Posted by Kenneth Anderson:
Does Health Insurance Make You Fat?
http://volokh.com/archives/archive_2009_07_26-2009_08_01.shtml#1248900348
According to [1]this new paper (HT McArdle & WSJ), it constitutes a
"true economic subsidy for obesity." As one of the [2]WSJ economics
blogs sums the paper up:
According to the paper, which estimates weight gain in terms of
body mass index, a measure of weight related to height, �private
insurance increases BMI by 1.3 points and public insurance
increases BMI by 2.1 points.�
Economists have long been saying that fat people weigh on
taxpayers� finances. A 2005 study estimated that the federal
government pays for roughly half the total annual medical costs
associated with obesity, resulting in an average annual $175 in
per-capita taxpayers� costs to pay for obesity expenditures among
Medicaid and Medicare recipients.
And a study released today revealed that the overall cost of
obesity-related health-care treatment doubled in a decade to $147
billion, growing faster than obesity rates, which went up 37%
during the same time period.
The new evidence fits well with what Bhattacharya, Bundorf, Pace
and Sood argue: Health insurance isn�t simply a transfer of wealth
from thin taxpayers to overweight ones, but a �true economic
subsidy for obesity.� According to the study, health-care coverage
literally encourages obesity, because people tend to become less
careful about weight-gain when they know that insurance will cover
at least some of the weight-related health costs in which they may
incur.
Though the study found weak evidence that more generous insurance
encourages greater weight gain, or that risk-adjusted premiums
discourage it, there was �strong� statistical evidence that being
insured increases body mass index and obesity.
I am both intrigued with and skeptical of papers purporting to find
economic-sy rationales underlying cultural and, more exactly,
biologically-grounded behaviors (food, eating, hunger, etc.). A quick
(granted, very quick) read of the paper suggested that the details and
qualifiers make it far more cautious than suggested by statements such
as "insurance makes you fat" or that the fact of certain correlations
quite so literally "literally encourages obsesity."
My own personal sense, as someone who always struggles with weight
issues, is that the economics obesity accounts (this paper), or the
political-ideological-social accounts (Fast Food Nation or David
Kessler's new book) don't explain much about personal behavior. Well,
let's be more precise. They don't explain much about my behavior -
and, as my md-phd brother once remarked, think of yourself as the most
exciting statistical series possible of 1: I'm the one who matters
here (!).
At least in my own case, I think the more useful stuff lies at the
level of appetite changes, set points, hormonal changes triggered by
eating and digestion, research into what makes me eat at the
biological level. I struggle every bit as much with weight and obesity
as the obese African-American teenager who is apparently programmed to
go to McDonald's every day, or the middle class white teen who spends
all possible moments in front of the videogame and then goes to
McDonald's. I suspect, for whatever prognostication on this most
difficult of bio-behavioral topics is worth, that the most important
work will come from understanding how what we eat now affects our
eating at the next meal, along with the basic question of how much
physical activity. I don't think it will come from calorie counts in
restaurants - I don't mind them, but as a candidate for Jenny Craig,
my interior calorie consumer tells me that it's not the fundamental
issue.
That said ... look, I never thought I'd find myself admitting this in
public or, frankly, anyplace else. I ran across the S[3]eth Roberts
thing from Freakonomics and thought, well, here's one that is (a)
effortless (b) won't do any harm (c) worst downside is another 400
calories of monounsaturated fats a day (d) at an additional 400
calories a day, I'll know in a month or two what the verdict on the
technique is, for better or worse ...
But I'll be danged if over the last two years, I haven't found myself
gradually losing weight. Very gradually, and I've been working out
more, especially in the deadly light-deprived winter - but, anecdotal
series of one, I would swear that my appetite is simply less. I just
don't have the same interest in food. Your results might radically
differ and, who knows, it might all come back tomorrow or maybe it
will cause some weird cancer of the big toe, and also you have no idea
how embarrassing it is to be gratuitously plugging a thing called the
Shangri-la Diet ...
Bottom line is I'll stick with both my health insurance, Congress and
the President willing, thanks, and the Shangri-la Diet. I am also
mildly worried that telling you all about how this seems to have kinda
worked for me will - I don't know - jinx it or something. Maybe it
only works if you keep it a secret. I'd like to keep those twenty
pounds off, if possible. And if it's not possible for an academic with
control over his time, it's not possible for anyone. It's not as if
this diet has any scientific evidence behind it, as that same md-phd
brother has further pointed out; it is based explicitly on the Seth
Roberts series of 1.
References
1. http://www.nber.org/tmp/27864-w15163.pdf
2.
http://blogs.wsj.com/economics/2009/07/27/does-health-insurance-make-you-fat/
3.
http://www.amazon.com/Shangri-Diet-Hunger-Anything-Weight-Loss/dp/B0014E92NC/ref=sr_1_1?ie=UTF8&s=books&qid=1248899597&sr=8-1
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