Intuition would tell you that under socialized medicine, the ideal patients would be physically fit. After all, they wouldn’t be at risk for the ravages of smoking, drinking, obesity, sedentary lifestyle, any of these things. In places like Canada, where Big Doctor is Watching, you would think all of these things would be great.
But according to one expert, exactly the opposite is true. Counterintuitively, socialized medicine works better the more people that are unhealthy.
How does that work? Well, in a piece for the Washington Examiner, Tim Worstall of the Adam Smith Institute explains that there’s no particularly great incentive to keep people healthy under a socialized system.
Worstall’s commentary was responding to a New York Times piece by Dr. David Ludwig, a pediatrician, and Ken Rogoff, an economist, which raised the dread specter of systematic costs related to obesity and arguing that something needs to be done before it’s too late. (And naturally, that means greater government control over American lives and businesses.)
“They make a mistake which Rogoff, being an economist and a good one to boot, should know not to make,” Worstall writes. “He fails to look at opportunity costs and thus believes that obesity costs healthcare systems money.”
Instead, Worstall argues, “obesity saves money. Obesity reduces the costs of running the healthcare system (and pension and retirement systems) precisely because it does indeed kill people.”
Sound pretty heartless? Well, such are the wages of socialized medicine — even if The Times’ writers deny it.
“We cannot therefore accept, nor make, this argument, as Rogoff and Ludwig do: ‘Obesity doesn’t just hurt individuals’ pocketbooks; it also affects the national budget deficit. The epidemic substantially increases federal entitlement spending for medical costs through Medicare, Medicaid and Supplemental Security Income,'” Worstall writes.
“Much of the rest of what they say is fair enough: obesity shortens lives, it’s usually caused by a mix of bad diet and lack of exercise, etc. It could even be true that something must be done by the government to reduce it. But curing or reducing obesity would raise costs on healthcare and retirement systems.”
Worstall goes on to note that Sir Richard Doll — the man who discovered the relationship between smoking and lung cancer — was adamant about the fact that smokers didn’t actually cost governments money.
“The point is that we all die of something,” Worstall writes. “It’s the what and the when that is at issue, not the if. The longer we live while waiting to find out, the more healthcare we’re going to get in the interim.
“Someone dying of obesity doesn’t cost anything very much different from dying of smoking, alcoholism, cancer, or heart disease, nor from someone being healthy until they’re not. The vast majority of healthcare expenses come in the last year of life, and it doesn’t seem to vary all that much. The variations of lifetime costs come from how many years we all enjoy those minority of the total costs which are the treatments of those thing which don’t kill us.”
And this isn’t just theory. Worstall points to peer-reviewed evidence that this is the case: “Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained,” one study found.
“The finding is that the cost is, as with smoking, more than offset,” Worstall writes. “Lifetime health service costs were, in Euros, for healthy people €281,000, for obese people €250,000, and for smokers €220,000. That doesn’t include pensions costs. And it’s really pretty obvious that those who die young pay into pensions systems but draw out of them for some lesser number of years.”
It’s a common bromide to say that Social Security is a Ponzi scheme. The reason behind this is that the number of people receiving benefits needs to be relatively small in comparison to the number of individuals paying into it, irrespective of whether they’ll see a return.
The situation with socialized medicine isn’t quite as straightforward as it is with Social Security, but there are still perverse incentives at play in which there’s no particularly good reason to keep people fit, healthy or happy. In fact, as lifespans increase, so do the costs — particularly if reproduction rates remain steady or above zero. If a problem is more costly to fix than it’s worth, is it really a problem? Not to bureaucrats, it’s not. Who needs so-called death panels when you can encourage people to make bad decisions on their own?
By contrast, a society that expects its members to be responsible for their own health care can encourage citizens to maintain a healthy lifestyle because the benefits they enjoy will have no negative impact on the community as a whole. People are thus free to be as healthy, or unhealthy, as they choose — and suffer or enjoy the consequences, as they choose.
“I’m not saying that we shouldn’t do something about obesity,” Worstall concludes, in a jab at the reality of socialized medicine. “I am saying it will cost us more money as we fight obesity. Someone really should tell Rogoff and Ludwig, shouldn’t they?”
Forget about Rogoff and Ludwig. Perhaps someone ought to tell the American people.
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