The intensity of the opposition to health reform in the United States continues to shock and perplex proponents of the Patient Protection and Affordable Care Act. The emotion and the apocalyptic rhetoric, render civil and evidence-based debate over the implications and alternatives to specific provisions in the law difficult if not problematic. The public debate has largely barreled down two non-parallel yet non-intersecting paths: opponents focus on their fear of government expansion in the future if PPACA is implemented now, while (...) proponents focus on the urgency and specifics of our health care market problems and the limited number of tools we have to address them. Frustration on both sides has led opponents to deny the seriousness of our health system’s problems and proponents to ignore the risk of governmental overreach. These non-intersecting lines of argument are not moving us closer to a desired and necessary resolution. (shrink)

The issues before the Supreme Court, arising as they did out of multiple cases and divergent appellate court rulings, were quite complex, and its final decision will be parsed rather differently by lawyers, health policy wonks, and economists (or metaphysical philosophers, in Chief Justice John Roberts's memorable phrase). This essay will focus on one singular element: did the final ruling enhance or detract from our collective power to exercise stewardship over our health care resources? -/- Clearly Americans diverge on key (...) features of a desirable society and on the wisdom of using government to achieve even mutually desirable goals. But before politics settles the fate of the Affordable Care Act (and perhaps also the federal role in health policy for the foreseeable future), we should focus on what the Court has allowed us to consider: if we want it to, federal power may constitutionally be marshalled to compel insurers to end discrimination against the sick and to offer more transparent products so the marketplace will better serve consumers. (shrink)

Obesity is a particularly vexing public health challenge, since it not only underlies much disease and health spending but also largely stems from repeated personal behavioral choices. The newly enacted comprehensive health reform law contains a number of provisions to address obesity. For example, insurance companies are required to provide coverage for preventive-health services, which include obesity screening and nutritional counseling. In addition, employers will soon be able to offer premium discounts to workers who participate in wellness programs that emphasize (...) behavioral choices. These policies presume that government intervention to reduce obesity is necessary and justified. Some people, however, argue that individuals have a compelling interest to pursue their own health and happiness as they see fit, and therefore any government intervention in these areas is an unwarranted intrusion into privacy and one's freedom to eat, drink, and exercise as much or as little as one wants. This paper clarifies the overlapping individual, employer, and social interest in each person's health generally to avoid obesity and its myriad costs in particular. The paper also explores recent evidence on the impact of government interventions on obesity through case studies on food labeling and employer-based anti-obesity interventions. Our analysis suggests a positive role for government intervention to reduce and prevent obesity. At the same time, we discuss criteria that can be used to draw lines between government, employer, and individual responsibility for health, and to derive principles that should guide and limit government interventions on obesity as health reform's various elements (e.g., exchanges, insurance market reforms) are implemented in the coming years. (shrink)

The obesity epidemic is not only impairing the health of millions of Americans but also giving rise to billions of added dollars in health care spending. Climbing rates of obesity over the past decades are one of the predominant determinants behind the surging progression of health care expenses in the United States. Moreover, the less fit and less productive U.S. workforce has gradually eroded the nation’s industrial competitiveness. Since the early 1970s, adult obesity rates have doubled and childhood obesity rates (...) have more than tripled, while health expenditures have risen two percentage points faster than the Gross Domestic Product, burgeoning from 8.8 percent in 1980 to a projected 17.9 percent in 2011. Studies analyze that greater than a quarter of America’s health care expenses are attributed to obesity. The stunning growth in obesity has been imputed for 20 to 30 percent of the increase in health care costs since the late 1970s. If the proportion of obese population had stayed unchanged, then health care expenditures in America would be approximately 10 percent less on a per capita average than they are today. (shrink)

This essay makes the affirmative case for health reform by expounding on three fundamental points: one moral case for expanding access to coverage and care to all is grounded in scriptural concepts of community and mutual obligation which continue to inform the American pursuit of justice; the structure of PPACA springs from an appreciation of and approach to channeling market forces that was developed and proposed by a coalition of moderate and conservative Republican U.S. senators almost 20 years ago; the (...) most humane path to a better and more sustainable health system lies in implementing PPACA as fast and fully as we can. The purpose of this essay is to articulate why it is not possible to make our health system better, sustainable and serve us all without government playing specific and limited but absolutely crucial catalytic roles. (shrink)