Jewish World Review Oct. 24, 2003 / 28 Tishrei, 5764

Drs. Michael A. Glueck & Robert J. Cihak

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Want health service — go on a diet?


http://www.NewsAndOpinion.com | Some might call it a symbiosis. We call it a racket: Professional medical worrywarts find or manufacture a problem, label it a crisis, then demand that the government take action.

For example, who's responsible for medical consequences of obesity? You? Or a government health authority?

The British Labour Party wants to do something about government spending on obese Brits. And what they want to do gives new meaning to that old adage "Any government that's big enough to give it to you is big enough to take it away."

A headline in a recent issue of the Times of London read "Fat people will have to diet if they want to see the doctor." The author, political correspondent Melissa Kite, writes:

"Overweight people and heavy smokers would have to sign contracts promising to diet or give up cigarettes in return for treatment, under radical new plans being drawn up by Labour. The [London] Times reports that written contracts would set out the patient's responsibilities while offering them help to cut down or quit smoking, lose weight, take more exercise or eat a more nutritious diet. Those who fail to keep their side of the bargain" could be denied government-provided care.

The policy documents outlining the plan "will be debated at the party conference agreed to occur in 2004 and will form the basis of the next election manifesto."

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Unlike American Medicare recipients and the doctors treating them, British NHS patients and doctors are free to seek and provide medical treatment privately, outside the strictures of the government-provided NHS. So, when even this draft (or shall we say daft?) Labour Party document describes the National Health Service (NHS) as a "free, yet finite service" and that "Labour intends to stop wasting care resources," perhaps there is hope that humane sanity is creeping back into the debate.

Let's consider how such a system might work in America. We could take those who are "overweight" and not take care of them. One recent study claims that 20 percent of Americans are overweight and that 2 percent are morbidly obese, i.e., 100 pounds or more overweight.

Starting with about 300 million Americans, 20 percent would be 60 million. If government health programs currently cover half of these presumed fatsoes, and if half of the covered ones didn't follow the government-prescribed program adequately enough to please their medical/government inquisitors, we'd have 15 million recalcitrant fatties off the government health lists, eliminating over $50 billion of what the British Labour Party draft writers would presumably call "wasted resources."

While we're at it, we might also deny care to smokers who develop tobacco-related illnesses ... or at least stop them from collecting millions in lawsuits where they blame others for their self-inflicted predicaments.

But is there really an obesity crisis? Recently, syndicated columnist Paul Campos attended an obesity meeting in Boston. Noted Campos on Oct. 12, "Boston University's Knight Center hosted an all-star lineup of obesity researchers who gathered to promote their belief that fat is an epidemic disease. ..."

He also notes that "many doctors, scientists, eating disorder specialists, sociologists and other experts argue that these beliefs are profoundly mistaken and counterproductive. Yet ... such persons rarely participate in these sorts of conferences."

In other words, only the people who believe in the fat epidemic bother to show up to discuss the issue. This makes sense: For the non-believers, or for those who believe that public health epidemic control tactics won't work, it's a non-issue.

We agree with the latter group. Too many public health specialists see their public health knowledge the same way a 3-year-old boy with a hammer sees the world: Everything's a nail.

These discussions do betray the logical endgame of those elitists who not only believe they know more than you do but also believe that their mission in life is to tell you - nay, force you - to live your life they way they think is best.

The "problem" of allocating all our national resources is only a problem if someone can control all our resources. For example, there's no problem with our national shirt resources, which range from T-shirts to dress shirts, because no one can control all our shirt sources, short-sleeved or otherwise. Fortunately, not many people want to.

Who decides what medical care - or shirts - you should get? We believe it should be you, using your own resources and resourcefulness, not a health care dictator.

Who should reduce - or not reduce - their weight: That is the personal medical question. Would Americans tolerate the outrageous fortune of incentives proposed by the Brits?

Americans long ago learned that busybodies with power, such as George III, turn into dictators. That's why the American colonies broke away from his control and created a limited rather than all-powerful government. And that's why Americans are likely to continue to turn away from medical elite busybodies with their entourage of necessarily heavy-handed government control to personal responsibility and personal allocation of resources.

Rationing begins in the family - and should end in the family. Decisions about buying health insurance and medical care should be family - not government - decisions. Charitable institutions are secondary sources of support. Any government medical program should be much more sharply focused than our current Medicare and Medicaid programs.

As even the British Labour Party implicitly acknowledges, government control and provision of "free" medical care is very expensive and leads to great waste of resources.

So, rip up and burn the central-control drawing board and roast marshmallows on the fire.

And by the by, how would you like to be - and what would you think of - a physician who must refuse to treat a sick patient because he lost only 10 pounds instead of the mandated 20?

And what would you think of a physician who defied the government (and went to prison) to treat him?




Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a past president of the Association of American Physicians and Surgeons and a Discovery Institute honorary fellow and board member. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.

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