The following is a response to Bloomberg columnist Ezra Klein's article, "Young, Healthy and Rich Need Obamacare, Too":

Ezra,

While I agree (as a longtime reader) with a great deal of your recent column on Obamacare, I think you are overlooking the major issues, or at least not referencing them in this piece. You wrote, “the trick to making any health-insurance system work is to attract enough healthy and young people into the insurance pool. Their low costs offset the care provided to elderly and unhealthy people, who drive costs up.”

Yes, it is true that this may help, but it won’t solve the problem. It may even perpetuate the problem by numbing people to cost increases taking place. First, how much will the young (low cost) offset the elderly and sick (high cost) when we turn right around and offer them subsidies (because they are young and poor) -which would immediately offset the offset? Math will always be math, and insurance will always make sense in that everyone pays in little by little so that they can be paid back big when they need it. But all this ignores the two real drivers of the healthcare endgame:

Buff and Turf. If you haven’t read House of God by Samuel Shem, I urge you to, and to write about it. To ‘buff and turf’ is to make sure all the charting for a patient is done in such a way as to facilitate a discharge, or a ‘turf’ to a different physician or team in the hospital. The buff and turf issue reminds me of the saying “penny wise, pound foolish.” We will never catch the runaway train of medical costs unless the pay-for-service model is eliminated- no matter how many young healthy folks we have chipping in to help pay the bills. Journalist Steven Brill tried to expose this months ago in his excellent Time article, but I haven’t heard Brill’s name mentioned since. 

Obesity. It drives me nuts that anyone would fight Mayor Bloomberg on the extra large soda argument. Anyone with a conscience knows that calories in, less calories out equals net weight gain/loss. If you spend time in the medical profession you learn quickly that obesity is a primary driver of costs, be it the frequency of medical attention necessary or the complexity added by the obesity. We are a nation of individuals free to do as we please- to sit on the couch instead of exercise, or eat McDonalds at every meal if we wish. But why stomp on the spirit of this initiative when widespread application of this idea would do far more than any small addition to the insurance denominator ever could? It is a primary driver, yet it is to a certain extent preventable, as opposed to Cancer, Alzheimer’s, etc…

I fear everything is just too divisive to talk about or solve, but you continue to fight the good fight, Mr. Klein, so thank you and good luck. The era of personal responsibility is gone, and I realize that. I realize that some individuals may not technically be at fault if left by their parents to sit around eating Doritos and playing video games to become overweight, just as they may not stand a strong chance at an education or becoming employable one day if those same parents let them ditch homework. But eventually, someone in policy needs to recognize the impact of obesity and be more successful than Michael Bloomberg at implementing common sense changes. I hate to even suggest taxing as an effective deterrent, but we’ve seen the impact of taxation on smoking rates, and while our government will never be good parents, government has shown itself to be exceptional at taxation!

Kind regards,

Jim Slade

‘Big Jim Slade’ resides in Western Massachusetts.