The problem with leaving people alone regarding their food choices is that we socialize the cost of treating our citizenry's health problems. As our population ages, and available technology for dramatic intervention continues to increase, paying for health care will suck the dollars out of all other social purposes. Remember, right now, 70 percent of health care expenditures goes towards the maladies of only 10% of the patients--and because half the population isn't sick in any given year, this money is being used to treat 5% of the population. This group is currently absorbing $1.4 trillion dollars a year in health care, or roughly $100 K per head. Technology is driving the cost of treatment up around 1% a year (i.e., controlling for the growth of the population and inflation). What will happen if the high cost patient pool expands beyond 5% of the population to say all of...10% because of bad eating habits and aging? Governmental insolvency? National bankruptcy?

It's possible Brad DeLong is right--if we continue to socialize our health care expenses (that is, tax everybody to pay for healthcare that will inevitably chiefly benefit the sickest fraction of the population)--we may have no choice other than to enforce nanny-state rules on restaurants and food producers to minimize the size of that highly ill group. Along with, no doubt, a bunch of other fairly draconian restrictions on treatment options, with ill patients and their families screaming every foot of the way. It ain't a pretty picture, no matter how you look at it.

Posted by: Friedrich von Blowhard on March 25, 2007 9:54 AM

I like both Bourdaine and Ray. Okay, she's a bit too perky. But there's something about her that bugs Bourdaine. Real animus. I don't get it.

Bourdaine made another great comment about food and fear: "Eating a little dirt never killed anyone."

Posted by: ricpic on March 25, 2007 10:09 AM

FVB: A miserable sick old age is about 75% gene related and 25% lifestyle (partly eating habits) related. So even if it were possible to legislate eating habits the payoff in reduced health costs would be questionable, maybe marginal.
Nature trumps nurture: if not everytime, most of the time.

Posted by: ricpic on March 25, 2007 11:36 AM

So, FvB, to cure one gaping state interference (nationalised healthcare) you propose another - regulation of eating habits of population?

Wouldn't it be more logical if we request the state to stay the hell out of healthcare and stop taxing us for our own good instead?

Posted by: Tatyana on March 25, 2007 2:01 PM

Tatyana--

I'm open to the idea, but...what do you think the odds are that the state will listen?

Posted by: Friedrich von Blowhard on March 25, 2007 2:58 PM

It's not like government financed medicine is some radical new social experiment that we have no experience with. France, along with every other Western European county, has socialized medicine. And they have less, not more, nanny-state regulation of restaurants, smoking, etc. So I'd say there isn't any evidence that one leads to the other.

Also, it is completely unclear to me which will reduce health care costs more over a lifetime -- being overweight and dropping dead of a nice clean heart attack at 55, or living on to a ripe old age and having cancer or whatever at 90. We all die, it's only a question of what gets you in the end and how expensive it is to treat.

Posted by: MQ on March 25, 2007 6:27 PM

Have you tried talking to them?
The monster is enormous, but David dared to fight him...

Posted by: Tatyana on March 25, 2007 6:39 PM

Dear FvB:

Twenty years ago, my rheumatologist explained the medical costs dilemma simply and clearly: most of the money is spent on people at the beginning and end of the life cycle who have extreme conditions - preemies and other infants born with horrible congenital disorders and at the other end, seniors dying from end-stage renal failure.

What needs to be discussed, but is anathema to most people and suicide for any politican is whether we should abandon our belief that one's life must be maintained for as long as possible without regard to the quality of life or the cost.

Posted by: Peter L. Winkler on March 25, 2007 6:47 PM

At least Rachel Ray is cute. I find her energy and enthusiasm sexy.

Bourdain is a one-trick pony whose act has ossified into that of a faux tough guy. His idea of outre is to go visit an absinthe bar. Exciting and new!

Posted by: Peter L. Winkler on March 25, 2007 7:40 PM

I have to admit that I'm stunned that anyone can hear Rachael Ray say "EVOO" without feeling an urge to strangle her.

Friedrich, Florence King said that whenever people quote the statistics about the amount of medical resources devoted to the sickest few, there is a certain "die, damn you" undertow to the conversation. Calls for restricting certain foods (always McDonalds, not creme brulee or Joel Robuchon's potato puree ) seem driven mostly by horror at the disgusting habits of the unwashed masses, with medical bills as the excuse.

Posted by: CyndiF on March 27, 2007 11:39 AM

CyndiF--

That's a pretty vivid way of putting the issue, but possibly not the last word on the subject. There is an enduring question of just how many resources can or should be brought to bear for any given citizen. You'll admit that it's a little schizophrenic to have the government draft millions of healthy young men in WW2 (sending thousands to deaths that were premature by many decades) and then turn around and claim that it is impossible, simply impossible to limit the resources that should be lavished on a sick, elderly patient with a possible life span measured in months.

In any event, that isn't actually what I was getting at--I was just repeating (and amplifying) a comment by Brad DeLong that the increasing cost and capability of medical technology would almost certainly create strong incentives toward nanny-state-ism. One area that we are likely to see this has to do with food, especially, one suspects, packaged food.

Posted by: Friedrich von Blowhard on March 27, 2007 8:49 PM

Tough talk from healthy people. I'd pay attention if you were sick and still felt the same. In fact, if you do get sick, please stand by your principles and refuse any expensive care.

Posted by: the patriarch on March 28, 2007 12:43 AM

Yes, my response was a bit vivid, but that's hard to avoid when quoting Florence King. And I agree that it's a tremendously complicated question, how much effort to devote to the most ill, and that such questions will inspire calls for nanny-state intervention. My point was that, just as when Al Gore lectures on the environment, what makes many recoil is a sense that unstated passions are driving the proponents harder than the stated ones.

Nevertheless, I believe my point about Rachael Ray stands. Woman has the effect of nails on a blackboard. Yum-O!

Posted by: CyndiF on March 28, 2007 8:05 AM

Patriarch:

Were you addressing your comment about tough talk to me? I missed the part where I was advocating any course of action. I was simply discussing the likely future outcome of existing trends. Am I not supposed to notice a looming problem?

Actually, in some ways, I would suggest that the high concentration of medical spending is a boon; it makes it very, very likely that it is possible to significantly economize on the care of such people. And remember, a mere 10% reduction in the cost of their care (something that I'm confident can be achieved without the slightest negative impact on the quality of care delivered) would save $140 billion a year--approximately twice as much as it would cost to insure all of America's medically uninsured.

In any case, I recommend you develop a tolerance for tough talk about medical cost containment; another prediction I feel highly confident of is that you'll be hearing far more of it, not less, in the future.

Posted by: Friedrich von Blowhard on March 28, 2007 12:06 PM






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