vendors pushing bad solutions to improve profits? Some of them, probably.
gotta agree with you here. who says are rulers are not insane?
re kharris good luck, i guess i used to be lucky like that too, though not to that extent. then alla sudden (it seemed) i had gained 30 useless pounds. i got rid of them. like you said: fork control and exercise. i’d bet it works in most cases. for me it was pretty easy. the tricky bit is not feeling sorry for yourself for all those good things you are not eating.
oh, nancy, what you say is undoubtedly true. but don’t think those operations won’t be used for the behaviorally fat. that said, i suspect your epidemic of diabetes and obesity is related to bad diets (easy foods) and zero exercise. children don’t play outside anymore.
I won the genetics lotto also, my cholesterol numbers are low more by luck than diligence, although I do eat more salad than the average goat, and i do drive past Krispy Kreme these days.
As a lover of all things carbohydrated I can only say that I hate you. I once lost enough weight to get to the lean and mean condition. It required stringent adherence to an Atkins style of diet. Nothing else works for me. Unfortunately I haven’t lately had the level of control necessary to stay in the best shape. Five pounds go on just lokking at a bag of roasted cashews, never mind pastry, pie and pasta. As noted, I’ve decided to hate you.
I think that any procedure/medication can be pushed for the wrong reasons. But, as I said, look at the alternative. Had we a public option, other choices might be available for medical providers. Now, you have to use the tools you have. Maybe it’s a case of a “screwdriver is all you got” so every problem is a screwdriver problem. But, it could buy some young people time. NancyO
“Had we a public option, other choices might be available for medical providers.”
I don’t follow that logic at all.
I misspoke. I meant “single payer.” There might be better cost controls on some aspects of medical practice (thinking here of the Texas approach to med testing/specialist referrals). If so, then more money might be allocated to the necessary research getting at the origins not only of diabetes but also other chronic diseases such as Alzheimers and various dementias. However, that’s pure wishing on my part. No way to know for sure what savings could be achieved or how research would be affected in such a system. NancyO
coberly, you are not quite proving my point about bias, but you are doing a good job proving a related point. You want to “bet” that fork control and exercise” works in “most cases”. Read up, lad. There is very little evidence to support your view. If we are going to discuss policy, my strong preference is to have us rely on something other than personal bias.
If it’s any consolation, being a mesomorph doesn’t help get dates.
A Book of Verses underneath the Bough,
A Jug of Wine, a Loaf of Bread–and, well, that’s about it…
Shouldn’t they bring back the “corset” as a non-surgical approach?
The data says that you are probably wrong about how much you eat.
It has been carefully studied. Overweight people eat more, thin people eat less (or excercize a lot). The “thin metabolism” meme is a myth, “thin apetite” would be much more accurate.
People are not at all good about tracking how much they eat conciously. Unless you have rigerously kept records for a sufficiently long time (including things like weighing your plate after you are done to find out how much you are leaving behind) you don’t really know.
The fascinating thing is, of course, how unconcious this all is. The subtle impulses that unconciously dictate how often and how much and what you will eat and how very difficult it is to resist them consistently.
To be less gloomy, however, I do think that biological science is likely to crack this one in the next couple decades. We will get a diet pill that works and has no notable negative side effects. It will go right into your brain and make you want to eat a bit less.
A point that Krugman feels he needs to make at times regarding economic policy is that it is not a morality play. Moral hazard is a reason not to allow bad behavior to go unpunished. Calibrating incentives correctly is a reason to see that rewards are commensurate with the marginal social return of efforts, rather than just the marginal private return – or with rent seeking. But that gets confusing at times, because what is actually an efficiency argument looks like a moral argument.
So here we are, talking about another area of policy, and here we are, sounding an awful lot like health care policy is a morality play. It should not be. We need to get incentives right. We need to avoid moral hazard – an idea that originated with insurance, so surely has a place in disucssion of health care. However, judgements that veer into “fat people are to blame for being fat, so screw ’em” are nothing but mean spritedness. We can wrap them up in high-sounding blather, but it’s the same impulse that leaves the fat kid sitting alone on the playground.
Health care policy is meant to increase the general welfare, not to reward thin, attractive people who behave in ways that we find seemly.
No one here has made such a judgment.
Given the linkages with such problems as diabetes and high blood pressure, both of which cause misery and can cause death, obesity is a very serious problem.
The question is then: should a $25,000 surgery with significant side effects be our preferred course of treatment?
Experienced doctors and other medical providers have pretty good judgement most of the time. No guarantees are really possible for this or any other procedure. On the other hand, diabetes will kill you sooner or later. I’m inclined to see more potential good than harm in lap band procedures for most people–based on what I have seen so far. In the future, I could very well change my mind. NancyO
i bet. and i won my bet. fork control and exercise did it for me. can’t claim it would work for you, but if it was me, i’d bet.
i am aware there are medical conditions, but i am not much of a believer in medical conditions. don’t have to be. been lucky that way. on the other hand people i know have had their lives ruined by doctors.
i think the “very little evidence” supports the view that most people can’t change their behavior. i’d bet on that.
figure a pound a year will make you fat at fifty, and that a pound of fat is 4000 calories, you are looking at an imbalance of ten calories per day (round numbers, rotund even). you aren’t going to keep track of that. no way to measure the output. on the other hand, eating and working as if you were a hunter gatherer seems to work, kharris and the medical profession to the contrary notwithstanding.
Scary calculation. One small latte at starbucks a day will do it.
Equally scary, I know a cross trainer cranked up to pretty high resistance can burn about 500c in 45 minutes. I won’t bet it catches on big time among the masses tho.
But they say eating 2000c a day is ok, which really isn’t that hard to do. And if you do exercise then you maintain muscle mass that you need anyway and this also increases your resting metabolism, which helps.
I checked this with Mrs. R., who is a real legitimate expert in dealing with diabetes and stroke patients.
“Elective surgeries are down, surgeons needed to find some way to make more money.”
“I am damned sick of tired of families bringing doughnuts and cupcakes to diabetics – I’m going to quit working on Sundays.”
ABC Nightline did a story on this last night:
So, you really think being small-minded is the way to go? You want to take a single data point as the basis for making policy decisions? You want that datum to be yourself, so that the single datum is the one about which you are least objective? You want to do this in a situation in which even extreme objectivity can’t correct for the many factors which operate on weight and matabolism? You go ahead and make that bet with yourself. But don’t make bets for the rest of us until you figure out a better, less self-absorbed way of thinking about how things work.
So far, we are miles away from a situaiton in which your “the question is” matters. There are lots more gym memberships, lots more diets, lots more obese people than there are weight loss surgeries. By insisting on “the question”, you are insisting on a point of view from which the policy decision is to be made. I think the point of view you offer risks skewing the debate far from reality.
You have claimed “no one here has made such a judgment” without any way of knowing whether that’s true. You cannot see into the minds of those posting here. I would answer, “no one here is saying that surgery should be the prefered course of treatment.” But we should not moralize the decision about whether to make the surgery available, because that will tend toward too little surgery.
Well, if we spend more billions of dollars on this sugery each year, the money has to come from some where. And there are side effects.
Within the context of the current national reform movements and debates, that seems to be an important question for many.
I am inclined to Mrs. R’s sentiments. While a discussion is necessary on best practices, I am inclined to believe it is not decided on that basis for niche offerings.
Meanwhile, the bigger story happening in MA is that floors are closing or retrenching severely with the downturn in electives, but also that the cost cutting is on the backs of nurses and per diems. 1:6 ratios have changed to 1:10 in the last year for per diem to patient. Staff positions have been eliminated in closing and re-openings have been staffed with per diems. No overtime at all. Means medical notes need to be done after shift on your own time.
Per diem CNAs have the worst end of the deal….pretty much similar to day labor on the street corner in terms of cancellations one hour before shift start by contract, and no assurance of minimum hours.
Medicine and Education have been the big trains of the post-NAFTA economy:
when these start to go, things are going to get real sticky.
Don’t let Mrs R quit the Sunday gig. It may kill her patients. Better to take two 18″ rulers, the old wooden kind. Band them together with rubber bands and use lots of bands at one end. It makes an effective convincer when applied swiftly across the knuckles of those well meaning but stupid relatives.