Banning Trans-Fatty Acids and Requiring Menus to List Caloric Content of Foods

[Miami_med]

---

Members do not see this ad.

Right. Most of us are knowledgeable about trans-fatty acids, but most Americans are not. We take for granted a lot of things because we have learned a lot of advanced medicine.

The ins and outs of trading on margin, principles of option trading, etc. might be basic knowledge to someone who holds an MBA, but it's not common knowledge with most Americans. The same can be said of TFA's with regard to physicians and most Americans.

If I choose to buy stock on margin, I will learn about it or ask someone who knows about it. If I chose not to, that would be my fault. It is the same with this. People who are worried about the quality of their food need to learn about their food. We don't need big daddy government making these decisions for everyone.

 

[southerndoc]

My point exactly. The lack of knowledge about what is and isn't healthy is a far, far, bigger problem than TFAs, in and of "themselves." If we ban TFAs, people will eat the saturated fatty acid substitute(s), thinking that they are perfectly healthy because they are not TFAs. Then, what have we really solved by banning TFAs?

Saturated fats are safer than TFA's.

 

[southerndoc]

If I choose to buy stock on margin, I will learn about it or ask someone who knows about it. If I chose not to, that would be my fault. It is the same with this. People who are worried about the quality of their food need to learn about their food. We don't need big daddy government making these decisions for everyone.

When it costs me money at the expense of business profiting from it, yes, we do need government regulating it.

 

[eleventh]

Which state is this true in cause boy every time I have ever ordered a salad I would get a plate of lettuce with a smattering of something on it and a bill higher than any value meal I have seen.

I live in one of the most expensive places on the planet, SF Bay Area. Sure NYC and London and whatever are pricier, but you get the idea.

That's your problem... you're "ordering a salad." I didn't say choosing a salad while eating out was cheaper. How much are fruits and vegetables at your grocery store? I just paid over $10 for like 3 hot pocket boxes.... when I spend $10 on fruits and veggies I get bags full of things.. that i take home and cook with... i don't 'order' them lol Plus, I'd rather have a $9 salad with salmon than a $9 meal at Burger King anyday.

 

[Sol Rosenberg]

Saturated fats are safer than TFA's.

That is like saying that hitting a brick wall head-on in your car is safer at a speed of 75 mph than it is at 80 mph. Obviously true, yet you've not conveyed any useful information to this discussion, since both are harmful to your health.

 

[southerndoc]

That is like saying that hitting a brick wall head-on in your car is safer at a speed of 75 mph than it is at 80 mph. Obviously true, yet you've not conveyed any useful information to this discussion, since both are harmful to your health.

Saturated fats are safer than TFA's. Just like unsaturated fats are safer than saturated fats.

 

[Sol Rosenberg]

Saturated fats are safer than TFA's. Just like unsaturated fats are safer than saturated fats.

Just like hitting a brick wall at 70 is safer than hitting it at 75, which is safer than hitting it at 80.

The real way to solve the problem is to teach drivers to not hit the brick wall, not regulate the maximum speed at which it should be hit.

 

[southerndoc]

Just like hitting a brick wall at 70 is safer than hitting it at 75, which is safer than hitting it at 80.

The real way to solve the problem is to teach drivers to not hit the brick wall, not regulate the maximum speed at which it should be hit.

It's more like hitting a brick wall at 45 v 80 mph. Yes, there are substantial differences. If you calculate the energy using E=mv(squared), you will find that speed adds more energy than does mass. The difference between driving 55 mph and 60 mph is substantial.

In the average mid-sized sedan of 2 tons, the difference is certainly substantial. At 60 mph, the energy created in a crash is 20% more than created in a 55 mph crash. Likewise, your chances of a fatal injury increase by 15% and is statistically significant.

Although not really the topic of this discussion, if you want more information on crash-related injuries and fatalities at various speeds, you can easily find it on the National Highway Safety and Traffic Administration (NHTSA) website.

 

[Sol Rosenberg]

.

 

[DragonWell]

Just like hitting a brick wall at 70 is safer than hitting it at 75, which is safer than hitting it at 80.

The real way to solve the problem is to teach drivers to not hit the brick wall, not regulate the maximum speed at which it should be hit.

To extend the analogy a bit 😉 , since TFA content of foods served in restaurants is largely not revealed to consumers, it's like driving a car with a speedometer which only works intermittently. You can try to guess how fast you're going but there is no objective way to really tell.

The invisible, insidious nature of TFAs in the food supply creates a different challenge and need for regulation than say, smoking, which one can easily choose to avoid.

 

[Faebinder]

HUZZAH!!!!

NYC health boards ban trans fat at restraunts...

HUZZAH!!!!😀

 

[Miami_med]

HUZZAH!!!!

NYC health boards ban trans fat at restraunts...

HUZZAH!!!!😀

Hurray,

The *****s in NYC have managed to find new ways to interfere with free enterprise and personal choice. This will help all of the people in NYC who are in need of cheaper food options for sure 🙄 .

 

[Sol Rosenberg]

HUZZAH!!!!

NYC health boards ban trans fat at restraunts...

HUZZAH!!!!😀

Even that article repeats what I have been saying over and over again in this thread:

New York's move to ban trans fats has mostly been applauded by health and medical groups, although the American Heart Association warns that if restaurants aren't given ample time to make the switch, they could end up reverting to ingredients high in saturated fat, such as palm oil.

You are naive if you think that eating out in NYC just got any healthier.

 

[DragonWell]

Hurray,

The *****s in NYC have managed to find new ways to interfere with free enterprise and personal choice. This will help all of the people in NYC who are in need of cheaper food options for sure 🙄 .

Where is the evidence that eliminating TFAs leads to higher priced food? Sure, the processed food industry may threaten this, but, personally, I haven't noticed a change in price in the foods which have eliminated TFAs - ie corn chips, lay's potato chips, etc.

You are naive if you think that eating out in NYC just got any healthier.

Epidemiologically, the evidence seems to suggest that even a straight switch to SFAs, though not optimal, would still result in lowered risk of CHD. Practically, however, the TFAs will probably be replaced by a mixture of SFAs and PUFAs, with the increased consumption of PUFAs resulting in positive health effects even beyond just eliminating TFAs.

Roll on NYC 👍! Too bad there's too much back room lobbying to allow changes like this to happen at a federal level.

 

[Miami_med]

Roll on NYC 👍! Too bad there's too much back room lobbying to allow changes like this to happen at a federal level.

Yeah, that and the 10th amendment should get in the way.

 

[Whodathunkit]

You are naive if you think that eating out in NYC just got any healthier.

People are naive if they expect a large part of the restaurant industry to give a crap about what people are eating. Money is the bottom line...not health.

New York's move to ban trans fats has mostly been applauded by health and medical groups, although the American Heart Association warns that if restaurants aren't given ample time to make the switch, they could end up reverting to ingredients high in saturated fat, such as palm oil.

This warning alone proves that point. Even if they were given ample time,when exactly could we expect them to switch from these high saturated fat replacements?

The answer: likely never.

 

[dpmd]

Restauraunts are driven by a desire to make money. They do this by pleasing customers. This can be done quite easily by feeding them things that taste good. Appealing to a customer's sense of good health can work for some places. For many others, if they try to make a change to healthier ingredients they run the risk of losing customers if it doesn't taste as good, and losing profit if the ingredients cost more and the market they are in won't accept higher prices. A sneaky solution to the second problem is to slightly decrease the amount served. Can't be enough to be noticed, but over many servings this can add up.

I encourage those of you who think regulations are the answer to vote with your pocketbook instead. Ask for nutritional information when you go out to eat. If the place doesn't have it then go somewhere else. Ask what kind of oils they use. Ask if they use organic stuff if that matters to you. Ask if they use hormone treated meats if that is important to you. If you don't like the answer or they don't have it, go somewhere else. If there are a majority of you out there (or if you make enough of a fuss), businesses will notice and change their practices so as to regain market share. If there aren't, then deal with it and lets not make another rule that forces the many to do what a few want.

 

[Faebinder]

Restauraunts are driven by a desire to make money. They do this by pleasing customers. This can be done quite easily by feeding them things that taste good. Appealing to a customer's sense of good health can work for some places. For many others, if they try to make a change to healthier ingredients they run the risk of losing customers if it doesn't taste as good, and losing profit if the ingredients cost more and the market they are in won't accept higher prices. A sneaky solution to the second problem is to slightly decrease the amount served. Can't be enough to be noticed, but over many servings this can add up.

I encourage those of you who think regulations are the answer to vote with your pocketbook instead. Ask for nutritional information when you go out to eat. If the place doesn't have it then go somewhere else. Ask what kind of oils they use. Ask if they use organic stuff if that matters to you. Ask if they use hormone treated meats if that is important to you. If you don't like the answer or they don't have it, go somewhere else. If there are a majority of you out there (or if you make enough of a fuss), businesses will notice and change their practices so as to regain market share. If there aren't, then deal with it and lets not make another rule that forces the many to do what a few want.

At a certain point you can't vote with your pocket. You cannot depend on the population to know what's good for the healthcare system and the population health in general. We can't continue to support ingredients that increase cardiac disease... Incase you didn't know, cardiac disease is the number 1 killer in the US. You can't depend on a corporation or multiple corporation to do something against what-makes-business-sense. Using better ingredients makes less business sense to them and make GREAT sense for the healthcare. Overall, this is better for all of us. Stop trying to act like the general population knows crap about its own health.... If they did, then we wouldnt need to educate so many people on so many health topics. If they did, then most people would not have needed higher taxes and prohibition of public smoking to stop smoking. You are correct... you draw the line somewhere and you can't control everyone... but cardiac disease is THE #1 KILLER.... the line has not been reached.

The no transfat policy is already established in Europe and you dont see them suffering for it... Note they didnt ban regular fat... just the transfat. You'll still be able to eat french fries and a flat top grilled burger and a steak as well.

 

[Sol Rosenberg]

Epidemiologically, the evidence seems to suggest that even a straight switch to SFAs, though not optimal, would still result in lowered risk of CHD. Practically, however, the TFAs will probably be replaced by a mixture of SFAs and PUFAs, with the increased consumption of PUFAs resulting in positive health effects even beyond just eliminating TFAs.

This argument is ridiculous. Both SFAs and TFAs contribute SIGNIFICANTLY to the development of coronary/heart disease. How many doctors recommend diets high in SFAs to patients otherwise at risk for coronary disease? How many doctors recommend diets high in SFAs period?

You are arguing that one deadly poison is more deadly than another. Both are horrible, and both contribute significantly to increased risk of heart/coronary disease. You are essentially saying that given the choice between ingesting Cyanide and Arsenic, you would choose the Arsenic, because it is trivially less deadly. This is ridiculous.

Please tell me why you have any reason to believe that TFAs would be replaced by PUFAs (I'm assuming that PUFA = PolyUnsaturated Fatty Acid.) Are PUFAs cheaper than SFAs? McDonalds, for example used to use Beef Fat to cook their French Fries. They switched to [hydrogenated] vegetable oil in the early 90s, but now (at least in NYC) need to switch from those TFA containing oils. Why wouldn't they just switch back to beef fat?

Go brag to your Cardiologist that you are now eating much healthier by consuming a diet high in SFAs rather than TFAs and tell me what his reaction is.

 

[Sol Rosenberg]

At a certain point you can't vote with your pocket. You cannot depend on the population to know what's good for the healthcare system and the population health in general. We can't continue to support ingredients that increase cardiac disease... Incase you didn't know, cardiac disease is the number 1 killer in the US. You can't depend on a corporation or multiple corporation to do something against what-makes-business-sense. Using better ingredients makes less business sense to them and make GREAT sense for the healthcare. Overall, this is better for all of us. Stop trying to act like the general population knows crap about its own health.... If they did, then we wouldnt need to educate so many people on so many health topics. If they did, then most people would not have needed higher taxes and prohibition of public smoking to stop smoking. You are correct... you draw the line somewhere and you can't control everyone... but cardiac disease is THE #1 KILLER.... the line has not been reached.

The no transfat policy is already established in Europe and you dont see them suffering for it... Note they didnt ban regular fat... just the transfat. You'll still be able to eat french fries and a flat top grilled burger and a steak as well.

Cardiac disease is not caused by Trans Fat consumption alone. According to the American Heart Association, coronary heart disease caused 479,305 deaths in America in 2003. According to a study previously posted in this thread, approximately 30,000 deaths per year can be attributed to TFA consumption. 30,000/479,305 = 6.26%. So, obviously the vast majority of CHD deaths are caused by some factor OTHER than TFAs.

 

[DragonWell]

This argument is ridiculous. Both SFAs and TFAs contribute SIGNIFICANTLY to the development of coronary/heart disease. How many doctors recommend diets high in SFAs to patients otherwise at risk for coronary disease? How many doctors recommend diets high in SFAs period?

You are arguing that one deadly poison is more deadly than another. Both are horrible, and both contribute significantly to increased risk of heart/coronary disease. You are essentially saying that given the choice between ingesting Cyanide and Arsenic, you would choose the Arsenic, because it is trivially less deadly. This is ridiculous.

If you want to argue that a TFA ban restricts a right to pursue poor health, well, personally, I find that rather ignorant, but at least it's a legitimate argument. Now it sounds like you are trying to argue that banning TFAs will not result in any health benefits, in spite of the volume of evidence to the contrary already posted on this thread. We can argue about the morality of banning TFAs all day, but arguing about whether TFAs increase health risks is like arguing about evolution: it's a fact some people may not like, but to refuse to accept it is to choose to ignore basic science.

Please tell me why you have any reason to believe that TFAs would be replaced by PUFAs (I'm assuming that PUFA = PolyUnsaturated Fatty Acid.) Are PUFAs cheaper than SFAs? McDonalds, for example used to use Beef Fat to cook their French Fries. They switched to [hydrogenated] vegetable oil in the early 90s, but now (at least in NYC) need to switch from those TFA containing oils. Why wouldn't they just switch back to beef fat?

Go brag to your Cardiologist that you are now eating much healthier by consuming a diet high in SFAs rather than TFAs and tell me what his reaction is.

From the NEJM article which I have quoted several times on this thread :

..."These estimates are based on the replacement of trans fats with carbohydrates. In practice, however, trans fats in partially hydrogenated oils would most commonly be replaced with unhydrogenated (cis) unsaturated fats,(6) which may have additional potential benefits as compared with carbohydrates. If such additional potential benefit is considered, greater proportions of CHD events (12 to 22 percent) might be averted (Figure 5). Partial hydrogenation also largely destroys {alpha}-linolenic acid, the plant-based n–3 fatty acid. Although the cardiovascular benefits of {alpha}-linolenic acid are not established conclusively,83 the replacement of partially hydrogenated fats with unhydrogenated oils containing {alpha}-linolenic acid (such as soybean oil) may further reduce the risk of CHD by increasing the population intake of n–3 fatty acids.

The reference given for the bold statement (6) is for "Leth T, Bysted A, Erendah-Mikkelsen A. The effect of the regulation on trans fatty acid content in Danish food. First International Symposium on Trans Fatty Acids and Health, Rungstedgaard, Denmark, September 11–13, 2005.", so I think we can presume that this is based on what fats have replaced TFAs in the real world danish experience of a total TFA ban.

 

[Faebinder]

Do I need to do homework for people? Really? Is pubmed.com really hard to search? Did they stop teaching lipids in med school?

Trans fatty acids in adipose tissue and the food supply are associated with myocardial infarction.

Metabolic studies have clearly shown that trans fatty acids (TFAs) elevate LDL and lower HDL cholesterol. Epidemiologic studies showed a relation between TFA intake and the risk of myocardial infarction (MI), but studies examining adipose tissue TFAs have not uniformly confirmed this. We performed a case control study examining both adipose tissue levels and dietary intake of TFAs and first MI. Between 1995 and 1997, 209 cases of first MI completed a 300-item FFQ and 79 had an adipose tissue biopsy; 179 matched controls completed the FFQ and 167 had a biopsy. During the course of the study (mid-1996), TFAs were eliminated from margarines sold in Australia. Cases biopsied before mid-1996 had greater levels of trans 18:1(n-9) (32% P < 0.03) and trans 18:1(n-11) (23%, P < 0.001) than controls biopsied before mid-1996. After June 1996, there were no differences between cases and controls in any of the adipose tissue TFAs measured. Logistic regression showed that trans 18:1(n-11) (P = 0.03) was an independent predictor of a first MI. Cases consumed 0.5 g/d (P = 0.002) more TFAs than controls. Subjects in the highest quintile of TFA intake had an OR for first MI of 2.1 (95% CI, 1.1-4.3), which was not independent of saturated fat intake. Apparent TFA intake from margarine was related to adipose tissue 18:1t[(n-9) and (n-10)] in 1995 (r = 0.66, 0.66, respectively). We conclude that TFAs in adipose tissue are associated with an increased risk of coronary artery disease and rapidly disappear from adipose tissue when not included in margarines.

Those are pretty freaking high r values... higher than the MCAT/USMLE relation....

I rest my case.

 

[Miami_med]

Yeah for NY:

http://www.washtimes.com/op-ed/20051218-100757-5077r.htm

Maybe next we'll have the police knocking down people's doors to search for the common cold.

 

[Faebinder]

Yeah for NY:

http://www.washtimes.com/op-ed/20051218-100757-5077r.htm

Maybe next we'll have the police knocking down people's doors to search for the common cold.

The common cold doesn't come to the ER with diabetic Ketoacidosis and a sugar level of 1000 and now you gotta act immediately or the person dies soon. Having done my ER in NYC, I can tell you that NYC is a monster of epidemics and the ER is full of uncontrolled diseases that medicaid pays for. However, I do agree with you. See I can be a middle man and understand both sides... This is too much control...not the same for transfat where the ingredient is man made and unnecessary.

 

[DragonWell]

Yeah for NY:

http://www.washtimes.com/op-ed/20051218-100757-5077r.htm

Maybe next we'll have the police knocking down people's doors to search for the common cold.

Do you also find mandatory vaccination an invasion of your freedom? Vaccines carry some inherent risk, but is it preferable to live with diseases like smallpox and polio?

Public health strategies have been very effective in combating infectious disease, and the vast majority of people have realized strategies like mandatory vaccination and its associated risks are a small price to pay for substantial health benefits. As the cost of treating chronic diseases continues to increase with the looming demographic shifts in America, society will necessarily find similar strategies to deal with diabetes, CHD, etc. We can't afford a CABG for everyone. NYC is just a little ahead of the curve.👍

 

[docB]

Public health strategies have been very effective in combating infectious disease, and the vast majority of people have realized strategies like mandatory vaccination and its associated risks are a small price to pay for substantial health benefits. As the cost of treating chronic diseases continues to increase with the looming demographic shifts in America, society will necessarily find similar strategies to deal with diabetes, CHD, etc. We can't afford a CABG for everyone.

And this is exactly why this is a debate. There is a growing attitude that since our healthcare system is socialized enough that the government bears the costs of poor lifestyle choices it therefore has the right to regulate and criminalize anything it decides drives up healthcare costs. I know that all of you want to do this "for our own good" however those of us with some libertarianism in us would rather take care of ourselves, deal with the consequences ourselves and keep the government out of our daily lives. We are also very concerned about the slippery slope that this type of regulation causes. I could list off a batch of regulations that currently seem ridiculous but are scary and everyone would just say I'm being an alarmist. I would point out that 50 years ago no one thought that the government would try to destroy the tobacco industry. 20 years ago no one thought that people would be suing McDonalds because they are fat. California tried to tax junk food (which was later repealed). So we are inevitably headed toward where the regulatory crowd wants to go. But it will not be without costs. And remember that sooner or later they will likely want to get rid of something you do care about.

 

[Miami_med]

Do you also find mandatory vaccination an invasion of your freedom? Vaccines carry some inherent risk, but is it preferable to live with diseases like smallpox and polio?

Public health strategies have been very effective in combating infectious disease, and the vast majority of people have realized strategies like mandatory vaccination and its associated risks are a small price to pay for substantial health benefits. As the cost of treating chronic diseases continues to increase with the looming demographic shifts in America, society will necessarily find similar strategies to deal with diabetes, CHD, etc. We can't afford a CABG for everyone. NYC is just a little ahead of the curve.👍

The difference is that all of those diseases are CONTAGIOUS. No one would have EVER dreamed of this sort of approach to CHD or DM when they started vaccinating for polio. I will not get into the issue of mandatory vaccination here, though I think that there are some problems there too. Now NYC is regulating your diet and your blood sugar content. Doesn't that seem just a little invasive 🙄 .

If what you do hurts you, that is a personal choice. If what you do hurts someone else, then that dispute must be mediated. That is the difference between DM and Polio. Also, please don't quote me that it will lower ER costs. You can't force me to pay for something that I don't think I should have to pay for and then invade my privacy as an excuse to save some of the money that was confiscated from me. I have no problem with a law that says that we won't pay for the diabetic if he fails to control his blood sugar. That solves your cost problem and my payment problem without invading anyone's privacy.

 

[killerleaf]

ok, has anybody watched "Demolition Man"? yes, I know, it is kinda cheesy... but there are some good and scary things in there....

paraphrasing just a little, because it has been a little while...

"Cigarettes are bad for you, hence they are illegal. So is salt and chocolate" and they got fined everytime they said what was considered a cuss word... "exchange of bodily fluids? eeewww!" permits had to be applied for and approved to have a child...and then it was done in a lab after fluids were collected, processed, and cleaned... in other words, everything was regulated down to the smallest level... really really scary.

Yes, TFAs are bad. Today, anyway. I remember when my doctor said to quit eating eggs, they were a road to a heart attack. Now, he says I can have a couple. It seems to me that as a nation, we have forgotten the little word, "moderation". Everything has to be better, bigger, faster....including food.

 

[BeatrixKiddo]

bbbbbbbbbbbbbbbbbbbb

 

[BeatrixKiddo]

ffff

 

[DragonWell]

The difference is that all of those diseases are CONTAGIOUS. No one would have EVER dreamed of this sort of approach to CHD or DM when they started vaccinating for polio. I will not get into the issue of mandatory vaccination here, though I think that there are some problems there too. Now NYC is regulating your diet and your blood sugar content. Doesn't that seem just a little invasive 🙄 .

If what you do hurts you, that is a personal choice. If what you do hurts someone else, then that dispute must be mediated. That is the difference between DM and Polio. Also, please don't quote me that it will lower ER costs. You can't force me to pay for something that I don't think I should have to pay for and then invade my privacy as an excuse to save some of the money that was confiscated from me. I have no problem with a law that says that we won't pay for the diabetic if he fails to control his blood sugar. That solves your cost problem and my payment problem without invading anyone's privacy.

OK, so people who don't follow your rules for a healthy lifestyle should be denied medical treatment and left to die. If someone who drinks too much develops liver disease, we should deny him/her medical care because that was their choice, right? I guess a genetic predisposition to alcohol addiction is no excuse. What about a brittle diabetic who does everything possible and still regularly has hyperglycemia? I guess they should have tried harder. Obesity...don't even bother coming to the hospital. Suffering will be a fitting punishment for those weak people who made poor health care choices, while you will omnisciently decide who truly deserves medical care and who doesn't.

Next time I meet a patient who needs treatment for one of these conditions, I will be sure to send their family on over to you so that you can explain to them that even though their loved one's condition is treatable, you have judged them undeserving of receiving medical care and they should go home to die. Hmm, yeah, that's really a much more equitable solution than banning TFAs in restaurants.

 

[dpmd]

He never said not to treat them. He merely advocated making them actually have some financial responsibility. I have seen many people taking advantage of (and I do mean taking advantage of) the county system who take no personal responsibilty for their health and also are offended by the idea they should have to put forth a single dollar for their care. I know it isn't all of them, but the ones that have their cell phones and brand name shoes on make me want to scream. Then they leave in their new SUV to go watch their direct TV at home. I am not saying they are in a position to afford thousands of dollars of medical care, but why aren't they made to pay what they can?

 

[Miami_med]

OK, so people who don't follow your rules for a healthy lifestyle should be denied medical treatment and left to die. If someone who drinks too much develops liver disease, we should deny him/her medical care because that was their choice, right? I guess a genetic predisposition to alcohol addiction is no excuse. What about a brittle diabetic who does everything possible and still regularly has hyperglycemia? I guess they should have tried harder. Obesity...don't even bother coming to the hospital. Suffering will be a fitting punishment for those weak people who made poor health care choices, while you will omnisciently decide who truly deserves medical care and who doesn't.

Next time I meet a patient who needs treatment for one of these conditions, I will be sure to send their family on over to you so that you can explain to them that even though their loved one's condition is treatable, you have judged them undeserving of receiving medical care and they should go home to die. Hmm, yeah, that's really a much more equitable solution than banning TFAs in restaurants.

This is not actually what I said at all, though your reaction to my statement is a vivid example of the problem. All I said was that I (Read any taxpayer) should not have to PAY for other people's poor choices. I am not a socialist, or a communist, or any other sort of politico that believes that everyone is responsible for the actions of everyone else. I NEVER said that these people shouldn't have the ability to get care. They can purchase private insurance, pay cash, seek charity, or *gasp* take some responsibility for the actions that put them in the hospital in the first place. Believe it or not, even I have been known to help some people who have made poor choices when I am not coerced into doing so.

Also, drop the stupid genetics examples. Most diseases, especially these adult onset diseases that we are referring to, are a combination of environment and genes. Just because it is harder for someone to stop drinking doesn't mean that they have no responsibility to stop or that I should pay for all of there care if they do not stop. As for the initial example in this thread, I don't buy that there is an evil trans fat addiction gene that causes hordes of people to gorge themselves uncontrollably. Heart disease and diabetes are in large part the result of lifestyle choices that have only become possible due to the abundance of the 20th and 21st centuries. All of these people could go back to a peasant diets of the 19th century and not get these disorders. I am not advocating that, as I don't believe in controlling people's personal decisions. However, the argument that they have no choice is completely bogus.

 

[beetlerum]

I NEVER said that these people shouldn't have the ability to get care. They can purchase private insurance, pay cash, seek charity, or *gasp* take some responsibility for the actions that put them in the hospital in the first place. Believe it or not, even I have been known to help some people who have made poor choices when I am not coerced into doing so.

How will we implement this system of selectively denying people coverage for making poor lifestyle choices? Sounds like a lot of government bureaucracy to me. Will we have case workers to conduct lengthy evaluations and then decide who the "unworthy" are?

On a different note, I've already pointed out that you can't avoid spreading the cost of these illnesses simply by not paying for them. And you would need a way to do the evaluation quick, because if we don't deny the "unworthy" emergency care, we'll definitely spread the cost. We'll spread it anyway, but if we give them emergency treatment, then there's no hope of getting them and their familiies to bear the entire amount. I think this will be tough. As others have pointed out, EDs are already overburdened. I don't think they have time to add an extra process to evaluate worthiness.

 

[Miami_med]

How will we implement this system of selectively denying people coverage for making poor lifestyle choices? Sounds like a lot of government bureaucracy to me. Will we have case workers to conduct lengthy evaluations and then decide who the "unworthy" are?

On a different note, I've already pointed out that you can't avoid spreading the cost of these illnesses simply by not paying for them. And you would need a way to do the evaluation quick, because if we don't deny the "unworthy" emergency care, we'll definitely spread the cost. We'll spread it anyway, but if we give them emergency treatment, then there's no hope of getting them and their familiies to bear the entire amount. I think this will be tough. As others have pointed out, EDs are already overburdened. I don't think they have time to add an extra process to evaluate worthiness.

Well,

If you ask me, I'd say that we shouldn't have the government paying for ANYONE's medical care. That of course would fix the problem. That being said, this would be no more or less convoluted than any other stupid government scheme for determening benefits. In a free market the costs WOULD NOT spread. It is only through coercion that someone HAS to pay for someone else's mistake. Unless of course you're attempting to argue that everyone else is entitled to the productivity of the affected individual.

Society is not some large faceless entity, it is a compilation of individuals. What is good for the individual eventually benefits the society, as society is nothing but individuals. The question of course becomes, who should make decisions. Goodness is hard to define. What is good for one may not be good for another. The point of life isn't just to live as long as possible. We all take varying amounts of risk in life to enhance the quality of the life we live. These can be skiing, driving, bungee jumping, eating crap, or just working too hard. The best person to judge the proper amount of risk is the individual taking the risk. If we don't force other people to pay for their mistakes, people will be able to make these decisions without hurting other people who do not choose to associate with them. I am not RESPONSIBLE for you. I can CHOOSE to help you, but you do not have a RIGHT to my aid.

I'm sure I'll just get flamed for pointing this out, complete with a lecture from someone about how not wanting the government to intervene in every facet of our lives proves that I am evil and non-compassionate.

 

[Faebinder]

Well,

If you ask me, I'd say that we shouldn't have the government paying for ANYONE's medical care. That of course would fix the problem. That being said, this would be no more or less convoluted than any other stupid government scheme for determening benefits. In a free market the costs WOULD NOT spread. It is only through coercion that someone HAS to pay for someone else's mistake. Unless of course you're attempting to argue that everyone else is entitled to the productivity of the affected individual.

Society is not some large faceless entity, it is a compilation of individuals. What is good for the individual eventually benefits the society, as society is nothing but individuals. The question of course becomes, who should make decisions. Goodness is hard to define. What is good for one may not be good for another. The point of life isn't just to live as long as possible. We all take varying amounts of risk in life to enhance the quality of the life we live. These can be skiing, driving, bungee jumping, eating crap, or just working too hard. The best person to judge the proper amount of risk is the individual taking the risk. If we don't force other people to pay for their mistakes, people will be able to make these decisions without hurting other people who do not choose to associate with them. I am not RESPONSIBLE for you. I can CHOOSE to help you, but you do not have a RIGHT to my aid.

I'm sure I'll just get flamed for pointing this out, complete with a lecture from someone about how not wanting the government to intervene in every facet of our lives proves that I am evil and non-compassionate.

Hey listen, no one is saying your wrong, it's just a matter of balance... too much control vs no control is an endless debate... the point is though.... Trans Fat Acids limitation in restraunts is a must... It no longer is an indivisual person issue... it's all our problem as more people come to the ER and dont pay for their medical care.

 

[Miami_med]

Hey listen, no one is saying your wrong, it's just a matter of balance... too much control vs no control is an endless debate... the point is though.... Trans Fat Acids limitation in restraunts is a must... It no longer is an indivisual person issue... it's all our problem as more people come to the ER and dont pay for their medical care.

#1: Is there any evidence that people who eat trans fat pay for medical care at a lower rate than the population at large. Unless you have such evidence, it is quite possible that those who do pay their bills are funding those very ERs that are in trouble and allowing them to stay open.

#2: If we didn't mandate that the ERs treat these people, then it is not all of our problem. We might have to *gasp* return to the pre-EMTALA world of the 1980s. We all remember the fire and brimstone that rained upon the earth at that time.🙄

 

[beetlerum]

Well,

If you ask me, I'd say that we shouldn't have the government paying for ANYONE's medical care. That of course would fix the problem. That being said, this would be no more or less convoluted than any other stupid government scheme for determening benefits. In a free market the costs WOULD NOT spread.

No, it will spread. That's the whole idea of a negative externality, which is a free market phenomenon.

Unless of course you're attempting to argue that everyone else is entitled to the productivity of the affected individual.

It's not a question of entitlement. The point is you say you don't want to pay for the health care costs of other people. My rather uncontroversial point, from an economic standpoint, is that you can't avoid those costs. They will show up in one form or another. You may be better off helping paying for other people's care, like it or not.

The best person to judge the proper amount of risk is the individual taking the risk.

Exactly, and that's why the government shouldn't be in the business of deciding who has taken too many health risks. Whatever you think about public benefits programs, I think you have to agree that it is not feasible to evaluate everyone's behavior and selectively give coverage to the deserving. People will lie about their past. What are you going to do? Have an army of case workers interview their friends and family? And the emergency care issue is a big problem. I guess you would have to have a policy of not treating anyone who couldn't immediately present cash or an insurance card, even for dire emergencies. Remember that EDs bill everyone. In fact, they bill the uninsured at higher rates. The problem is just that some people don't pay. So you would have to figure out very quickly in advance who can pay.

 

[Miami_med]

Well,



No, it will spread. That's the whole idea of a negative externality, which is a free market phenomenon.



It's not a question of entitlement. The point is you say you don't want to pay for the health care costs of other people. My rather uncontroversial point, from an economic standpoint, is that you can't avoid those costs. They will show up in one form or another. You may be better off helping paying for other people's care, like it or not.



Exactly, and that's why the government shouldn't be in the business of deciding who has taken too many health risks. Whatever you think about public benefits programs, I think you have to agree that it is not feasible to evaluate everyone's behavior and selectively give coverage to the deserving. People will lie about their past. What are you going to do? Have an army of case workers interview their friends and family? And the emergency care issue is a big problem. I guess you would have to have a policy of not treating anyone who couldn't immediately present cash or an insurance card, even for dire emergencies. Remember that EDs bill everyone. In fact, they bill the uninsured at higher rates. The problem is just that some people don't pay. So you would have to figure out very quickly in advance who can pay.

As to your first comment, CHD and DM are not contagious, and this is a moot point. Your second point may be "uncontroversial," but it is still wrong. The costs can be avoided by anyone who is not the person making the decision, as I have said before, as long as there is no coercion. As to your third point, I TOTALLY AGREE, which is why I can't understand what makes you think that government interference into private decision making is a good idea. I already pointed out (albeit sarcastically) that in the pre-EMTALA world, there were not mass epidemics or death in the streets.

 

[beetlerum]

As to your first comment, CHD and DM are not contagious, and this is a moot point. Your second point may be "uncontroversial," but it is still wrong. The costs can be avoided by anyone who is not the person making the decision, as I have said before, as long as there is no coercion.

Why do you mean "wrong?" You're going to have to hold a press conference. Imagine, every health econ course teaching about negative externalities when, whoops, they don't exist. Do you not believe in negative externalities at all? Or just not with health?

When people don't have health care, they tend to be sicker. This causes them to be less productive at work, take worse care of their children, default on loans from making less money (poor health is a leading cause of bankruptcy), be less likely to get training to become more productive at work, take less good care of their homes, and so forth. When children get sicker, they do worse at school and don't get the same quality of education. Put it this way, your loan payments are slightly higher because bad health is causing some people to default.

On top of all that, we are probably not going to stop all emergency care. It seems unlikely that hospitals are going to get together and resolve to immediately eject at the door the next MI who doesn't have health insurance or sufficient cash. So in practical terms, the cost will continue to be passed on in that form as well.

 

[dpmd]

The health outcome from eating TFA's is not an externality. The party consuming this good is the one who suffers the health consequences. Particles of it are not aerosolized during consumption resulting in exposure to individuals not party to the transaction. The effects are not passed to individual in contact with the consumer. This is strictly a matter of a negative consequence of consuming a particular commodity which people can factor in their decision whether to consume this or not (similar to the way that someone can choose not to eat foods containing lots of calories if they don't like the weight they gain by the end of the year).

The problem that we have created by fostering a society in which people feel entitled to medical care without cost (or at unrealistic cost) is a moral hazard. People can abuse their bodies in a variety of ways with the understanding that modern medical care can return them to a whole state (not that this is true even if people paid full cost for their care). The perception is that I can do whatever I please and the government will bail me out.

The attempt to counter this problem by restricting personal freedom in this manner is upsetting to me and evidently several others on this forum. I can see where this path leads and it is counter to the the principles this country is founded upon.

I am not saying the government should not intervene in areas where true externalities cause serious damage. However, it is frequently better to deal with externalities by forcing the cause of the externality to internalize costs.
In this case where there is no externality, I don't feel it is appropriate for the government to respond with increased regulation. However, if they want to create more limitations on the level of care that is mandated for uninsured/underinsured patients (or if insurers want to add riders that make you ineligible for certain high cost procedures if your own actions can be shown to have caused the need for them) that would be a more appropriate response. People would them have to turn to charitable organizations, their family, or other methods to get the care they desire.

 

[beetlerum]

The health outcome from eating TFA's is not an externality. The party consuming this good is the one who suffers the health consequences. Particles of it are not aerosolized during consumption resulting in exposure to individuals not party to the transaction. The effects are not passed to individual in contact with the consumer. This is strictly a matter of a negative consequence of consuming a particular commodity which people can factor in their decision whether to consume this or not (similar to the way that someone can choose not to eat foods containing lots of calories if they don't like the weight they gain by the end of the year).

The problem that we have created by fostering a society in which people feel entitled to medical care without cost (or at unrealistic cost) is a moral hazard. People can abuse their bodies in a variety of ways with the understanding that modern medical care can return them to a whole state (not that this is true even if people paid full cost for their care). The perception is that I can do whatever I please and the government will bail me out.

The attempt to counter this problem by restricting personal freedom in this manner is upsetting to me and evidently several others on this forum. I can see where this path leads and it is counter to the the principles this country is founded upon.

I am not saying the government should not intervene in areas where true externalities cause serious damage. However, it is frequently better to deal with externalities by forcing the cause of the externality to internalize costs.
In this case where there is no externality, I don't feel it is appropriate for the government to respond with increased regulation. However, if they want to create more limitations on the level of care that is mandated for uninsured/underinsured patients (or if insurers want to add riders that make you ineligible for certain high cost procedures if your own actions can be shown to have caused the need for them) that would be a more appropriate response. People would them have to turn to charitable organizations, their family, or other methods to get the care they desire.

The point, for the zillionth time, is that bad health itself carries negative externalities. So yes, there is an externality if TFAs are bad for you. I'm not taking any position on TFAs or banning them.

 

[dpmd]

You are using an economic term to describe a societal problem. You say bad health carries negative externalities. I take exception to that terminology. It implies that you believe there is a transaction between someone selling bad health and someone purchasing bad health where both benefit, but society is harmed. There is no marketplace where actual health is bought and sold. A variety of factors are involved with determining whether a person will be healthy or not. The person that ends up with bad health bears a cost, and in our society it is possible that society will bear costs as well. That does not make it an economic externality that can be dealt with in the same way pollution from a industrial plant is dealt with.

 

[Miami_med]

The point, for the zillionth time, is that bad health itself carries negative externalities. So yes, there is an externality if TFAs are bad for you. I'm not taking any position on TFAs or banning them.

This theoretical person who is less productive at work will be passed over for promotions, fired, or still function at a sufficient level to do his job. Your whole premise rests on the false assumption that society is somehow entitled to the work of the individual. I believe that you are incorrectly defining a negative externality. The only people that are being "hurt" in this case are those that are not entitled to the benefit that is being "taken away."

In a free market, this individual would face the consequences of his poor decisions, and those that made good decisions would benefit, as their productivity would earn them more money in the end compared to this theoretical non-productive individual. When this individual gets too sick to work at all, he will either pay for medical care through his now more modest savings (which will be economically beneficial to those providing the care), seek charitable aid (which will all be given by choice), or succumb to his illness (unfortunate, but everyone WILL eventually succumb to something, and there are only so many resources in the world to treat people).

 

[beetlerum]

This theoretical person who is less productive at work will be passed over for promotions, fired, or still function at a sufficient level to do his job. Your whole premise rests on the false assumption that society is somehow entitled to the work of the individual.

You say this:

If you ask me, I'd say that we shouldn't have the government paying for ANYONE's medical care. That of course would fix the problem. That being said, this would be no more or less convoluted than any other stupid government scheme for determening benefits. In a free market the costs WOULD NOT spread. It is only through coercion that someone HAS to pay for someone else's mistake.

The point I keep making is that this assertion is false, or at best, greatly oversimplified. The problem is not "fixed" by not paying for people's care, because of the societal costs of having people be in worse health. These costs do spread. It has nothing to do with whether you're entitled to those gains or not. You say you can avoid the costs by not paying for health care. I have, in response, made two points: 1) You cannot avoid those costs so easily because of the societal costs of bad healthand 2) You probably cannot even avoid the direct passing of medical costs because we are not going to stop giving uninsured people any emergency care.

It is not true that only the guy in poor health is hurt by his lack of good health. Society is hurt. It doesn't matter that he will be passed over for promotion. It will still result in a marginal loss of productivity to society. According your logic, a virus could incapacitate 10% of the population and there would be no economic effects since each person, looked at individually, will just get passed over in favor of a healthy person. But clearly that is not what would happen.

 

[Miami_med]

You say this:

2) You probably cannot even avoid the direct passing of medical costs because we are not going to stop giving uninsured people any emergency care.

It is not true that only the guy in poor health is hurt by his lack of good health. Society is hurt. It doesn't matter that he will be passed over for promotion. It will still result in a marginal loss of productivity to society. According your logic, a virus could incapacitate 10% of the population and there would be no economic effects since each person, looked at individually, will just get passed over in favor of a healthy person. But clearly that is not what would happen.

To the first thing, I never said that we would completely. I said we should stop paying for it.

As to the bolded statement: SOCIETY IS NOT ENTITLED TO HIS PRODUCTIVITY. Society doesn't own. Society is a makeup of individuals who own individually. The idea of a virus killing 10% of the population would cause a temporary restructuring of the economy, but in the end, we would be supporting 10% fewer people. The total productivity might go down, but the productivity per person wouldn't change. This is also irrelevant, because it hasn't happened.

 

[DragonWell]

I have no problem with a law that says that we won't pay for the diabetic if he fails to control his blood sugar. That solves your cost problem and my payment problem without invading anyone's privacy.

Well, If you ask me, I'd say that we shouldn't have the government paying for ANYONE's medical care. That of course would fix the problem.

Ah, OK, I see now. What you were really trying to say is the gov't shouldn't pay for anyone's care. At least this position makes more sense than trying to ration out medical care based on how well someone manages their diabetes. I think you may have some problems convincing people that it is in the best interest of society to let someone bleed out on the steps of the hospital because they don't have an insurance card, but, well, good luck with that.

#2: If we didn't mandate that the ERs treat these people, then it is not all of our problem. We might have to *gasp* return to the pre-EMTALA world of the 1980s. We all remember the fire and brimstone that rained upon the earth at that time.🙄

Just an observation, but I notice you seem to use the phrase "these people" with some regularity. I find this interesting since it seems to suggest some disconnection between "those people" and the rest of us. I myself have been in the unfortunate position of presenting to the ER at 3 in the morning with acute progressive dyspnea and no health insurance, although I was working over full-time. I didn't plan on getting sick, but I got stuck, and if not for the safety net of EMTALA, it is quite possible that I might not be sitting here typing this right now. Sometimes bad things happen unexpectedly and suddenly, and good people find themselves in bad situations needing help.

Also, drop the stupid genetics examples. Most diseases, especially these adult onset diseases that we are referring to, are a combination of environment and genes. Just because it is harder for someone to stop drinking doesn't mean that they have no responsibility to stop or that I should pay for all of there care if they do not stop. As for the initial example in this thread, I don't buy that there is an evil trans fat addiction gene that causes hordes of people to gorge themselves uncontrollably. Heart disease and diabetes are in large part the result of lifestyle choices that have only become possible due to the abundance of the 20th and 21st centuries. All of these people could go back to a peasant diets of the 19th century and not get these disorders. I am not advocating that, as I don't believe in controlling people's personal decisions. However, the argument that they have no choice is completely bogus.

It's surprising to me that someone attending a modern medical school would be so quick to dismiss genetic influences on illness. Genetics are vital to this discussion because they represent hidden modifiers of risk that the individual has no control over. One person may eat a very healthy diet, but carry a gene for familial hypercholesterolemia, while someone else may eat a very unhealthy diet but not have the gene. Both may end up in your ER with an MI and no health insurance. If you deny them care since, according to you one can control their risk of an MI through the choices they make, aren't you basically punishing one patient for the genes they carry, something they have absolutely no control over?

I'm sure I'll just get flamed for pointing this out, complete with a lecture from someone about how not wanting the government to intervene in every facet of our lives proves that I am evil and non-compassionate.

I don't even know you; I'm certainly not going to judge you as evil or non-compassionate. Believe it or not, I consider myself a libertarian on most social issues. In the long run, I think encouraging good health and good choices through education is infinitely preferable to banning something. In this case, however, TFAs are invisible enough and harmful enough that I think a little interference is justified, especially when most people will not even notice the difference.

 

[Miami_med]

Ah, OK, I see now. What you were really trying to say is the gov't shouldn't pay for anyone's care. At least this position makes more sense than trying to ration out medical care based on how well someone manages their diabetes. I think you may have some problems convincing people that it is in the best interest of society to let someone bleed out on the steps of the hospital because they don't have an insurance card, but, well, good luck with that.

I suspect that they would begin to present to the charity hospital instead. This is exactly what people used to do.

Just an observation, but I notice you seem to use the phrase "these people" with some regularity. I find this interesting since it seems to suggest some disconnection between "those people" and the rest of us. I myself have been in the unfortunate position of presenting to the ER at 3 in the morning with acute progressive dyspnea and no health insurance, although I was working over full-time. I didn't plan on getting sick, but I got stuck, and if not for the safety net of EMTALA, it is quite possible that I might not be sitting here typing this right now. Sometimes bad things happen unexpectedly and suddenly, and good people find themselves in bad situations needing help.

I am using that phrase in order to differentiate between people who are paying and not paying. I find no other disconnect. If you tried to not pay, you would fall into that group as well.

It's surprising to me that someone attending a modern medical school would be so quick to dismiss genetic influences on illness. Genetics are vital to this discussion because they represent hidden modifiers of risk that the individual has no control over. One person may eat a very healthy diet, but carry a gene for familial hypercholesterolemia, while someone else may eat a very unhealthy diet but not have the gene. Both may end up in your ER with an MI and no health insurance. If you deny them care since, according to you one can control their risk of an MI through the choices they make, aren't you basically punishing one patient for the genes they carry, something they have absolutely no control over?

I am not denying them anything. This statement makes it sound like I have interfered with them using something that they already have. I help MANY people who can't afford care. I have been involved in many programs that do this. However, I do NOT support funding for these things being taken from me or anyone else by force. This government stealing from the rich and giving to the poor concept is like condoning the Sheriff of Notingham playing Robin Hood. I am not punishing them. Care isn't free. We are all different, and we all have strengths and weaknesses. This argument could be taken to an infinite extreme. I believe wholeheartedly that they should have EVERY RIGHT to pursue aid for these conditions without interfering with the rights of others.

I would suggest however, that it would be in the best economic interest of the hypercholesterolemic to take medication to control this condition EARLY in order to avoid complications in the future. This will be MUCH cheaper. An individual who is proactive about his own health will start treatment at his time, because he will have to pay for the consequences in the future. This is no different than the Prilosec that I pay for in order to prevent Barret's Esophagus as a consequence of my Hiatal Hernia. I got that thing in my late teens, and I can assure you that it has a genetic basis in connective tissue laxity. I still pay for my own medication.

I am familiar with genetics. I am familiar with genetic variation and mutation. I assure you that some of these more severe problems are even in my own family. That doesn't give anyone the right to steal.

I don't even know you; I'm certainly not going to judge you as evil or non-compassionate. Believe it or not, I consider myself a libertarian on most social issues. In the long run, I think encouraging good health and good choices through education is infinitely preferable to banning something. In this case, however, TFAs are invisible enough and harmful enough that I think a little interference is justified, especially when most people will not even notice the difference.

This is a slippery slope. NYC, which recently banned trans fats, is now proposing a program where the government will monitor diabetic blood sugars. I have less problem with mandatory reporting. However, if a business wants to use trans fats and the consumer wants to consume them, then no one should interfere in this transaction.