Lessons in Incentives
By Ian
Hospitals are trying to figure out if it sends the "wrong signal" to have a Mickey D's in the lobby ready and waiting for the guy who just had heart surgery.
At a time when two-thirds of American adults are overweight or obese, putting their hearts and arteries at grave risk, health officials and physicians are urging people to be watch their weight and eat healthier.Having french fries at a leading center for treating heart disease sends the wrong message, officials of the Cleveland Clinic believe.
Of course, if the hospital is private property, I don't mind at all if they decide that the only food service should be through Seattle Sutton, Lean Cuisine, Baja Fresh, the Outback, or Cold Stone Creamery. Then again, I would mention that, at a time when hospitals are losing money, turning away rent from high-volume places maybe isn't the wisest financial move. If they're just going to stop through a drive-thru on the way home, why not capture some of the market? But that could just be me.
If people bore more of the direct cost for their medical problems -- heart disease in this case -- would they be more willing to take care with their eating habits? Sure, the heart poblem the man in the story is having treated is going to drive up premiums, and makes it hard for him to get new or different insurance, but that's a far cry from getting a bill a week later that has, say, a five- or even six-figure bottom line. If there was some sort of tote-board next to the refrigerator, totalling up the likely medical costs for every extra slice of cheese or spoonful of sour cream, then the answer is clear. Since people are often very bad at weighing potential risks and assessing the future, however, it's not so clear.
To be sure, the poor are both the most likely to be without health care, and also the most likely to be overweight. The issue, I think, stems from the progress in making processed foods has driven out costs while infusing the product with items that put on weight. Or at least their concentration has increased dramatically -- think "high fructose corn syrup". Without paying monthly premia, these people also don't face a direct cost for health care, but do assume a much higher risk and face a far more worrisome situation. Eating well is an expensive proposition in this country as compared to pre-packaged meals and fast food, however, and the increased risk doesn't reduce the gap.
But my question then becomes: is providing state-funded health care -- such as proposed plans to extend health insurance in an ever-more socialized way -- to the riskiest possible group going to help in terms of producing better health results? Certainly the costs of health care provision would be driven up by the new people who are now using services at a higher rate than the less risky group. And the presence of health insurance hasn't created a drive towards healthy living among the covered. In fact we'd expect the opposite. I understand that some people would feel better knowing that more and more people are covered, but I'm not certain that I see how this results in what I assume to the be ultimate goal of health insurance and thus access to health care: healthier people. (Note that I don't count children or coverage of children in this, since I think there is a strong case to be made about their inability to understand -- though how we cover children alone is a question I've not got a good answer to.)
Is the desire to make sure people are covered, or to have healthier people? If it's public funds being spent to achieve and end, I'd prefer to have a clearer purpose.
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