Monday, February 26, 2024

The Silent Killer That No One Likes To Talk About

It is the second leading cause of preventable deaths.  An estimated 300,000 people die annually from diseases related to this condition. Yet the issue lurks in the shadows because of unhealthy anguish about social stigma. By not shining a light on the subject, America is inviting a catastrophic health crisis.

Obesity is a health risk the nation can no longer ignore.  Obesity is linked to chronic medical conditions, including Type 2 diabetes, heart attack, stroke, kidney failure, nerve damage, gum diseases and some forms of cancer.  And there are a host of lesser disorders, such as sleep apnea.     

Statistics document that obesity is one of the most serious public health challenges of the 21st century:

  • Data shows that 41.9% of adults are obese according to data from the Centers for Disease Control and Prevention (CDC).  In 1995, obesity affected 15.3% of adults.  Adult obesity rates have increased 37% since 2008.
  • More than 80% of obese people develop Type 2 diabetes, according to research from the National Institutes of Health (NIH). Obesity related cardiovascular disease deaths tripled between 1999 and 2020, reports the American Heart Association. 
  • The American Cancer Society data found excess body weight is responsible for about 7% of all cancer deaths in the country, including 11% in women and 5% in men.  
  • The rate of childhood obesity is increasing at a faster rate than adult obesity. As of 2023, one in five children in the country is obese. Youth obesity rates have increased 42% since 2008. 
  • A recent report by the Milken Institute estimates the annual medical and economic impact of obesity exceeds $1.3 trillion. The direct medical costs to treat obesity related diseases ranges from $147 billion to $260 billion annually, reports the CDC. 
Who is considered obese?  Answering that question would appear simple.  The process involves a calculation based on a person's weight in pounds, divided by the height in inches squared, multiplied by 703, to determine a Body Mass Index (BMI).  The number is adjusted for age and gender.  

For the average American, it sounds like voodoo medicine.  A study reported by the NIH found only 22% of obese women and 6.7% of obese men correctly classified themselves as obese. Complexity is the enemy of dealing with preventable health issues.

Improbably, the American Medical Association has been at the forefront of quashing honest discussions about obesity and its impact on health. A report in the AMA Journal of Ethics stated that focus on BMI and weight has "yielded few health benefits and contributed to weight related discrimination."

How can the country tackle obesity if the leading medical group hushes information about unhealthy weight gain?  Apparently, the medical profession prefers to treat obesity related diseases rather than target prevention. No wonder U.S. medical costs are soaring, reaching $4.5 trillion in 2022.

Another impediment is the country's obsession with race.  Since African-Americans are disproportionately impacted by obesity, many academics and medical groups blame systemic racism for the rise of obesity.  Even pointing out the statistics is considered racist.  What does that solve?

Lifestyle choices play a large role in obesity.  Unhealthy diets and Americans addiction to screen time --cell phones, computers, video games and television--contribute to sedentary lifestyles. Only 28% of adults and 22% of adolescents meet the CDC's physical activity guidelines.

Prevention can be as simple as a healthy diet and exercise, such as walking 20 minutes a few times a week.  But let's acknowledge that for some, hormones and genetics make some people predisposed to obesity or excessive weight gain.  Unhealthy stress can also be a contributing factor. 

But why eat healthy and exercise when a drug can do the heavy lifting? It's the American way, and pharmaceutical companies are eager to profit from the solution.  The Food and Drug Administration has approved two Type 2 diabetes drugs, administered with an epipen, for weight loss.  

Diabetes medications Mounjaro from Eli Lilly and Ozempic from Novo Nordisk are soon expected to be rebranded and marketed for weight loss. Currently, the drugs cost about $1,000 to $1,200 for a month's supply. No prices have been announced for the weight loss versions.

Today most insurance companies do not cover weight loss drugs.  A 2003 law prohibits Medicare from doing so.  However, given the size of the obesity cohort, expect growing political pressure for insurance companies to cover the drugs, which will raise the cost of health premiums for everyone.

The sensible solution is for the medical profession and public health organizations to launch campaigns to increase education about the causes of obesity, while describing its harmful effects.  The campaign should include information on unhealthy foods and the benefits of physical activity. 

Unfortunately, many medical organizations and health advocates want the government to step in and legislate health.  Zealots want Washington to pass laws mandating better food labeling, healthier fast food, organic vegetables while outlawing red meat.

Onerous federal edicts are not the answer.  Arresting obesity rates requires individuals and families to take responsibility for their health. Prevention starts in the home with healthy food and physical activity. That means arming Americans with facts, not silencing discussion of obesity.  

Monday, February 12, 2024

34 Trillion Reasons To Cut Federal Spending

Every hour the U.S. debt jumps $218 million. That's $5.2 billion each day.  Current total government debt stands at a staggering $34.228 trillion. As scary as those figures are, the debt is expected to skyrocket to $50 trillion by 2033, less than a decade away.

For perspective, the nation's debt was $5.67 trillion at the beginning of 2000.  In just over two decades, the current debt is nearly seven times higher.  Since 2018, Congress has shoveled on another $12.7 trillion to the debt mountain. 

Today there is no limit on how high the federal debt can rise.  Congress passed a bill in June of last year suspending the nation's debt limit through January 1, 2025.  It is the equivalent of handing a credit card for Congress to continue to rack up more debt without any restraints.   

The debt balloon is the result of Congress's insatiable appetite for spending more than the tax dollars the government collects. In the most recent fiscal year 2023, the federal government collected $4.44 trillion in taxes, but spent $6.13 trillion, creating a $1.7 trillion deficit hole. 

Deficits matter because the feds issue debt to fund the yawning canyon between revenues and spending.  Beginning with fiscal year 2020 through 2023, the government accumulated deficits totaling $9 trillion. Even drunken sailors are spendthrifts by comparison.   

Don't expect a baptism of fiscal responsibility to convert the current Congress. The Congressional Budget Office (CBO) forecasts a $1.6 trillion deficit by the end of fiscal year 2024 on September 30. Deficits are expected to top $2 trillion annually after 2031, reaching $2.6 trillion in 2034.

Revenues are not the problem.  Tax collections and fees rose 8% from 2022 to 2023.  Individual taxpayers forked over $2.18 trillion, accounting for 49% of the revenue collected by the feds. Fiscal accountability is a fleeting idea that has been drowned by a gusher of spending.

Paying for the debt created by deficit spending is getting more expensive.  Interest costs have nearly doubled the past three years from $345 billion in 2020 to $659 billion in 2023.  Interest is now the fourth largest spending category, behind only Social Security, Medicare and defense.

Those eye watering figures are projected to get worse.  Based on trends, the CBO forecasts that interest on federal debt will reach $1.4 trillion in fiscal year 2033, creating a budget nightmare.  This is fiscally unsustainable without Draconian tax increases or budget cuts or both.   

Balancing the budget, a feat performed by millions of American households, is apparently beyond the mental acuity of Congress.  Only twice in the last half-century has Congress found the political will to reach financial equilibrium--in 1969 and from 1998-2001 under President Bill Clinton,

Before even tackling a balanced budget, Congress must first reign in deficits.  Although it's easy to blame COVID spending for the spike in the size of deficits, Congress has been spending more than government revenues for the last 22 years.  Lawmakers have a spending dependency. 

Since 1997, senators and representatives of both parties have ignored the regular budget process of approving a budget that fully funds the government.  Congress seems to prefer chaos, failing to pass more than five of its 12 regular appropriation bills by the deadline in the last 26 years. 

In 11 of the past 13 fiscal years, lawmakers have not passed a single spending bill by October 1, which marks the beginning of a new federal budget year.  Instead, Congress employs a shell game, approving what's called continuing resolutions to partially fund the government over several months. 

Continuing resolutions maintain government funding at current levels, but often supplemental appropriations are shoehorned into a CR.  These stopgap gimmicks allow lawmakers to spend while obfuscating the full impact on deficits. This lack of transparency would not be tolerated in any business.

For all the brouhaha over CR's, these appropriation measures only cover discretionary spending. The hefty money is federal outlays for Social Security, Medicare, Medicaid, unemployment compensation and other entitlement programs. Funding is mandated by statues.  

These programs accounted for $4.6 trillion in spending in 2023, about 73% of the federal budget. Unless Congress tackles mandatory appropriations, spending will reach the stratosphere.  Lawmakers of both parties are deathly afraid of the political blowback of even suggesting a reduction in programs. 

Representatives and Senators are easily spooked.  Mention "government shutdown," defaulting on the national debt," or "reducing food stamps" and lawmakers capitulate. They prefer political theatre and gamesmanship to tackling the unpalatable but essential choices to restore fiscal integrity. 

What will it take to restore financial sanity?  Most likely an economic meltdown.  Short of a financial Armageddon, the solution is for voters to quit electing the same people to Congress and expecting a different outcome.  If voters make balancing the budget their top priority, there is hope for change.