health insurance does not equal health

Tuesday, August 1, 2017

Dear Politicians. Let me ask a question. If every person in our country had health insurance, would we be any healthier?

-Mark Cuban. Twitter. 7/30/2017

Dear Mark,

Thank you for such an insightful question. Unfortunately, I am not a politician and cannot provide you their perspective, but I do care for patients on weekends, in the middle of the night and whenever they perceive an emergency to exist.  And I wish that I had a satisfying and uplifting answer toyour question. But I do not. The reality is that health insurance and access to health care does not equate to health. This is not an opinion based upon fact but instead, from anecdotal personal experience and bolstered by a few cherry-picked statistics.

Ideally, access to health education and disease prevention would begin before birth and continue through childhood and adolescence so that each person was delivered to adulthood with the best chance of living a healthful life. The concept that health insurance availability alone will reach such a goal fails to account for societal ills and governmental agency policies that are add odds with providing a highway to healthy adulthood.

Beginning with pregnancy, there are too many unlucky babies born to mothers who abused alcohol, opioid narcotics or tobacco during pregnancy. The numbers can be staggeringly high.

  • 21,700 babies were born in 2013 (latest statistics available from the CDC) with neonatal abstinence syndrome, where the newborn goers through narcotic withdrawal because of the mother’s drug abuse. Short term complications include poor growth, dehydration and seizures; the long-term problems are uncertain since there is not enough data yet available.
  • Fetal alcohol spectrum disorder affects between 0.2% and 1.5% of all births in the US. In 2002, the lifetime cost per infant was more than $2 million and a yearly cost to the health care system of more than $4 billion.. In some western European countries, the incidence of fetal alcohol syndrome can be as high as 5%. It seems that universal healthcare can’t stop the adverse effects of alcohol abuse.
  • 10% of mothers smoke during the last 3 months of pregnancy. This affects placenta development and can lead to premature deliveries and low birth weight babies. Other issues include congenital heart problems and cleft lip. There is also increased numbers of asthma, pneumonia and SIDS (sudden infant death syndrome)

Tobacco continues to rear its ugly head in teenage years, when most people begin smoking. More than 90% of people have their first cigarette before age 18. Each year more than 450,000 people die from smoking related deaths, from cancer to heart attack and stroke, to COPD and emphysema.

“The overwhelming amount of death and disease attributable to tobacco is caused by addiction to cigarettes – the only legal consumer product that, when used as intended, will kill half of all long-term users,” – FDA Commissioner Scott Gottlieb

And not to be forgotten, the cost of alcohol abuse in lives lost and broken. More than 10,000 people die each year as victims of a drunk driver. 1.1 million people were arrested for drunk driving. In Wisconsin, known for its beer and binge drinking, there were more than 5,100 alcohol related crashes in 2015, resulting in 2,872 injuries.

US obesity rates have increased to affect nearly 40% of all adults and 17% of all children. Complications include heart attack, stroke, diabetes, sleep apnea and cancer.

Mr. Cuban, you’ve asked a profound question. Regardless, of how many people have health insurance, there is no guarantee that they will pursue a healthy lifestyle. The question then might be asked whether personal choice should affect access to the full spectrum of possible health care available. Most recently, one health authority in England has decided to withhold elective major surgery from people who are morbidly obese or who smoke.

When Congress debates the merits of one health insurance system over another, they forget to consider perhaps the most important intangible. There is an unlimited and insatiable demand for health care and unless society is willing to pay for it all, one day, choices will have to be made about who gets what care.  Welcome to the world of rationing.




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competitive gluttony and obesity

Monday, July 6, 2015

The Fourth of July is all about celebration. There are picnics, parades, fireworks and sport. While baseball is the all American sport and the country rallied behind the Women’s World Cup victory, perhaps nothing epitomizes the American spirit like the Nathan’s annual hot dog eating contest. Gluttony may be a deadly sin but it is also major programming for ESPN, the network that live broadcast the competition and aired replays over its numerous outlets. The winner, Matt Stonie, ate 62 hot dogs (including buns) in the 10-minute contest, and to make certain that equality has arrived to competitive eating, there was a women’s division, with Miki Sudo crowned champion after consuming “only” 38 dogs. Unlike Wimbledon, there was no junior division.

It should come as no surprise that the American public embraces competitive gluttony. Two thirds of the adults in this country are overweight and one third qualifies as obese. Overweight describes excess weight that comes from muscle, bone, fat or water. The excess weight in obesity all comes from fat. There is no benefit to obesity. It increases the risk of high blood pressure, high cholesterol and diabetes leading to more heart attacks and stoke. The skeleton of the body is also not well adapted to carry extra weight and that leads to muscle and joint problems including joint and back pain, arthritis and degeneration.

There is no single cause for the epidemic of obesity and there is no single approach that can be recommended or prescribed for prevention and treatment. Some who are obese look for an “easy” answer in a pill or through surgery, but it takes a lifelong combination of diet and exercise to control weight. Food, especially empty calories, are readily available and these empty calories are especially prevalent in poorer neighborhoods where food desserts are the norm and healthy eating alternatives are not available.


When it comes to weight loss, it’s all about the math…sort of. A pound of human fat contains 3,500 calories. A calorie is a unit of energy. Eat more than you burn and weight is gained, eat less and the weight comes off. In obese people, that weight loss will likely come from fat, with a smidge of water loss thrown in. Cutting carbohydrates means forces the body to used stored glycogen for energy and that releases a little water that gets peed out. Add protein and exercise and there may be increase in muscle mass, which is a good thing, but that may mean that the weight loss slows just a little. As the body gets closer to ideal body weight, some of that weight loss will come from muscle, as the body tries to retain some fat, just in case famine strikes.

The body is a machine and requires a certain amount of energy intake to function. If there is a calorie deficit, the body uses its energy stores to make up the difference. Weight loss takes dietary control and all food is not created equal. A glazed donut from Krispy Kreme contains 190 calories, while one from Dunkin Donut rings at 260 calories.

It takes effort to lose a pound of fat. A mile of walking or running will burn roughly 100 calories. It doesn’t matter how fast that mile distance is covered; the calorie burned is the same. Moving faster increases cardiovascular performance and allows more distance to be covered in the same amount of time. More distance equals more calories burned. All things being equal, and if food intake remains the same, walking an extra mile a day (about 2,000 steps), will result in a 10-pound weight loss in a year.

Weight control is a national obsession but a frustrating one. Good intentions can be waylaid by a few moments of indiscretion. The few minutes at the Nathans’ hot dog eating contest that crowned Matt Stonie champion, cost him more than 15,000 calories or almost 5 pounds. And we celebrate gluttony for why?

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