Sunday, March 27, 2011

The ACA Turns 1, How Well Do You Know It?

This past Wednesday marked the first birthday of health reform's passage into law. Much like a  toddler beginning to walk, the Affordable Care Act and those responsible for its implementation are still learning how to best develop its balance, coordination, and communication abilities.

So how well do you know the little guy? The Kaiser Family Foundation put together a short quiz to gauge the public understanding of what the law will actually do. Here are the 10 yes-no questions, and you can plug your answers in here to see how you compare nationally:

  • Will the health reform law require nearly all Americans to have health insurance by 2014 or else pay a fine? 
  • Will the health reform law allow a government panel to make decisions about end-of-life care for people on Medicare?  
  • Will the health reform law cut benefits that were previously provided to all people on Medicare? 
  • Will the health reform law expand the existing Medicaid program to cover low-income, uninsured adults regardless of whether they have children?
  • Will the health reform law provide financial help to low and moderate income Americans who don't get insurance through their jobs to help them purchase coverage? 
  • Will the health reform law prohibit insurance companies from denying coverage because of a person's medical history or health condition? 
  • Will the health reform law require all businesses, even the smallest ones, to provide health insurance for their employees? 
  • Will the health reform law provide tax credits to small businesses that offer coverage to their employees?
  • Will the health reform law create a new government run insurance plan to be offered along with private plans? 
  • Will the health reform law allow undocumented immigrants to receive financial help from the government to buy health insurance?
KFF released some informative poll data on results from the quiz and found that 59% of Americans did equal to or worse than a coin flip:

This means a couple things. Firstly, it means that bloggers like myself will have no shortage of opportunity to separate fact from fiction and fill the knowledge gap. Hooray relevance! More importantly, it means that the bill is experiencing a marked developmental delay in its communication skills and needs something along the lines of a speech therapist. Whether it is public agencies, the media, advocacy groups, or simply word of mouth there is a clear need to better disseminate even its most basic elements. Even more interesting is the breakdown of scores based on a number of other qualities:

In general we see that those who are not fans of the law perform consistently worse on the quiz than supporters. Whether the disapproval is caused by a belief in misinformation about negative claims or vice-versa, there seems to be is a significant correlation between knowledge and support (and of course, source of information). As more of the law's provisions roll out and individuals begin to directly experience benefits like some of those listed above, the knowledge gap will undoubtedly reduce. Until then, though, data like that seen here shows there is long way to go towards sufficient public awareness, which is a vital tool that will be needed in deciding how best to implement and augment the law across our diverse populace. 

Saturday, March 5, 2011

A California Soda Tax: How it Can Help the Obesity Problem

Last week, Assemblymember Bill Monning (D-27) introduced AB669, a bill that would impose a one cent per ounce tax on every soda and sugar sweetened beverage sold in California. The bill would create the Children's Health Promotion Fund, raising $1.7 billion a year for programs that are facing severe cuts due to the state budget crisis including school lunch programs and physical education programs. Funds could also be used to develop new programs targeted at obesity prevention in children, including enhancing community parks and other targeted endeavors.

Is a soda tax a realistic solution? Here are some numbers to consider from CCPHA and Michael Pollan:

-Per capita soda consumption has increased nearly 250% over the last 30 years
-Added sweeteners represent 16% of the average daily dietary intake
-Since 1985 the percent of personal income spent on food has decreased from 15% to 10%, but the real price of fruits and vegetables has increased by 40% while the real price of packaged food and soft drinks has decreased by 25%
-56% of California adults are obese or overweight, and now 28% of children are as well
-An estimated $41 billion is spent every year in California as a result of chronic disease costs, most notably diabetes.

Food prices are a significant factor in regard to these trends, and people are inherently cost conscious in what they purchase, especially low income individuals. Research has shown that food cost plays a significant role in diet, and overall economic factors may be a much larger influence than lifestyle or personal will. Simply put, the current system is geared to make the most unhealthy calories in the marketplace the only ones that poor people can afford (who also tend to have higher obesity rates). 

It is hard to argue against the fact that obesity rates have reached epidemic proportions. Strategies to combat the epidemic must be multifactorial, and a modest fee on one of the greatest culprits would not only help raise funds to better target obesity, but also justify the issue as a top public priority in order to reduce future health care costs. Skeptics of a new levy may see this as just another 'tax and spend' maneuver, but it is important to understand that the health and productivity costs associated with complications from obesity are astronomical. As such, a concerted effort to target this risk factor will pay off as savings in the long term in both community ratings for health insurance (your premiums) and Medicare costs.

Moreso, it seems quite irrational to have public dollars funding an unhealthy system that public health dollars try to combat. Taxpayer supported agricultural subsidies (to the tune of the Farm Bill's $25 billion a year) for products such as corn, soybeans, and wheat have decreased the price of energy-dense foods. As a result, we are now experiencing lowered food quality with manufactured low-cost substances like high fructose corn syrup in soda. In order to truly curb the obesity epidemic, it will be necessary to examine quality and health ‘costs’ in addition to quantity and market costs in food production. Shifting subsidies to healthier food products would not only promote cheaper and healthier choices in the market as a whole, but would more importantly set the national agenda as being more health-conscious as opposed to solely market conscious. Consumers will continue to search for the best value (calorie) per dollar, and though it is ultimately their choice as to what food they purchase it is of the utmost importance for future policy to protect and promote the nutritional values of our food products.