2007-11-19 00:00:00

NY Times Magazine: Conspicuous (Healthcare) Consumers vs. the Categorically Needy

Did anyone notice how yesterday’s New York Times Magazine juxtaposed two of the greatest problems facing the healthcare industry and the U.S. population as a whole — the country’s rampant obesity problem and the 47 million uninsured Americans?

In The Stomach-Surgery Conundrum, Freakanomics authors Stephen J. Dubmer and Steven D. Leavitt ponder the rationale of thousands of obese Americans opting for expensive bariatric surgery despite the physical and psychological complications and replacement addictions that may result.

There are at least two ways to think about the rise in bariatric surgery. On the one hand, isn???t it terrific that technology has once again solved a perplexing human problem? Now people can eat all they want for years and years and then, at the hands of a talented surgeon, suddenly bid farewell to all their fat. There are risks and expenses of course, but still, isn???t this what progress is all about?

On the other hand, why is such a drastic measure called for? It???s one thing to spend billions of dollars on a disease for which the cause and cure are a mystery. But that???s not the case here. Even those who argue that obesity has a strong genetic component must acknowledge, as Bessler does, that ???the amount of obesity has skyrocketed in the past 30 years, but our genetic makeup certainly hasn???t changed in that time.???

So the cause is, essentially, that people eat too much; and the cure is, essentially, to eat less. But bariatric surgery seems to fit in nicely with the tenor of our times. Consider, for instance, the game shows we watch. The old model was ???Jeopardy!,??? which required a player to beat her opponents to the buzzer and then pluck just the right sliver of trivial knowledge from her vast cerebral storage network. The current model is ???Deal or No Deal,??? which requires no talent whatsoever beyond the ability to randomly pick a number on a briefcase.

In stark contrast in the same issue are emotive photos accompanying the article “Patients Without Borders” by Sara Corbett. The article/photo essay describes the efforts of Remote Area Medical (RAM) — a corps of volunteer dentists, doctors, nurses, hygienists and X-ray technicians. Normally deployed to thirld world nations, they are spending increasing amounts of time tending to the uninsured in this country.

The setting for the article was a three-day period this summer when RAM treated more than 2,500 patients who had lined up for care beginning at 3 a.m. Working in animal stalls and makeshift tents on a fairgrounds in Appalachia, Virginia, the corps had to turn away several hundred more from this medically underserved population.

Imagine the good that might result if future candidates for bariatric surgery modified eating behaviors and rerouted some of those billions toward the uninsured population. Then perhaps we’d all sleep better. (That, by the way, was the subject of a third article in the NY Times Magazine.)

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