A cynical game

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Last weekend I dipped a toe into the sewers of right-wing talk radio, and listened to a rant by Michael Savage, during which the nationally syndicated commentator suggested that America's health-care problems could be solved by relocating fat people to "work camps."In the course of what began as an attack on Hillary Rodham Clinton's support for universal health care, he vented his disgust toward "fat women," and claimed that non-thin Americans didn't deserve access to health care.That a shameless demagogue like Savage advocates concentration camps for people with what he considers inappropriate bodies is bad enough (Savage's parents, it's worth noting in this context, were Jewish).What's worse is that the same sort of ignorant hysteria that fuels Savage's foaming at the mouth also inspires more respectable, but potentially much more dangerous, suggestions from our political elite.For instance, at last week's Democratic presidential debate in Des Moines, Iowa, Barack Obama noted that certain unnamed experts claim we could save Medicare $1 trillion if obesity rates were reduced to 1980 levels. He embraced this assertion for the purpose of illustrating how we can pay for universal health-care relatively easily.The theory, it seems, is that an ounce of weight loss is worth a pound of Medicare spending.There's so much wrong with this that it's difficult to know where to begin. First, it remains very unclear to what extent, if at all, higher-than-average weight is an independent cause of health problems and their associated costs.Second, even if it turns out to be true that, in the abstract, "obese" people would be healthier if they lost weight (a theory that, it bears repeating, remains almost completely untested), it certainly doesn't follow that attempting to lose weight improves health.Plenty of evidence suggests that losing weight and then regaining it has a negative overall effect on health. Furthermore, many of the things people do when pursuing weight loss, such as using diet drugs, are clearly unhealthy in and of themselves.All this merely underlines a third point, which is that at present we don't have the faintest idea how to reduce "obesity" rates to what they were 30 years ago, even assuming this would be worth doing. There is no known method for producing long-term weight loss in statistically significant numbers of people, let alone in a nation of 300 million, one-third of whom are currently categorized as "obese."Fourth, even if it were true that we knew how to make people thinner, and that doing so would improve their health, this hardly means such interventions would reduce health-care costs, especially for a program like Medicare.After all, almost all Medicare expenses go toward health care for the elderly. If making fat people thinner extended life expectancy significantly, then putting America on a successful diet would in all likelihood actually increase Medicare costs.Obama's claim is just one example of the dubious assumption that improving public health will produce a net reduction in health-care spending. The reason Medicare costs are skyrocketing is because Americans are living longer and longer, and very old people almost always eventually become very sick people, who are very expensive to care for.Indeed, those who wish to do their patriotic duty, in fiscal terms, ought to aim to die of massive heart attacks at the precise end of their economically useful lives.The reality is that a significant portion of the anti-fat hysteria that has gripped the culture over the past decade is driven by a desire to find any plausible excuse for not doing what every other developed nation in the world does: provide basic health care for all citizens.It's too bad that a progressive politician like Obama is being drawn into this cynical game.(Paul F. Campos is a law professor at the University of Colorado and can be reached at Paul.Campos(at)Colorado.edu.)