How to Keep Santa from Making Our Kids Fat –Three Ways to Reduce Childhood Obesity

The holidays are upon us. It’s a time to celebrate with loved ones, maybe even enjoy a well-earned vacation. But it is also a time that many of us gain weight, with children developing eating habits that could set them on a trajectory towards being overweight or obese.

It is really crucial to help our children avoid gaining too much weight. Because once people become obese, a myriad of biologic factors conspire against their efforts to lose weight. Consider a study that came out last year showing what happened to contestants on the Biggest Loser – most of whom gained back most of the weight they lost while participating on the television show. Or look at the difficulty even wealthy people with great willpower have sustaining weight loss, people like Mike Huckabee and Oprah Winfrey.

That’s why the key to combating America’s obesity problem is to prevent children from developing obesity.

But how can we keep our children from becoming obese? All of us with children can do our best to serve our kids healthy, appropriately portioned meals, while encouraging them to be physically active. But what about us as a society – what can we do? What policies can we embrace that will reduce the rate of childhood obesity?

(To read the rest of this article, please visit Forbes.)

Why Charging Smokers More for Health Insurance Costs All of Us Money

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Cigarette smokers have rights. No one should be able to tell an adult that she can’t spend her hard earned money on cigarettes. But non-smokers have rights, too. Specifically, they shouldn’t have to pay to subsidize health care costs of people who choose to smoke. In fact, smokers hurt non-smokers by racking up health care expenses brought on by the hazards of their habit.
The folks behind Obamacare thought they’d figured out how to respect everyone’s rights, by giving healthcare insurance companies the ability to charge higher premiums – a surcharge – for smokers, up to 50% higher in some parts of the country. The idea is simple: smokers have the right to smoke, but not the right to pass on the increased cost of their health care to others.
The idea is also dead wrong. Higher insurance premiums price smokers out of insurance markets. When an uninsured smoker gets emergently sick, that means hospitals and clinicians don’t get reimbursed, which forces them to pass those costs on to people with insurance. When insurance companies price smokers out of their products, we all pay.
Fortunately, there’s a simple solution to the problem. To appreciate the solution, let me expand on the flaws in healthcare insurance surcharges.
(To read the rest of this article, please visit Forbes.)

Is It Fair to Reward Medicaid Patients for Receiving Flu Shots?


My son was underperforming at school, and I was gently encouraging him to try harder (if gesticulating like an over caffeinated Italian qualifies as gentle encouragement). He could not understand why I was upset: “Dad, most of my friends are doing drugs and engaging in unprotected sex. You should be rewarding me for being such a good kid.”
“Reward you for not being bad?!?,” I replied incredulously. That made no sense to me. “When you go above and beyond – when you exert exceptional effort to achieve important goals – then we can talk about what reward you have earned.”
The folks running South Carolina’s Medicaid program don’t appear to agree with my parenting philosophy. A couple years ago, they contracted with a private insurer, the Centene Corporation, to manage its Medicaid population. Part of the company’s approach involved rewarding Medicaid enrollees for receiving recommended preventive care.
This rewards program flips medical payment on its head. Normally, when people go to the family medicine doctor for an annual checkup, they are charged a modest copay for the visit. But through its CentAccount program, the folks at Centene pay patients for receiving such care. You got that right – they aren’t charged for the visit; they are rewarded for it!
When a Medicaid enrollee brings her infant in for a Well Child visit, she receives $10. If she makes all six visits for the year, she will get $25 in that final appointment, adding up to a $75 reward from taxpayers for bringing her child to appointments that the rest of us brought our kids to at our own expense.
In fact, here’s a list of some of the healthcare services CentAccount rewards its customers for receiving:

  • Annual Adult Well Care Visit
  • Well Child Visit
  • Infant Well Child Visits
  • Childhood Immunizations
  • Health Risk Screening
  • Annual Cervical Cancer
  • Annual Breast Cancer Screening
  • Annual Diabetes Screening – HbA1c Tests, Eye Exams, Kidney Screening, and LDL-cholesterol Screening
  • Flu Shot
  • Prenatal Visits
  • Postpartum Visit

At first glance, it might seem obvious that such rewards are unfair. For the same reason it seems wrong to reward my teenager for not doing drugs, why should we reward a parent for vaccinating a child – for doing what any good parent ought to do?
On the other hand, it is also not fair that many Medicaid enrollees are poor enough to qualify for the program despite working full time. It is also not fair that many lose out on their hourly earnings when they take time from work to bring their children to pediatricians.
(To read the rest of this article, please visit Forbes.)

Peer Comparison Can Reduce Antibiotic Prescribing

Very interesting article in the Lancet recently, from the nudge unit in the United Kingdom. They give physicians feedback on how much they prescribed antibiotics compared to their peers, and found that such feedback reduced antibiotic prescriptions.
Peer Comparison Can Reduce Antibiotic Prescribing
I hope to see more of this work!
 
 

Q & A With Richard Thaler On What It Really Means To Be A "Nudge"

Copyright The Telegraph
Copyright The Telegraph

Nudge is one of the most important and influential books on behavioral science and public policy I’ve ever read. Co-authored by economist Richard Thaler and lawyer Cass Sunstein, the book lays out the rationale for adopting policies designed to make it more likely that people will act in their own best interests rather than, say, spend money they shouldn’t spend or eat food they shouldn’t consume. In the book, Thaler and Sunstein discuss how recent advances in behavioral science should inform our attitudes towards rational decision making. Specifically, these behavioral science findings show that people don’t always make rational decisions, raising questions about when or whether outsiders—like governments or employers–should step in to help people avoid making bad choices.
But has enthusiasm for the book led people to see nudges where they don’t exist? That was the question I posed in a recent post, where I argued that it was wrong to call a well-designed traffic light a nudge: “Not all good design, even good design that influences behavior, is a nudge,” I wrote. “A well-designed prison cell is more likely to deter prisoners from trying to escape than a poorly designed one. But that does not make it a nudge.”
The day after I wrote those words, my email inbox included a forthright message from Dick Thaler, telling me I was seriously misguided about nudges. That email began an exchange that turned into a question and answer session reproduced here with Thaler’s permission. (To read the rest of this post and leave comments, please visit Forbes.)

PeterUbel