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Arguing fat falls flat
Friday, November 21, 2008
A bunch of CEOs met this week and decided that one of the most pressing health care issues that needed to be dealt with was obesity. Now, I'm as obsessive as anybody about obesity -- mainly forestalling my own -- but their comments just drove me up the wall. Especially vis-a-vis this story today in the LA Times about how more and more seniors are approaching senior-hood with a litany of chronic diseases. It's true that obesity is the root cause of some chronic diseases for some people. And chronic diseases then cause the rapid escalation in medical care costs to treat these diseases. But the way that "obesity'' is often framed in the health care context is "individual responsibility,'' especially when spoken of by CEOs, who seem to exist in a different plane -- literally. Usually, when CEOs think about obesity and health policy, they want everyone to go to the gym and take their medicine when they're supposed to and walk around rather than drive a car. Obesity lies at the intersection of so many different areas of social policy. Obesity disproportionately affects low-income, communities of color, who -- as the story says - live in neighborhoods to dangerous to walk around in. Or you live in neighborhoods -- like mine in Downtown Sacramento -- where the most affordable gym (if you can afford one) is one where there is algae growing at the bottom of the pool and was actually the site of drowning. Some people can't just go to a doctor and take meds for chronic diseases -- possibly caused by obesity -- when instructed because many are in jobs that don't offer health benefits, or don't offer very good ones if they do, making health services cost prohibitive. Current food policies and subsidies contribute to the availability of cheap bad food (McDonald's and Taco Bell), versus expensive good food (like cauliflower) -- which, in turn, causes obesity. Cauliflower is expensive: $5 for a head -- at least that's what it cost the last time I bought it. It's really expensive when you consider that a head of cauliflower could be a side dish, but that an entire meal at McDonald's -- the meat, the cheese, the "vegetable" -- is less than $5. I'm not saying obesity isn't an important thing to tackle. But it's just so annoying and tone deaf for CEOs to address what has been the effect of our entire social policy, rather than the cause. Labels: HealthyLiving, InTheNews
posted by Hanh Kim Quach |
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1:25 PM
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Healthy lifestyles and health care
Monday, October 13, 2008
I meant to comment on this piece in the San Diego Union Tribune last week about testing that would show genetic predispositions to heart disease, cancer or diabetes. The hope of scientists and officials at Scripps Health System in San Diego is that consumers would change their eating/exercise habits if they knew they were at risk. I understand the desire to get as much information as possible into consumers' hands about their health history so that they can be conscientious. What makes me uncomfortable about discussions about "individual responsibility" is that it takes out of the debate other social causes for health problems. It alarms me when discussion about healthy habits does not also include a more full-throated discussion about the environmental, geographical, socio-economic and cultural influences that affect a person's health. Many lower income families live in neighborhoods where there are fewer stores stocked with fresh, healthy produce -- and those items are often too expensive. McDonald's and Taco Bell provide inexpensive meals with enough calories to nourish a family, though we all know its content is less than high quality and more like high fat. These families also live in neighborhoods where there are fewer parks available where children can safely play and get exercise. These children, because of their environment (living close to where pesticides are sprayed or an industrial area), are susceptible to asthma and diabetes. An inspiring article, though, was Michael Pollan's (of Omnivore's Dilemma) New York Times Magazine piece about -- okay, food policy -- but it talks about it more holistically, and how we all (and our desire for cheap, abundant food) have played a role in the way our food is delivered now. We can change that now. We are all responsible and can be responsible for getting safe, fresh healthy foods to everyone. Labels: HealthyLiving, InTheNews
posted by Hanh Kim Quach |
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12:00 PM
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Medical Errors: an issue that's Yours, Mine, and Ours
Friday, March 28, 2008
 Sarah Arnquist at The Health Care Blog and Rong-Gong Lin of the Los Angeles Times report from the Association of Health Care Journalists (which I hope bucks the trend of declining membership). The big news: Actor Dennis Quaid is considering suing Cedars-Sinai Medical Center, which gave their twin newborn babies a massive overdose (1,000 times the prescribed dose) that almost caused their death. The bigger news: The experience has made Quaid an activist against medical errors. He's set up a organization, The Quaid Foundation, dedicated to patient safety. He's urging Cedars-Sinai and hospitals across the country to implement a bar code system that would ensure that the right drug and dose are provided to patients. It's a worthy cause to highlight: the Insitute of Medicine suggests that there are between 44,000 to 98,000 preventative deaths each year because of medical errors--not to mention the significant costs that could be saved. There's a lot of policy efforts on the subject. There is Consumers Union's work on hospital infections. There's health reform efforts at transparency of cost and quality data, both last year with AB x1 1, and this year, with bills like AB2967(Lieber). And there's the question of enforcement. Julie Sevrens Lyons at the San Jose Mercury News reported that some of the first fines allowed under a new law were levied against Cedars-Sinai and 10 other hospitals, for severe--and even lethal--mistakes like the Quaid case. The fine, however, was a mere $25,000--which is the billed charged of only a day or two at a hospital.  Quaid says that Cedars-Sinai at least decided not to send a bill. And some hospitals are adopting the policy of not charging insurers or patients for "never events"--the severe mistakes that lead to injury or worse. So the financial incentives are starting to turn. But the key is to prevent the medical errors in the first place. Labels: HealthyLiving, Hospitals, InTheNews
posted by Anthony Wright |
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11:07 PM
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And then what?
Tuesday, November 20, 2007
The America's Health Insurance Plans is patting itself on the back for discovering that the majority of high-deductible health plans, which are connected to Health Savings Accounts, cover recommended preventive benefits -- meaning that patients can go in and get pap smears, well-baby visits, colonoscopies without having to pay full price for the office visit. Okay..that's a good start. But what happens when your preventive screening shows you have Diabetes? Asthma? Breast Cancer? Then what? Herein lies the problem. Actually, there are a couple problems. First, while more than 90% of HSA-eligible plans offered through employers covers preventive care -- most of these plans are purchased through the individual market. There, only 59 percent of policies offer preventive care, meaning that 41 percent of those with these plans don't have preventive coverage. Secondly, in consumer-speak, "preventive care'' means not only the preventive screening for diabetes, but it also means coverage for insulin shots and other medications to "prevent'' further illness. In the industry, however, it's called "chronic disease maintenance,'' which is NOT covered. So consumers may be buying these plans believing that they'll have coverage for all their meds and follow up doctors visits because it includes "first-dollar coverage for preventive care'' but it's not the care they think it is. I'm looking forward to the press release from AHIP that says 100% of plans pay to keep people healthy. Labels: HealthyLiving, Insurers, Underinsurance
posted by Hanh Kim Quach |
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10:54 AM
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Poverty: It's bad for your health
Thursday, May 24, 2007
A big piece of health reform rhetoric -- coming from multimillionaire CEOs -- is the need for personal responsibility and healthy lifestyle choices. This LA Times story today re-highlights what I thought was a long-established fact, poor women -- many of whom happen to be minorities -- suffer disproportionately from chronic diseases such as diabetes, heart disease, stroke etc. The study notes that poverty and lack of insurance are complicit in causing these diseases in this population. As health advocates, we know that the uninsured are twice as likely to forgo medical care and half as likely to fill prescriptions they need, causing their chronic conditions to get worse. And as members of Congress and various others are learning this week in an empathy exercise, a $3-a-day food stamp allowance that as many as 26 million Americans live on is not enough to live healthy lives. Healthy fresh fruits and vegetables are perishable and more expensive, so what's left is higher sodium, higher sugar, higher calorie foods. If this emphasis on "healthy lifestyles'' and "healthy choices" really is going to be a part of the reform debate, let's be real about the "choices" that are out there for poor people. Will Safeway stop stocking up on potato chips and candy and offer discounts on fruits and vegetables? Will health insurers start eliminating copays and coinsurance to help people manage their chronic diseases? Otherwise, there doesn't really seem to be much of a choice. Labels: HealthyLiving, InTheNews
posted by Hanh Kim Quach |
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7:39 AM
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Killing jobs? or Killing people?
Wednesday, May 23, 2007
The Chamber of Commerce has just released its annual list of "job-killer'' bills. Among them -- AB8 and SB48, the Legislature's health reform legislation. You'll recall that both bills woudl require businesses to dedicate 7.5 percent of their income to pay for health care for their employees. (They also opine about "green energy'' and "green building" bills. Maybe global warming doesn't kill jobs.) Now maybe nobody at the Chamber ever gets sick, but I'm thinking that many of the Chamber's member businesses know better. According the National Committee for Quality Assurance, sicker employees are less productive(Duh) and expensive. Businesses lose about $1.2 billion annually due to heart disease, asthma, hypertension, depression, diabetes, and smoking-related illness. And that 7.5 percent, if anyone up there in the Chamber ivory tower cared to do the math – is less than many businesses pay now for health care. And, to take the Chamber on its own terms, I can think of no worse "job-killer'' for an employee than being dead. (You think I'm exaggerating, but 18,000 people die a year because they are uninsured making it the sixth leading cause of death in the U.S., according to the Institute of Medicine). So what do you say? Will it be a job killer? Or people killer? Labels: HealthyLiving, Research, Uninsured
posted by Hanh Kim Quach |
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11:38 AM
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Here's something that ruffles my feathers....
Thursday, May 17, 2007
It kind of sounds like saline implants for chicken breasts. Whatever it is, it's certainly not "natural." Apparently, Tyson Foods, Inc. and Pilgrim's Pride Corp. have been calling their chickens -- which are kept moist with injections of a salt water, seaweed concoction and "natural flavor" -- "100% All Natural Marinated Fresh Chicken'' or something like that. (Here's the story in the WSJ.) Gross. Their claim is that the chickens have no "artificial ingredients'' because salt and seaweed are both natural. ** So is the saline (sterile salt water) in some breast implants, but no one calls them natural. ** Anyway, this labeling is making real poultry farmers mad because their chickens are really natural. "Seaweed occurs naturally in the ocean, -- not in chickens,'' said Lampkin Butt, president of Sanderson Farms.
Now, what does this have to do with health reform? Here's the nexus. Lots of people are suddenly calling for "healthier living,'' which includes healthier eating. All this talk about personal responsibility needs to be coupled with changes in corporate behavior and policy to actually provide healthier choices to begin with. The problem with the saline-breast chickens is that they contain more sodium than au'naturale chickens. More sodium means "potential health implications,'' according to the American Medical Association. Mr. Butt (his real name) is right. But the information about the exact "natural'' content of the saline-breast chickens isn't clear unless consumers read the really, really tiny print on the label. Most people don't read the tiny print. They just read the "100% natural" and assume that it's true. This type of misleading labeling is pervasive in the packaged food industry. The same problem exists for labeling of trans fats, which are bad for reasons I won't go into here. A person should not eat more than 2 grams of trans fats a day. So, you could feel really virtuous and check the label on everything you eat and think you've hit the target. But if a food item contains less than .5 grams of trans fats, then it can be listed is zero. So if you have six items of food with .4 grams of transfats, you've exceeded your limit. My rambling point is this, that there is broad complicity in our unhealthy lifestyles. Sure, we need to watch what we eat and exercise, but another part of reform and prevention is also changing the culture that enables companies to dupe consumers -- whether it's about food, or health insurance. Labels: HealthyLiving, InTheNews
posted by Hanh Kim Quach |
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12:02 PM
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This sounds good and all, but....
Thursday, May 10, 2007
The governor, a bunch of California CEOs and some lawmakers aligned themselves outside the Capitol this morning – squinting, sweating and soaking up cancerous sun rays – and showing how excited they are to fight for health care reform. It’s Safeway CEO Steve Burd’s Jet-Setting CEO Show. Earlier this week, he was in Washington D.C. promoting the Coalition to Advance Healthcare Reform. (Here's a San Diego Union-Tribune story about Burd and his coalition). Joining him today was Del Monte Foods, BumbleBee Foods, Long’s Drug Stores and a smattering of other big businesses. Altogether, nearly 40 corporations – including a number of insurers (except Blue Cross) have signed on with Burd to campaign for health reform. First thing’s first. We’re glad that after years and years of fighting and disagreeing with us, California’s deep-pocketed CEOs, agree that we need to fix health care and make sure people can lead healthier lives, and get the health care they need, when they need it. We appreciate that one of the coalitions core tenets is “Financial Assistance for Low-Income Individuals” and encouraging healthier lifestyles. We’re all for that. But (you knew there had to be a “but”) I want to quibble with a few of their assertions and kvetch a bit. First, Burd said “25% of the uninsured have the financial wherewithal to pay for insurance.’’ I’m not sure where he gets his numbers. Judging from the latest California Health Interview Survey, if everyone who is currently uninsured and made more than $50,000 a year purchased health care, we could cross off 18%. That’s significantly below the “quarter of the uninsured’’ that Burd talks about. And we can’t really assume that all 18% can afford coverage. A number of those are families who have children. A family, with an income of $50,000 in Oakland, is unlikely to be able to afford health coverage. Backing out the families with kids, we’re down to 14%. Secondly, many of speakers referenced the role that individual responsibility plays in leading healthy lifestyles. In particular, the CEO of Del Monte Foods talked about nutritious eating to ensure that people live longer. I think that’s a fabulous idea -- but since when is canned fruit (steeped in sugar) a health food? Del Monte’s pear halves contain more than twice as many carbohydrates and nearly twice the calories as the same fresh piece of fruit (I'm an obsessive calorie counter). Of course – canned fruits are also less expensive – which will be part of my point. Really, though, the point these CEOs are trying to make is that diabetes, heart disease, asthma and obesity (the biggest cost drivers in health care) are easily preventable if people take responsibility and take care of themselves. That means exercising, taking your meds, seeing the doctor when you're supposed to, etc. First off, a lot of what determines whether or not you get one of these chronic diseases is genetics. So, if I could have chosen a father who doesn’t have heart disease and diabetes (my father is 130 pounds, a tennis player and hiker, NOT overweight), that would have been the best way for me to exercise prevention. But many people are able to manage their diseases with healthier living... ....That assumes, though, that struggling families, who are considered middle-income, have time after working two jobs to exercise. ...That assumes that you can afford to buy or rent a house far from the carbon-spewing industrial areas, further from the freeway, away from fields where they are spraying pesticides (or even away from Fresno, where Bay Area smog rolls in) ...That assumes that you can afford fresh fruits and vegetables, not ones preserved in cans. ...That assumes that your neighborhood is safe enough for your children to actively play in the streets, and walk to school. ...That assumes that you can afford the regimen of drugs, inhalers and follow up visits that are required to manage your disease. (** Note: while plans say they cover 100% of "preventive" care,
they don't mean managing chronic diseases, although covering chronic disease is a new "phenomenon" that is written about in this WSJ article that I blogged about yesterday)
If CEOs are going to insist on individual responsibility, the other pieces (government and employer and corporate responsibility) need to be a piece of the solution too. I was disappointed that Burd didn't come out and definitively say -- as he has in the past -- that an employer mandate is necessary and 4% contribution from employers is too low. This is an important point because without being in an employer-pool, workers making $15 an hour ($30,000 a year) would have to go out and buy insurance on their own at exhorbitant rates. Again, I do appreciate that big business is pushing health reform and annoying some of their smaller compatriots. But loosely saying that "the market'' should be allowed to work, when it hasn't been controlled thus far, is no longer enough. Emergency rooms are packed to the gills and sick people are dying because they can't get in. We've been talking about health reform for decades, it's time to get specific and move forward. Labels: HealthyLiving, InTheNews, YearOfReform
posted by Hanh Kim Quach |
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4:23 PM
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Prevention...
Tuesday, February 06, 2007
Many of our consumer allies have been invited to major press event today by the Governor, focusing on prevention and wellness issues. Expect that he might release more details about the public health campaigns on diabetes, obesity, and smoking cessation. You can watch the event at the Governor's website, here: http://www.gov.ca.gov/Labels: HealthyLiving, Prevention, Sacramento, Schwarzenegger, YearOfReform
posted by Anthony Wright |
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9:46 AM
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