New York Times writer Anemona Hartocollis (2012) followed 20-year-old Shani Gofman through a year with a weight condition. Shani provides a case study for obese Americans in general, who struggle with surgical and behavioral treatment for a disease that has reached alarming proportions, and for a subgroup, young obese Americans aging out of Medicaid coverage (Hartocollis, 2012). Once they become adults, Medicaid no longer provides the same coverage if any at all, although "bariatric" surgical weight-loss procedures have increased by a factor of seven over the last ten years (Hartocollis, 2012).
The Brookings Institute corroborates these statistics, citing various estimates of direct cost of obesity-related conditions and obesity itself at around 10% of all U.S. medical spending, or around $147 billion for 2008 (Finkelstein, et al., cited. In Hammond and Levine, 2010). "Private payers bear the majority of estimated costs," Hammond and Levine explain (2010), "although public-sector spending is also substantial" enough that Medicaid spending would fall by nearly 12% "in the absence of obesity" (Hammond and Levine, 2010). Lee, Sheer, Lopez and Rosenbaum (2010) corroborate Medicaid coverage by state, for adults and minors, and identify states which allow private insurers to charge higher rates or deny coverage to applicants with pre-existing obesity. Another New York Times article cites peer-reviewed findings there are far more individual costs to obesity, including foregone earnings; lower educational attainment and higher unemployment for example (O'Connor, 2012). Hammond and Levine (2010) concur, adding indirect costs to society from lost productivity, skill development and even transportation to "suggest total annual economic costs associated with obesity in excess of $215 billion."
This all should come as no surprise. Researchers Mann et al. found as far back as 2007 that even then obesity-related health problems were the second-highest cause of death in the U.S. following only smoking-related health problems, that dieting often caused short-term weight loss but over the long-term dieters usually gained that all back and more; that such "weight cycling" carries risk of its own, and that the "benefits of dieting are simply too small and the potential harms of dieting are too large for it to be recommended as a safe and effective treatment for obesity" (Mann, et al., 2007). Studies these researchers cite date back to 1980 (Mann, et al., 2007). Hartocollis (2012) cites several studies where surgeries have begun to show consistent complications over longer periods, as high as 30% of surgeries in some cases.
Could funding weight loss programs by Medicaid save millions? Yes. It could save many billions and more, according to the research above. How? If it worked. If we knew how to solve obesity, we could patent that, sell it and capture the savings ourselves, which no one seems to have been able to do or they would have, as evidenced by the attempts of Jenny Craig; Lap Belt; and the diet and medical surgery industries (Hartocollis, 2012). Obesity is an unstoppable plague against which our medical sector lies helpless, which will ultimately consume us all. Or not: If the weight loss program that actually worked once and forever was indeed found, and it was funded by Medicaid, it could save billions and more, without a doubt. For whom? Herein lies a deeper problem resulting from asking whether Medicaid should fund prevention as a solution to obesity or not, which most of these authors address implicitly but not overtly, that all these questions deal with symptoms rather than root causes. Maybe it has been solved but that is not as profitable as perpetuating obesity. If so the question becomes, if this is a new problem, why do we allow it to persist?
Some people see obesity as a problem. Stephanie Strom described in a July 2011 New York Times article how McDonald's had to put the Happy Meal on a diet. The firm "made it clear that it was changing the composition of Happy Meals in response to parental and consumer pressure" (Strom, 2011), but McDonald's is not alone: "It and other fast-food restaurants also are facing increased pressure from local governments that are moving to impose regulations" because of the rising tide of (particularly juvenile) obesity (Strom, 2011). The previous June, Strom described political battles taking place in state legislatures, where restaurant associations were beginning to promote laws removing local jurisdictions' power to impose ordinances regulating obesity-encouraging food sales (2011b). The National Restaurant Association became concerned that "it is in the best interests of the consumer to have one uniform standard" when it comes to such regulation (Strom, 2011b). So therefore lawmakers in Ohio, Arizona, Florida and other states began embedding prohibitions into budgets and other laws in order not to "give those kinds of things [public health regulations] a chance to become a problem for the restaurant industry," according to Florida lawmaker Steve Crisafulli (Strom, 2011b).
What conclusions emerge from this review? The restaurateurs' lobby is pressing for no local legislation under the probably somewhat valid rhetoric of undue compliance cost (Strom 2011b). What neither the industry lobbying group nor Strom points out is that the lobbyists are not advocating uniform anti-obesity law, but the preemption of such law. If we use a Political Science lens called "interest analysis," constituencies begin to emerge: Who could possibly gain from obesity? Who could benefit from the absence of obesity in our society? What would happen if obesity and its related spending simply disappeared as per Hammond and Levine (2010)?
Imagine all spending on obesity treatment and acquisition ceased. Where would it go? Some people would hoard cash to be sure, but the rest of many billions in very real money not spent on obesity would go two places. That money would be spent on other goods or it would be saved (voluntarily destroyed is a possible but implausible third option). If the money that was spent on obesity was all saved, this would put the obesity industry out of business yes, but the savings would necessarily be invested in new ventures, pay down debt, or be capitalized in the form of equity to shareholders who would then spend or save it after capital gains tax. The Earth is a closed economy. All savings not hoarded in cash accrues to individuals, and this includes the savings to all public and private sector insurance and medical consumers.
If the cost of obesity magically disappeared, the remaining money in hand not saved would be spent, on something other than obesity products / services. Thus emerges our second "interest" constituency, "everyone else." Who stands to lose from obesity prevention? The obesity industry. Who stands to gain every penny of what is currently spent in that industry? Everyone else, which includes here all (medical) consumers and taxpayers. If we count the unpriced human costs of ostracism, self-denigration (Hartocollis, 2012) and other real but induced 'opportunity costs,' even including time spent legislating obesity regulation that could be spent addressing other equally valid problems, for an ironic example if there was persistent hunger in schools alongside growing obesity rates, the direct dollar savings seems perhaps a grievous understatement of this cost / potential saving/spending-somewhere-else.
Therefore one conclusion a close reading suggests is that a minority is profiting at the harm of all other producers and consumers outside their group. "We'll get you in somehow," Shani Gofman is promised when she loses her insurance (Hartocollis, 2012). This implies the question "Why do we allow people to sell harmful products?" One typical response is that they are cheaper. A rebuttal might argue this is because they shift total cost, i.e. The obesity cost caused by but not included in shelf price of trans fats in foods; the cost of unnecessary medicine, or very real costs of cloth, airplane fuel, parking space, surgical supplies and other commodities, onto all consumers in price of other goods. Those products end up not being cheaper; in fact the entire expense is unnecessary and artificial shift of wealth to the group "obesity industry" from "all other consumer-producer-taxpayers."
Therefore one recommendation to policy makers would be to make friends with the "not-obesity industry" group before their opponents do, abandon the minority special interest, and break the cycle of exploitation. McDonald's capitulation to such public pressures suggests an admission if not of guilt, then of vulnerability to and thus inability to defend equivocally against, such allegations (i.e. McDonald's is 'not-guilty'). This vulnerability is also hidden under the restaurant lobby's preemptive drive to rescind local agencies' power to pass anti-obesity law (Strom 2011), rather than advocating for enactment of a uniform anti-obesity statute.
The moment lawmakers believe they have a stronger constituency in the non-obesity industry they will go over and change the laws. This will cause temporary frictional unemployment in the short run but consumption will shift, perhaps at higher levels, hopefully to other goods that do not deliver negative public costs, or to savings, which will increase investment in other ventures without so much artificial, unnecessary and harmful 'deadweight loss' deliberately producing obesity and its satellite treatment…