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.
