The Supreme Court upheld the Affordable Care Act of 2010, otherwise known as Obamacare. Judging from the polls, American public opinion appears to be very sharply divided over the legislation. Some view it as socialism, others as the first success in a half-century of efforts to achieve a sensible national policy on health care.
Those who have the most to gain from President Obama’s health care legislation are those who have a pre-existing condition or are pre-disposed to illness, and that obviously applies to overweight and obesity Americans. They are more likely to need medical care in the future, but can be charged higher rates if they try to buy private insurance, by virtue of their condition. Or without a change in policy they can be excluded completely. Each obese American currently incurs medical costs 42% higher than those of normal weight, that insurers can have been able to avoid that risk.
One of the interesting things about opposition to the ACA, was that some of the most obesity states voted against their own best interest. The chart below shows how Congressmen from each state voted on the Affordable Care Act on the vertical axis of Figure 1, with the state rates of obesity on the horizontal axis. There is a statistically significant relationship. But the relationship goes the other way: states where more people are overweight, such as Mississippi, Alabama, South Carolina and Texas, are more likely to oppose Obamacare. In those parts of the country where people are slimmer, such as New England, New York and Colorado, there is strong support for health care reform. For every one percentage point increase in obesity, support for Obamacare declines by an estimated four percentage points on average.
Figure 1: States with higher obesity rates tend to oppose the Affordable Care Act
Exercise and eating habits obviously relate to be overweight or obesity. The states where residents get the most physical exercise are Minnesota, Utah, Oregon, Washington and Vermont; the states that get the least are Mississippi, Tennessee, Kentucky, Lousiana and Alabama. And which states do data data sources indicate has bad eating habits: the five worst-ranking are Mississippi, Alabama, Missouri, Kansas and Oklahoma.
In addition to obesity, what the data reveal about how states rank on the overall health index. The states that rank the best on an overall health index are Vermont, New Hampshire, Massachusetts, Minnesota, and Maine and Iowa. The states where people are the least healthy overall are Louisiana, Mississippi, New Mexico, Nevada, Oklahoma and Texas. The weight of the evidence is fairly clear: the states where people are most in need of help getting private insurance (and obesity related illness) are the states opposing the legislation that helps them do that.
It seems that the economists’ view of the world is wrong. People are not voting in their self interest.
Most people don’t know what Obama’s bill does. Broadcast media has contribute to the view that it reduces personal responsibility for health care. But the truth is the opposite. In our current system, hospitals are required to treat patients who show up at the emergency entrance with a heart attack - even if their condition is partly their fault, due to habits of overeating and under-exercising. This uncompensated care is passes on as a cost to insurers and other payors, and the rest of us end up footing the bill. The universal mandate is designed to fix that, by making everyone pay for the health care they get (and perhaps even encouraging them to see a doctor who will advise them to adopt a healthy life style). Establishing personal responsibility, not socialized medicine, is the reason why conservative think tanks proposed the idea of the universal mandate in the first place, and why Mitt Romney enacted it in Massachusettts. But most people seem still unaware of this.
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