Healthcare on the government

The Federal Parliament's House Standing Committee on Health and Ageing began its Inquiry into Obesity in Australia on March 19^th. It has received more than one hundred submissions from stakeholders with proposals for addressing obesity — Remember the submission from the Baker Heart Research Institute, Australia’s Future Fat Bomb? — and has been conducting a series of public hearings. Among the presenters at this past week’s public hearing were Queensland Health and the Centre for Burden of Disease and Cost-Effectiveness.

The Courier-Mail reported that the head of the population health branch of Queensland Health told the Federal Parliamentary Inquiry on Wednesday that the government should pay, through Medicare, for fat Australians to attend Weight Watchers. According to the paper, the proposal “was backed by obesity researchers at the University of Queensland's Centre for Burden of Disease and Cost-Effectiveness.” The Australian Medical Association, however, immediately argued against the proposal, saying Medicare funds should be reserved for medical care.

Medical News Today reported this morning that “the Pharmaceutical Society of Australia has supported calls for publicly funded weight loss programs to be made available to all Australians,” funded by the federal government “as part of its focus on preventive health policies.” Dr. Shane Jackson, vice president of the PSA said: “Models involving government funding could provide consumers with better access to evidence-based weight-loss services.”

Evidence-based medicine: Weight loss programs, based on diet and exercise behavioral interventions, have not demonstrated long-term effectiveness or to improve clinical outcomes for the overwhelming majority of patients. In fact, the FTC charged five of the largest commercial diet companies (Weight Watchers, Jenny Craig, Diet Center, Nutri/System and Physicians Weight Loss Center) with deceptive advertising for making unsubstantiated claims about weight loss and long-term maintenance.

The Sunday Mail reported that obese people in Queensland could be denied State-funded healthcare under a user-pays plan proposed by conservatives in the State Government. Under this plan, obese people would have to pay for their own healthcare. It said that treating preventable “so-called lifestyle diseases” costs the Queensland health system nearly $5 billion, as well as costs Queensland’s economy “$22 billion in lost productivity and social factors, including lost earnings and the cost to carers.” According to the paper: “The cost of treating these preventable conditions will wipe out 57 percent of the state's record $8.35 billion health budget for 2008-2009.” The paper quoted the Queensland Health Minister, Stephen Robertson, as saying preventative health care was absolutely the responsibility of individuals, as much as government, and adding:

We're facing a tsunami of chronic disease in the coming years, thanks to lifestyle changes and our rapidly ageing population. Queenslanders need to realise they face an increasing financial burden from preventable chronic diseases… If Queensland continues its current rates of population growth, economic growth and public health spending, by 2042 the entire state budget will be consumed by health. That's why we need to tackle this upsurge in chronic disease before it overwhelms us.

Evidence-based medicine: Australia government’s own statistics fails to support an obesity fat bomb or tsunami of chronic disease. Chronic diseases of aging are not preventable or due to irresponsible lifestyles and eating ‘bad’ foods; nor are popular health indices indicators of lifestyle choices, but have been shown to be primarily reflections of ageing, genetics and socio-economic disadvantage. In other words, penalizing those with higher numbers and health conditions is discriminatory.

The Australian reported a slightly different story, saying that the Health Minister said he disagreed with the suggestion of a user-pays health system for obese people. However, compulsory health checks for three and four year olds at day care centers are being considered to address Queensland’s spiraling childhood obesity epidemic, said Mr. Robertson. According to the paper, “Mr. Robertson said it was ‘frightening’ how many children were being affected by the avoidable and chronic disease Type 2 diabetes because of bad diets and inactive lifestyles. ‘That's a terrible indictment on us as a community and we need to take some drastic steps to turn that around,’ he said.”

Evidence-based medicine: Australia government’s own statistics disprove the myth of a spiraling epidemic of childhood obesity or chronic disease. Type 2 diabetes is not epidemic among children, preventable or caused by bad diets and behavior.

In other Australian news, the Macquarie National News reported this morning that “in a desperate bid to curb the childhood obesity epidemic, the government is injecting funds into Westmead Children’s' Hospital for gastric banding… Taxpayers will foot the bill for overweight teenagers to go under the knife for drastic weight loss surgery.”

As The Australian also reported this morning, under a new South Wales Government strategy to fight the obesity epidemic, Children’s Hospital at Westmead will be the first in the State to offer taxpayer-funded bariatric surgery “to save teens with severe weight-related health conditions.” The paper reports that according to the State Government, “publicly funded weight loss surgery is expected to be available across the State by 2012.”

Evidence-based medicine: Clinical evidence on bariatric procedures in young people fails to support benefits that outweigh the risks that include long-term nutritional complications.

Together, these plans mean the government could pay for Weight Watchers, diet pills and bariatric surgery in some States, but not for medical care for fat people. Perhaps politicians see the logic. There is no evidence these plans would mean better access to healthcare or better health for Australians.

There’s a story going around the blogosphere that once health insurance is paid for by the government, our healthcare problems will be solved, politicians will base health policies on sound medical evidence and know what’s best for us and our children and act in our best interests, and influences from those with profit or political motives will suddenly disappear. Today’s news from Australia* offered a different perspective.

* Australia has universal health insurance coverage through the government, as well as a taxpayer-funded, government-run, and state-owned hospital and public health care system, which also provides a 30% rebate for residents who choose additional private health insurance.