Conversation about pet insurance

Friend 1: You're playing with fire if you don't have pet insurance.

Me: When my dog Dignan was under my sole care, I carried an alternative version of pet insurance that was totally free.

It was the belief that he could either tough out his expensive injuries or risk being put to sleep.

It's called the "What Our Parents, Grandparents, and All Other Ancestors Did For Doggy Health Care" Plan.

[fast forward a couple months and topic of pet insurance comes up again]




Friend 2: After spending as much time as I have with my girlfriend and her her dog, I remember what dog ownership is like. I take back my statement about thinking Kendall's method of insurance was funny. I want to buy insurance for this dog already.

Me: It's not supposed to be funny.

Dignan has cost me (and now my sister) nothing but food and a couple shots since I got him almost four years ago. I love him dearly but am also aware that dogs are much better adapted to living with discomfort and pain. If something happened to him that made him uncomfortable, I would wait for the problem to clear up on its own. If it got worse, I would probably bite the bullet and take him to the vet. If it was an overly expensive problem to fix, I would have to weigh the costs v. the benefits of getting him fixed.

Basically, I wouldn't spend much money on making the dog merely less uncomfortable, nor would I spend a lot of money on extending the dog's life when a dog doesn't live very long to begin with. It may sound callous, but it seems ridiculous to me to spend a lot of money on a non-human. Call me an asshole, but I'd rather put the dog to sleep, be really, really sad for a few days and then just get a new dog, which is actually a really fun thing to do, than be milked monthly by an insurance company or dump money down the never-ending hole known as a dog with health problems.

Friend 3: You have no soul.

Friend 4: You have no soul for real.

Me: If I had no soul, I wouldn't be sad about doing it. Knowing when it's time to let go of your dog doesn't mean you loved it any less. To me, pet insurance is another example of the wussification of America, or perhaps more accurately an example of America's crippling fear of death.

I guess I'm just more comfortable with death and with a dog's place in the food chain. People these days seem to think that dogs are actual family members or something and that if they spend enough money on their dogs, they'll live forever. No matter how much money you spend on your dog, he or she will not live longer than 10 or maybe 15 years. If it makes you feel better to spend thousands on insurance and deductibles over the years to cover reconstructive surgery and physical therapy and whatever else, go for it. But don't attack me because I'm comfortable with getting a couple extra opportunities over the course of my lifetime to pick out new puppies that will not spend their lives in traction, casts, and those dumb neck cones.

Friend 4: I get what your saying, Kendall, but regardless, I'm willing to spend 20 bucks a month to potentially save me from one of those decisions.

Me: Even if you completely reject my argument that we have gone too far in humanizing our pets, why pay an insurance company who will charge you a deductible and potentially 10 to 20 percent of the costs and most likely do everything in their power to reject your claim? I would probably go ballistic the first time I heard the words "policy limit" or "pre-existing condition" at the vet's office. Why not put $20 per month in an interest-bearing account and then use that to pay for the dog's vet bills if and when they come up?

*****

Check out this article on how pet names are becoming more human.

Senators oppose Know Your Farmer Program

Pat Roberts, from my home state of Kansas, believes that small farmers are rich hobbyists and not worthy of our support. He would rather we continue to give billions to the large conventional corporations that are making us fatter by the minute.

I wrote Senator Roberts to tell him how much his letter upset me.

Democrats fail at setting the agenda again

I read this great editorial in the New York Times by David Brooks about the Big Government War waging right now in which he said one of the biggest failings of the Democratic Party is that they're more concerned with winning arguments than deciding what they arguments will be. Or maybe more that the Democrats don't understand what the public perception will be of their agenda. For instance, the debate about health care was not really about health care itself but more about big government v. small government. We all have seen how well that worked out for them.

So my question is this: If the Democrats had sought to reform the food system, which I believe would have helped treat one of the real causes of the health care crisis, would we still be having the Big Government debate? Food reform probably would have required a reworking of the Farm Bill, which amounts to billions of dollars in spending by the Federal Government. In that case, Democrats would actually be taking on misguided government spending rather than increasing it. I'm guessing we would have heard from Palinites that elitist Democrats were declaring war on farmers, but would the Democratic party be in the free fall it is in now if they had picked a different agenda?

Bonus question: Would the backlash have been better or worse if Obama had tried to reduce government spending by scaling back the military and the Wars in Iraq and Afghanistan?

Part Two in AgLaw/BioLaw's series on the FDA

I tried to put up a comment last week asking the author what she thought about the rather tenuous link between high cholesterol and heart disease, but it wasn't approved. That's splitting hairs, though, because the point is not whether high cholesterol really does cause heart disease but whether products can claim that they can lower your cholesterol without subjecting themselves to FDA regulation.

http://aglaw.blogspot.com/2009/09/post-two-of-series-relationship-between.html

Tuesday, September 22, 2009

Post Two of a Series: The Relationship Between the Level of Regulation under the FDCA and the Health Status of a Product’s Targeted Population

The first post of this series began by asking whether functional foods should be regulated as drugs if they claim to treat abnormal health conditions. For example, was it appropriate for the FDA to characterize Cheerios as a drug as a result of its advertising claim that “you can Lower Your Cholesterol 4% in 6 weeks?” An abnormally high level cholesterol level is a serious risk factor for disease and those with high cholesterol levels are in an abnormal state of health. By virtue of its claims to help this group of unhealthy consumers with their struggle to return to a normal state of health, should the manufacturer of Cheerios be required to undergo the FDA's premarket approval process to show that eating Cheerios is effective in lowering cholesterol as claimed?

The answer to this question may become more apparent by looking at another category of products that claim to help unhealthy people return to a normal health status – weight loss products.

Click here to read the rest.

Pollan on health care reform

Why forcing health insurance companies to stop denying coverage on the basis of chronic diseases or pre-existing conditions could help turn the tide on reforming the farm bill.

http://www.nytimes.com/2009/09/10/opinion/10pollan.html?pagewanted=1&_r=1&ref=opinion

Big Food vs. Big Insurance

By MICHAEL POLLAN
Published: September 9, 2009

Berkeley, Calif.

TO listen to President Obama’s speech on Wednesday night, or to just about anyone else in the health care debate, you would think that the biggest problem with health care in America is the system itself — perverse incentives, inefficiencies, unnecessary tests and procedures, lack of competition, and greed.

No one disputes that the $2.3 trillion we devote to the health care industry is often spent unwisely, but the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained, as a study released last month says, by our being fatter. Even the most efficient health care system that the administration could hope to devise would still confront a rising tide of chronic disease linked to diet.

That’s why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry.

According to the Centers for Disease Control and Prevention, three-quarters of health care spending now goes to treat “preventable chronic diseases.” Not all of these diseases are linked to diet — there’s smoking, for instance — but many, if not most, of them are.

We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care.

The American way of eating has become the elephant in the room in the debate over health care. The president has made a few notable allusions to it, and, by planting her vegetable garden on the South Lawn, Michelle Obama has tried to focus our attention on it. Just last month, Mr. Obama talked about putting a farmers’ market in front of the White House, and building new distribution networks to connect local farmers to public schools so that student lunches might offer more fresh produce and fewer Tater Tots. He’s even floated the idea of taxing soda.

But so far, food system reform has not figured in the national conversation about health care reform. And so the government is poised to go on encouraging America’s fast-food diet with its farm policies even as it takes on added responsibilities for covering the medical costs of that diet. To put it more bluntly, the government is putting itself in the uncomfortable position of subsidizing both the costs of treating Type 2 diabetes and the consumption of high-fructose corn syrup.

Why the disconnect? Probably because reforming the food system is politically even more difficult than reforming the health care system. At least in the health care battle, the administration can count some powerful corporate interests on its side — like the large segment of the Fortune 500 that has concluded the current system is unsustainable.

That is hardly the case when it comes to challenging agribusiness. Cheap food is going to be popular as long as the social and environmental costs of that food are charged to the future. There’s lots of money to be made selling fast food and then treating the diseases that fast food causes. One of the leading products of the American food industry has become patients for the American health care industry.

The market for prescription drugs and medical devices to manage Type 2 diabetes, which the Centers for Disease Control estimates will afflict one in three Americans born after 2000, is one of the brighter spots in the American economy. As things stand, the health care industry finds it more profitable to treat chronic diseases than to prevent them. There’s more money in amputating the limbs of diabetics than in counseling them on diet and exercise.

As for the insurers, you would think preventing chronic diseases would be good business, but, at least under the current rules, it’s much better business simply to keep patients at risk for chronic disease out of your pool of customers, whether through lifetime caps on coverage or rules against pre-existing conditions or by figuring out ways to toss patients overboard when they become ill.

But these rules may well be about to change — and, when it comes to reforming the American diet and food system, that step alone could be a game changer. Even under the weaker versions of health care reform now on offer, health insurers would be required to take everyone at the same rates, provide a standard level of coverage and keep people on their rolls regardless of their health. Terms like “pre-existing conditions” and “underwriting” would vanish from the health insurance rulebook — and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change.

The moment these new rules take effect, health insurance companies will promptly discover they have a powerful interest in reducing rates of obesity and chronic diseases linked to diet. A patient with Type 2 diabetes incurs additional health care costs of more than $6,600 a year; over a lifetime, that can come to more than $400,000. Insurers will quickly figure out that every case of Type 2 diabetes they can prevent adds $400,000 to their bottom line. Suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits.

When health insurers can no longer evade much of the cost of treating the collateral damage of the American diet, the movement to reform the food system — everything from farm policy to food marketing and school lunches — will acquire a powerful and wealthy ally, something it hasn’t really ever had before.

AGRIBUSINESS dominates the agriculture committees of Congress, and has swatted away most efforts at reform. But what happens when the health insurance industry realizes that our system of farm subsidies makes junk food cheap, and fresh produce dear, and thus contributes to obesity and Type 2 diabetes? It will promptly get involved in the fight over the farm bill — which is to say, the industry will begin buying seats on those agriculture committees and demanding that the next bill be written with the interests of the public health more firmly in mind.

In the same way much of the health insurance industry threw its weight behind the campaign against smoking, we can expect it to support, and perhaps even help pay for, public education efforts like New York City’s bold new ad campaign against drinking soda. At the moment, a federal campaign to discourage the consumption of sweetened soft drinks is a political nonstarter, but few things could do more to slow the rise of Type 2 diabetes among adolescents than to reduce their soda consumption, which represents 15 percent of their caloric intake.

That’s why it’s easy to imagine the industry throwing its weight behind a soda tax. School lunch reform would become its cause, too, and in time the industry would come to see that the development of regional food systems, which make fresh produce more available and reduce dependence on heavily processed food from far away, could help prevent chronic disease and reduce their costs.

Recently a team of designers from M.I.T. and Columbia was asked by the foundation of the insurer UnitedHealthcare to develop an innovative systems approach to tackling childhood obesity in America. Their conclusion surprised the designers as much as their sponsor: they determined that promoting the concept of a “foodshed” — a diversified, regional food economy — could be the key to improving the American diet.

All of which suggests that passing a health care reform bill, no matter how ambitious, is only the first step in solving our health care crisis. To keep from bankrupting ourselves, we will then have to get to work on improving our health — which means going to work on the American way of eating.

But even if we get a health care bill that does little more than require insurers to cover everyone on the same basis, it could put us on that course.

For it will force the industry, and the government, to take a good hard look at the elephant in the room and galvanize a movement to slim it down.

How does food policy relate to health care?

Check out this editorial on Civil Eats. Paula Crossfield argues that all this health care hullabaloo really misses the mark. While liberals and conservatives are arguing about socialism and single payer systems and all this other crap that we can't understand from the proposed bill anyway, nobody has bothered to ask what's making us sick in the first place.

Why are people unhealthy? For those who see our food system as the magic bullet, the answer is pretty obvious. And while the food system is the number one contributor, bad urban planning is a big part (see Public Space). And Crossfield makes a great point about how financially dependent we are on The System and how that hurts our overall health.

Higher education is so expensive now that workers are bound to their workplace because of massive debt, feeling compelled to overwork in order to keep their health insurance, and therefore are too exhausted to cook. It’s all related.

The greatest strength of Crossfield's article is that she points out Obama's greatest weakness so far*: his inability to get the lobbyists out of Washington. Definitely no small task, but his pre-election rhetoric on this point was pretty strong. All you have to do to figure out why which politicians are aligning themselves on which sides of this issue is to follow the money. You will inevitably find ties to the business interests that have a stake in the outcome.

To fix health care--to fix our lives--we need big changes. We can do everything we can on a local and personal level, but it would be nice to see Washington working with us on this rather than against us. For that, Washington is going to have some major surgery of its own. Let's see if Dr. Obama will really follow through on his diagnosis and cut out the tumor known as special interest lobbying.


*Keep in mind we're not even a year into his Presidency.