This week’s New England Journal of Medicine contained a very, very interesting proposal put forth by a few prominent physicians and researchers working on the obesity crisis in America.
They propose that beverages loaded with sugar should be considered a public health hazard (much like cigarettes) and should be taxes. The proposal calls for an excise tax of “a penny an ounce” for beverages like sugar sweetened soft drinks that have added sugars. They cite research that links obesity to heart disease, diabetes, cancers, and other health problems. They say sugar sweetened beverages should be taxed in order to curb consumption and help pay for the increasing health care costs of obesity.
They estimate that the tax would generate about $14.9 billion in the first year alone and would increase prices of soft drinks by about 15-20%. That is big money, but at what cost?
My personal opinion is that while the tax would generate a lot of money that could be put to good use on anti-obesity programs, it is singling out one industry when obesity has numerous contributing factors. Calories Americans are getting from beverages have actually gone down in the past decade, but obesity rates still climb. Soft drinks alone are not making us fatter.
Americans need to pay closer attention to portion sizes and overall calories coming into their bodies from all sources. We know that Americans also eat too much fried food, candy, ice cream, etc. Should we tax everything that is “bad” for us? Absolutely not! And these foods are not “bad” when consumed in reasonable quantities in reasonable frequency.
We also need to learn how to move our bodies more to burn off some of the sweet treats that we love to indulge in. Weight loss is a simple equation that I don’t get tired of explaining again and again: Move more and eat less.
Taxing soft drinks will not decrease heart disease risk…exercising more and losing body fat by consuming less calories definitely will!
In his last post, DrRich considered the differences between a system of healthcare rationing in which individual autonomy is honored, and one in which the good of the collective takes precedence. DrRich concluded that the former is more desirable than the latter, since the latter would amount to throwing aside the Great American Experiment. In response to this post, an astute reader calling him/herself Jupe wrote:
. . in the case of a limited supply of an effective vaccine during a deadly epidemic, it doesn’t weird me out to think of docs and nurses being prioritized over, say, me. Or a hypothetical situation of military leaders being prioritized in the event of bio warfare So it’s not that collectivism inherently offends me across the board.
In my mind there seems to be some sort of invisible line in there somewhere, but I can’t identify what it’s based on or exactly where it’s at, or why. I just know when it’s been crossed.
Jupe then continues, quoting Ezekiel Emanuel on setting rules for healthcare rationing. Emanuel says, “. . .Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.”
Jupe continues:
[That] just screams “line WAY WAY WAY CROSSED! HOLY CRAP!” to me. I know (well, deeply suspect) there actually is a fundamental difference between “doctors, nurses and military first to be immunized in the event of a bio-warfare attack” and “no antibiotics for the feeble minded” but I can’t pinpoint it outside of “it just intuitively seems right/wrong”.
DrRich interprets Jupe’s question as follows: Why does it intuitively seem OK to ration healthcare in the manner described in the first instance, but not in manner described in the second?
The most obvious answer would be that in the former case there’s an emergency, and extraordinary times call for extraordinary measures. For instance, in times of a war that threatens our survival, most of us would agree that a military draft – perhaps the ultimate sacrifice of individual rights for the good of the collective – is appropriate. And Lincoln, who was fighting a war whose explicit purpose he defined as upholding the Great American Experiment (i.e., to see whether a nation “conceived in liberty and dedicated to the proposition that all men are created equal could long endure”) was himself quite willing to violate individual freedoms to achieve that goal. For instance, he was willing to suspend habeus corpus and jail newspaper editors for sedition. Read more »
If you just snapped a quick picture, you wouldn’t see it. Not unless you were looking for the small signs, like my insulin pump. Or my spotted fingertips.
Type 1 diabetes isn’t something you can see on me. It’s not an illness that, at this point in my life, comes with any constant external symptoms. I am fortunate enough to not use a wheelchair or need vision assistance devices. You can’t see my disease, even though it’s something I manage every day.
I seem “normal.” (Stop laughing. Let me use the word normal for the sake of this blog post, at the very least!) I seem like your average 30 year old professional woman (again, stop laughing), recently married, inspired to achieve, and happy.
And I am happy.
But my good health is not without great effort.
Type 1 diabetes is a chronic illness, and one that has required daily maintenance and effort from me, and from my caregivers, for the last 23 years. Every morning starts with my meter. Every meal I’ve eaten in the last two plus decades has been preceeded by a blood sugar check and an insulin dose. And every night has my finger pricked by a lancet before my head hits the pillow.
This isn’t a pity party. Not by a long shot. My life is healthy and I have a very fulfiling existance, even if days are bookended by diabetes and even if I’m now wearing medical devices 24 hours a day, every single day. And back when I was a fresh-faced litttle kiddo, people seemed to want to cure my disease because they didn’t like the idea of a small child dealing with this disease.
Kids are fun to cure. They’re cute. And their futures seem worth investing in.
What confuses me is how quickly people forget. Type 1 diabetes became a part of my life a long time ago, and I don’t remember even a snippet of “the before.” But even though I’ve lived very well with this disease and kept it from defining me in any way, it’s still here. And it’s still something I deal with every day, regardless of how well or poorly controlled. But just because I’m no longer a little kid with the bright, shining future, am I any less diabetic? Any less deserving of that cure? Just because you can’t see my disease, and because I seem to have it under physical and emotional control, does not mean it’s past the point of deserving a cure.
Here is a vlog post that I did back in February about vlogging during a low blood sugar and how “diabetes can look so normal yet feel so rotten.” It’s a video that shows how invisible diabetes can be, but how visible it feels from the perspective of those who live with it:
Children with diabetes grow up to be adults with diabetes. And all the while, we’re still ready for progress. And for hope. And for a cure.
In his Big Speech, it was noticed that President Obama hedged a little bit in his language regarding the numbers of the uninsured. Despite the fact that the newly-released Census data reflects conventional wisdom, that the number of uninsured totals around 46 million people, the President cited “over 30 million” as the number of the uninsured. OMB director Peter Orzag has a typically wonkish post explaining their numbers — about 39 million uninsured citizens & legal residents. Some of those — a few million, it seems — are eligible for various public health care insurance programs but for a variety of reasons are not enrolled. So they settled on the vague but defensible “over 30 million.”
Anthony Wright expands on this a bit over at TNR’s The Treatment, pointing out that, depending on how you count, the numbers could be much higher indeed. For example, the “millions” of people who are not enrolled in Medicaid and CHIP often are not because the states that administer the programs have in many cases raised administrative obstacles to enrollment, delayed enrollment and even closed enrollment, in order to reduce the strain on their budgets. And if you count the number of non-elderly Americans who at some point in the past two years were uninsured, the number is over 86 million — one out of three people. While at any given point in time, the numbers may be much lower, overall, the population of people at risk of being without healthcare coverage is quite large.
Yet, voices from the right continue to dispute even the more conservative census figures.
It seems the attack on the 46.5 million doesn’t just seek to undermine the facts; it seeks to both minimize the problem, and place the blame for being without coverage on the uninsured themselves. […] But this pervasive argument by health reform opponents, made by Sen. Orrin Hatch on Meet the Press, or Rep. Dan Lungren at a town hall meeting here in Northern California, suggests their true stance… that most of the opponents simply don’t see a big problem in the first place. President Obama should not avoid this rhetorical fight. If opponents want to deny the established Census figures describing the health crisis, to minimize that the problem isn’t that bad, or to blame the victims of our broken health care system, that’s a debate I am confident health reform supporters will win.
I think this is right. The uninsured may not be the best sales pitch, because most people don’t see themselves as a member of that group, but reminding people that reform offers security & stability in healthcare coverage is a compelling promise. Moreover, as opponents of reform try to resurrect the “America has the best health care” argument, it’s handy to remind them that the health care system in the US really is terribly broken and in need of reform. As the specter of rationing is raised to scare voters, the fact that we are already rationing by income should not be forgotten.
*This blog post was originally published at Movin' Meat*
There’s a case for killing Granny? I guess so, or at least according to Evan Thomas’ article in the most recent Newsweek. Thomas, after sharing the story of his mother’s last days, concludes that death is the key to health care reform:
Until Americans learn to contemplate death as more than a scientific challenge to be overcome, our health care system will remain unfixable.
Does everything need to have a political spin on it nowadays?
But let’s take Thomas’ advice and talk about death. Not “death panels,” not the politics or the cost of end-of-life care. Just plain old death.
I was reminded recently of how fragile life is. It made me remember something I read after our oldest child was born. I realized that one day she would learn the truth about death. And I thought how bad that was, and how I wanted to protect her from it. But then, by chance, I happened across this interesting little saying.
When your children are young, all you think about is that you don’t want them to die. But when they get older, all they think about is that they don’t want you to die.
It touched me, and it made me think about how my responsibility to protect my children extended even unto and beyond my own death.
It’s a nice philosophical point, but there are very practical things each of us can do to fulfill this responsibility. Here is my list of just a few of the very important things we all should do to plan for our deaths:
Buy life insurance
If you’re young and in reasonably good health you should be able to buy a term life insurance policy for a few hundred dollars a year. You should do this so your family can have your earning potential replaced in the event of your death. Find a good insurance broker and make sure you get coverage that suits your needs. Even if you have a pre-existing condition (like a chronic illness) a good broker should be able to find you some kind of coverage. You won’t be able to buy any coverage at all if you become acutely ill, so don’t wait until it’s too late.
Make a will
This is so much more than just planning for your family’s financial future. For example, if you have children, have you figured out who will take care of them if both you and your spouse die? There are many important and potentially difficult conversations that go along with this kind of planning – but you’re much better off having them now. After you die, those left behind will end up fighting out these issues not knowing your wishes. Find a good lawyer to help you.
Make an advance directive
You need to think about what kind of medical care you want if you become incapacitated and unable to decide on your own. Do you want to live for 30 years on a ventilator, unconscious? Do you want to undergo extensive and painful treatments if you don’t have much hope of a meaningful recovery? Don’t leave your family alone trying to make that decision for you, wondering what you would have wanted. Write down what your wishes are.
Appoint a health care proxy
Pick someone who you trust to make your medical decisions for you if you are unable to do so. Write it down and make clear what you want that person to do, so if the time comes there isn’t any dispute among your family as to who is in charge.
There are many other things you can do, but to me these are four of what I think are the most important things you can do to prepare for your death. Maybe some commenters can add some more that I missed.
Now, with all that said and done, I will still disappoint Mr. Thomas.
Why? Because I still prefer to think of death as a scientific challenge to be overcome. And you know, I’m glad that many other people feel that way, too.
Especially the people who make medical breakthroughs – I’m really glad they feel that way.
*This blog post was originally published at See First Blog*
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