Why Worry About Obesity?
Elizabeth Kolbert's review of a half-dozen new books on obesity is gracefully written, entertainingly paced, and well worth a read -- it is, in other words, a New Yorker article. But it doesn't draw much in the way of conclusions. More than likely, all the explanations she finds in these books are responsible for the uptick in obesity: We have bodies built to make the most of scarcity and an economy that is dedicated to maximizing an incredible abundance. We bought fewer calories when calories were expensive and we buy more of them now that they are cheap. We eat because we can, and because it feels good, and because it provides a quick reward on days when that's what we need.
I feel like I should say a word on why I'm writing so much about obesity and other chronic illnesses related to diet. It's not because I think there's a great professional future in being a scold, or because I'm planning on entering the lucrative world of publishing with Paternalist Weekly. It's because I've reluctantly come to the conclusion that we won't be able to avoid the fiscal crisis being driven by health-care costs simply by changing the health-care system.
That's not to say that we can't change a lot of health-care spending by reforming the system. But we can't change enough of it. What you see in the Congressional Budget Office graph atop this post is that the growth in health-care costs is not accounted for by an aging population or simple excess cost growth. It's other factors. More precisely, it's what Peter Orszag and the CBO call "technological change."
Technological change means new and more expensive treatments for illnesses. We develop a lot of those. Then we use them. And that costs money. A lot of it, in fact. Enough that it could eventually overwhelm our economy.
We're not going to stop developing those treatments, nor should we. We're not going to stop trying to give people access to lifesaving medicine, nor should we. We can cut costs somewhat by reducing the incentives for overtreatment and wasteful treatments and by negotiating better deals with providers. We can increase the value we're getting for our dollar with better evidence and electronic health records and more primary care. But that won't be enough.
As we keep getting richer, scientists and medical researchers will keep inventing things that can help us get less sick. That's exactly what you'd expect a wealthy society to spend its time and money doing. And if we keep getting sicker, we will keep having to use more and more of these new medical inventions. And that can only happen for so long until we go bankrupt. It would be good to avoid that point, at least so far as we're able. The key to that will be keeping our usage of the medical system at a manageable level. If we develop a lot of treatments but don't need to use them that often, that's quite a bit cheaper. That, however, will require reducing the prevalence of expensive, chronic diseases related to diet. Neither I nor anyone else has a good answer on how to do that. But it's an answer we need.
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