Fat City

In the spirit of full disclosure, let me first note that I am one of the growing population of individuals who have an excess of avoirdupois. I also have bum knees. Thus, it was with more than a passing interest that this story carried by the BBC caught my attention:

The NHS [British National Health Service] in East Anglia has announced overweight people will be denied knee and hip replacements.

NHS managers in East Anglia have decided obese people - classed as those with a body mass index above 30 [for the curious, yes, I fall into this category], which applies to nearly a quarter of the population - will not be allowed to have hip and knee replacements.

The decision by Ipswich, Suffolk Coastal and Central Suffolk primary care trusts, was taken in consultation with local doctors.

It is generally considered more dangerous to anaesthetise overweight patients, who are often asked to slim before going under the knife.

Other thresholds have been set for nine other procedures, including treatment for varicose veins and grommets for glue ear in children.

There is, however, a broader (no pun intended) issue of public policy illuminated by the story. Specifically, how is medical care rationed if there are no costs constraints to obtaining treatment?

One of the characteristics of the American health care system is that private insurers spend a good deal of money attempting to corral a healthy (read: younger) patient population and denying or limiting reimbursement for some types of care entirely. As a consequence, we spend far more of our GDP than any other industrialized nation on health care. Yet, our population is not notably more well-off. In fact, by many measures, we get significantly lower benefits from our health care system than other countries, even though our system is far costlier.

I happen to be in favor of a government sponsored single-payor health system. I believe, for instance, that it would make American industry more competitive. It would also give us a bigger bang for our health care buck. However, I am not unmindful that many of the benefits that those of us who have medical insurance have come to expect (e.g., free replacement knees and hips on demand) might not be as readily available if the government mandates the benefits available.