Is Universal Coverage Enough...No!!

Like many of you, I have watched intently as the heated debate regarding healthcare reform plays out in front of us. To be clear, the discussion to date is more about universal healthcare coverage than it is about reform of how we manage medical illness. As a practicing vascular surgeon, I see the consequences that lack of insurance has with Americans. No American should feel comfortable with the  contrast that in the wealthiest country in the world, 20,000 people per year should die from otherwise treatable illness because of lack of insurance.  The idea is horrifying and I think it is a moral imperative that we make a decision about how to care for all Americans.

That was the socially conscious part of me. The Ted Kennedy liberal if you will. The fiscally responsible part of me cannot understand the discussion that does not include any mention of how we plan to address the purple elephant in the room, Childhood and Adult obesity. In a little over 3 decades the obesity rate has doubled in adults and tripled in children. By various studies, obesity is responsible for up to 30% of our increased health spending over that time. Diseases like diabetes, heart attack and stroke and arthritis all brought on and worsened by obesity cost hundreds of billions of dollars to manage each year.  These disorders occur disproportionately in people of lower socio economic class and minorities.

So I don’t understand the reasoning that America, the most overweight and obese country in the world will now provide healthcare to all citizens.  Obesity is clearly a cause of multiple costly chronic diseases.  The rate of obesity is increasing at an alarming rate to the extent that this generation of adolescents may be the first generation to routinely die before their parents.  In some groups of Americans, the rate of obesity and overweight is expected to be nearly 90% within 30 years.  

Without any well elucidated plan laid out to me to address the obesity epidemic, I ask all of you to tell me where the money will come from to support our obese Country.  I referred to it as the purple elephant because Im not the only one that knows the absence of logic about the feasibility of this type of reform without a multi pronged attack successful attack on obesity.

To be clear, the theory of universal coverage makes complete sense from a moral and ethical standpoint.The practicality of me, my children and generations to come paying for it with increasing taxes because it was poorly thought out does not.