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Short answers, national edition: yes, but not the way health insurers want it to be.  As usual, detailed explanations are below the fold.

Short answers, local edition: Yes, most often in connection with land use planning.  Should Pleasantville use its park & recreation department funds for more soccer fields or more open space?  Should its traffic funds pay for a bike lane or a bike path?  Further discussion another day.

We will, I hope, have some form of healthcare reform by the end of this year.  Although my personal vote is for single payer (including abolition of for-profit health insurers, and most especially utter obliteration of the Evil Empire known as Anthem Blue Cross of California), all signs emanating from the Beltway show a much more incremental reform that assigns health insurers a large role.

And I don't like the ideas of America's Health Insurance Plans, the health insurers' trade group.  Maybe I just don't trust them.  However, to me, AHIP's comments on encouraging healthy lifestyles sound a lot like a variation on the theme of "privatizing the profits and socializing the losses" -- this twist being "socialize the prevention, we'll collect the profits until there are no more profits to be had."

According to AHIP, "the country" [does that mean the federal and state governments?] can support AHIP's objective of "driving higher value" [what kind of doublespeak is that?] by, among other things: "Conducting outreach to racially and ethnically diverse populations to help promote healthier lifestyles, timely preventive screenings, and appropriate medical care; and providing incentives for all patients to embrace healthy lifestyles [wait just a minute?  who provides what incentive?] and to follow their recommended treatment regimens."  

AHIP's position paper also states: "Our public health infrastructure needs to be better positioned to implement strategies that prevent or ameliorate health care concerns and promote well being and healthy lifestyles as part of health care reform.  [Again, I believe this translates as: Government should handle prevention.] We need to focus attention and allocate sufficient resources — particularly at the community level — to address significant public health issues, such as
obesity and tobacco dependence that cause an increasing prevalence of chronic illness. We advocate a new, targeted national initiative [emphasis mine] to increase public awareness of the links between preventable conditions and chronic illness and to support new and existing prevention programs in our schools, worksites, and communities. Health plans are uniquely positioned to assist in this effort and are committed to working directly with communities to promote safe and healthy living and provide models for targeted investments in public health across the country."  [I can't even translate that.] Source [pdf]

Notice that the insurers are not volunteering to do anything about prevention, awareness, or education themselves.  

A Los Angeles Times columnist is more cynical:

Briefly, the industry wants the government to assume the cost of treating the sickest, and therefore most expensive, Americans. It wants the government to clamp down hard on doctors' and hospitals' fees. And it wants permission to offer stripped-down, low-benefit policies freed from pesky state regulations limiting their premiums.

The insurers think government intervention is fine if it applies to customers they don't want. The way they put it in their reform plan is that we need a system that "spreads costs for high-risk individuals across a broader base" -- the base consisting of all taxpayers, that is.

Who are these "high-risk" individuals, by the way? At an AHIP convention last year, I heard a prominent industry consultant describe the customers the industry is desperate to dump on taxpayers as those with multiple chronic diseases, like diabetes sufferers with asthma or cancer patients with heart problems. He called these people "clinical train wrecks." (Nice way for someone connected with the "caring professions" to talk, isn't it?)

So, for people struggling with obesity, the health insurers' plan is simple: The government will educate you about obesity, but you'll pay premiums to us.  We'll clamp down hard on payments to your doctor.  When you get too sick, we'll dump you back on the government.

What kind of prevention do the health insurers want the government to advocate?  Tobacco education programs have made a difference, as generally the number of smokers has decreased.  Diet and nutrition programs haven't.  My Magic Eight Ball intuition tells me that reply hazy, ask again later the next tack to take will be exercise.  

Of course, education and prevention are very important, and I'm happy whenever people put down the remote and move their bodies.  I just don't trust anything coming out of the mouth of AHIP.  I also don't like the two extremist end-arguments: mandatory exercise and (more politically feasible) substantially higher premiums based on a "lack of personal responsibility."

Since obesity is generally perceived as a huge, preventable disease caused by poor choices in diet and exercise; since food choices are political (as orangeclouds and others have demonstrated so well); since governmental programs about diet have not stopped the obesity epidemic; and the stakes are high in health care reform, look for exercise to become political on a national level.

Originally posted to indigoblueskies on Tue Mar 10, 2009 at 05:04 PM PDT.

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Comment Preferences

  •  Tips for meaningful reform? (12+ / 0-)

    And please also check out another great diary by anotherdemocrat, Fitness Monday -- Why I Tri.  

    I'm also changing the publish time of this series to 5 pm PDT, effective this week.

    Healthy Minds in Healthy Bodies, now discussing fitness Tuesdays at 6 PM PST

    by indigoblueskies on Tue Mar 10, 2009 at 05:06:35 PM PDT

    •  I'm glad you liked my diary! (1+ / 0-)
      Recommended by:
      indigoblueskies

      I'm also leery of the AHIP. They are interested in their bottom line, not in anyone's health. Our health care system should be reformed by consumers and health care professionals. Probably retired health care professionals who sit on no boards - truly retired people.

      Btw, I did an important, if difficult thing in fitness - took a day off when needed. My ankle is irritated from yesterday, and my 5-10K class was going to do hills. I realized when I was stretching & warming up before class that hills would really, really hurt. So I picked up my yoga mat (we also do core work) and water bottle and left. I'm still fighting the impulse to go take a walk, but I know that staying off my ankle is the best thing.

      Thanks so much for this series!

      •  Take care of yourself! (1+ / 0-)
        Recommended by:
        anotherdemocrat

        A day of recovery is a good thing.  I'm near the end of training for a half marathon at the end of this month and really exhausted all the time.  The Sat. runs leave me so wiped out that I cut back on mid week x training, which I know isn't good.  

        Is Drbloodaxe still keeping his/her Sat AM series going, or did a good new year's resolution go the same way as all the others?

        Healthy Minds in Healthy Bodies, now discussing fitness Tuesdays at 5 PM PDT

        by indigoblueskies on Tue Mar 10, 2009 at 06:48:49 PM PDT

        [ Parent ]

      •  Although its a good feeling sometimes (3+ / 0-)
        Recommended by:
        sberel, HeyMikey, indigoblueskies

        to have to struggle to NOT exercise.

        Good habits are hard to break.

        I accidentally overslept on Saturday and missed my kickboxing class.  The day off was probably needed though, so I just rolled with it.  
        Lifted  twice as hard the next day. ;)

        Healthcare is a privilege? So is serving in Congress...

        by faction on Wed Mar 11, 2009 at 09:11:08 PM PDT

        [ Parent ]

    •  Yes. (1+ / 0-)
      Recommended by:
      indigoblueskies

      The creation of an excercise and health culture should be legaly mandated and funded, including resources to provided information, facilities for public excercise and excercise in public activities.

      The reason is before our eyes.

      Ask me about my daughter's future - Ko

      by koNko on Tue Mar 10, 2009 at 07:40:47 PM PDT

      [ Parent ]

    •  excellent diary; fascinating premise (1+ / 0-)
      Recommended by:
      indigoblueskies

      socialized prevention / privatized profits.  every time I think the corporateers couldn't sink any lower or be greedier, I am brought up short by a new nefarious plot like this one.

      maybe Congress should mandate that private insurance spend X#$ per insured individual for fitness or recreation facilities in their local area.

  •  I don't understand how some people think. (5+ / 0-)

    Exercise has proved time after time to improve health and ultimately reduce the health care costs.  Obesity costs the heath care system billions.

    I work for a pharma company.  And although I don't take as much advantage as I should, one of the benefits is reimbursement (up to $50/month) for fitness center membership costs.  They know that keeping us healthy is one way to insure that their costs for coverage for employees is reduced.

    This issue should be a no-brainer!

    Can someone please explain to me how there can be a "moderate" position on equality??

    by browneyes on Tue Mar 10, 2009 at 05:22:48 PM PDT

  •  That cannot work and would be foolish and stupid (4+ / 0-)

    You cannot force people to exercise. I know when I try to force myself to do anything, that is when I have the least desire to do it.  

    Exercise has to be a personal decision so that when individuals see and experience the benefits that came from exercise they congratulate themselves and then that creates a cycle of desire to exercise and fulfillment and pride from the results, which fuels desire, and so on.

    The best thing to do would be to create programs that make it easier for people to exercise, for instance free gyms open to the public.  Or, and big business would really jump on this, vouchers for club memberships.  It would be great to have bike lanes everywhere and free bike rentals around cities.  Just a few ideas.

    McCain does not support the troops

    by erin r on Tue Mar 10, 2009 at 05:54:42 PM PDT

  •  Another good argument for single payer (6+ / 0-)

    is that single payer aligns the incentives for prevention.  Under our system, just to give a single example among many, if a 55 year old is daignosed with high blood pressure, by the time it causes him to have heart disease or makes his kidneys fail, he'll probably be on Medicare, so there is no financial gain for his insurer in helping to bring his BP under control.  Ditto for obesity, type II diabetes, etc.  If everyone is in the same system across their lifespan, the system that pays for prevention gets the benefits of people being less sick.

    •  exactly, the way I see it is this: (3+ / 0-)

      we don't allow private companies to be involved in deciding who gets fire protection, who gets police protection, who is provided water or sewer because if we did many people would be denied these basic services.  The same goes for health care, it just doesn't work for private for-profit companies to be in control of making decisions about a basic right.

      Republicans like to talk about slippery slopes, so maybe they can understand that allowing business to make decisions about who should get the privilege of going to the doctor is just a slippery slope to business deciding which fires are worth putting out, who is deserving of police protection, who deserves water and waste disposal.

      The problem is, we're already on that slippery slope and we need to somehow get back up to the ledge, it can be done but it's necessary that everyone understand that is exactly what's going on.

      McCain does not support the troops

      by erin r on Tue Mar 10, 2009 at 06:12:07 PM PDT

      [ Parent ]

    •  Good point -- I hadn't thought about that (2+ / 0-)
      Recommended by:
      bushondrugs, erin r

      Healthy Minds in Healthy Bodies, now discussing fitness Tuesdays at 5 PM PDT

      by indigoblueskies on Tue Mar 10, 2009 at 06:14:02 PM PDT

      [ Parent ]

  •  Oh and the insurers are not going to (2+ / 0-)
    Recommended by:
    anotherdemocrat, indigoblueskies

    volunteer to do sh*t.  To expect more of them would be wishful thinking, they are by nature self-protecting enterprises that will do anything in their means to maintain the status quo, which is to continue to rip off the American public.

    What the insurance companies want is completely opposite of what the country needs.  

    I'm not saying we should go to other extreme, but things need to be fairer.  The insurance companies should not be as strong and big and greedy as they are.  And Americans need to have their rights stood up for by our elected officials.

    McCain does not support the troops

    by erin r on Tue Mar 10, 2009 at 06:02:28 PM PDT

  •  Here, let me translate that for you: (2+ / 0-)
    Recommended by:
    churchylafemme, indigoblueskies

    Our public health infrastructure needs to be better positioned to implement strategies that prevent or ameliorate health care concerns and promote well being and healthy lifestyles as part of health care reform.

                                  =

    Happy Horseshit we pulled directly out of our butts.

  •  You've Been Rescued (3+ / 0-)
    Recommended by:
    sberel, HeyMikey, indigoblueskies

    "What the cynics fail to understand is that the ground has shifted beneath them"

    by ItsJessMe on Wed Mar 11, 2009 at 08:21:38 PM PDT

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