The very dark side of health care reform

I don’t know about you readers, but I’ll be watching tomorrow’s health care decision with more than just professional interest.

That’s because I really don’t want to go to counseling!

The Los Angeles Times reported Tuesday that the U.S. Preventative Services Task Force urged doctors to identify obese patients and refer them to a weight-loss program that includes intensive counseling.

Medicare and private insurance companies would be required to cover these sessions, at least under the Patient Protection and Affordable Care Act. If the law is struck down tomorrow, then all bets are off.

On the off chance Justice Antonin Scalia’s expansive view of the Commerce Clause leads him to vote to uphold the act, or Justice Anthony Kennedy’s vaunted sense of liberty is not offended by the individual mandate, I decided to check out my BMI online. That’s stands for "body mass index," a correlation of height and weight that’s supposed to measure obesity.

The result: I’m obese, according to the Internet.

Screw you, Internet.

Now, to be fair to the Internet, my obesity designation is not a surprise. I’ve got a very good doctor who has been on my case for a long time about losing weight. He’s not persuaded by my confident prediction that science is on the verge of inventing a fat-eating enzyme that melts the pounds away as you sleep!

Thanks for nothing, science.

So, if the health care law is upheld, it looks like I’ll draw a referral to what the Times calls "intensive, multicomponent behavioral interventions" that involve monthly or even bi-weekly counseling sessions with a doctor or community-based program. I can see it now: "Hi, my name is Steve, and I’m addicted to Double-Doubles, animal style."

"Hi, Steve!"  

I’ve got to admit, I’m somewhat concerned about the nature of these intensive programs, especially when I see that exercise sessions are sometimes included. Why do I envision forced marches up mountains, and heavy-backpack hikes on the many miles of beautiful outdoor trails to be found in my home community of Henderson? Sure, it would be fun to meet somebody like R. Lee Ermey in person, but I’m thinking the charm of gunny’s persona would wear off around the fourth jody.  

Still, while I’m obviously no Michael Phelps, I have to quibble with the BMI calculator. According to it, I could lose up to 60 pounds and still be considered "overweight," the next category down from "obese." It would take me shedding 80 pounds to get to what the Internet claims is "normal weight."

Eighty pounds? Are limb amputations covered by the Patient Protection and Affordable Care Act?

It’s not difficult to see how health authorities – concerned about the rise in obesity and its related diseases, such as diabetes and poor cardiac health – will put pressure on those of us in the Hefto-American Community to shed pounds. According to the Times, obesity and related diseases already account for an estimated $147 billion in annual health care spending. How long before the skinnies in society rise up against us heftos and demand we stop costing them more in their health-care premiums? Or before employers start charging us more for insurance to defray their rising costs, the way some do now with smokers? Even if we had a single-payer, Medicare-for-all system, what’s to stop crusaders from assessing a "fatty levy" on our annual income tax to compensate the state for the additional costs of dealing with us big-boned?

It’s a vexing problem, and one that will continue no matter which way the Supreme Court rules tomorrow. But let me pose a question while we all wait for that ruling: Are you going to finish eating that doughnut?


Steve Sebelius is a Review-Journal political columnist and author of the blog Follow him on Twitter (@SteveSebelius) or reach him at (702) 387-5276 or

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