Marie & I Fix Food Stamps by Pat Conrad MD
A new study is claiming that worldwide obesity has hit 641 million, and that the two chubbiest offenders are the U.S. and China. I have no idea how to fix China (insert powdered rhinoceros horn-as-aphrodisiac joke here), but I’ve got an idea to help the home folks.
We have a large obesity population in the U.S., some (not all) of whom are clinically obese. We can extrapolate the probability that those on food assistance are also on government medicine programs, and so the cost of their care and feeding is a double whammy to the taxpayer.
Various sources put the total number of food stamp recipients between 45 and 47 million, so let’s go with 46 million. The CDC estimates that 35 % of the population is clinically obese. If we apply that figure to the food stamp rolls, we get 16,100,000 predicted food stamp recipients who are obese. As physicians – I hear from the media, the government, organized medicine, and do-gooder colleagues – it is our sworn duty to improve the health of people whether they want it or not. The Kaiser Family Fund as well as official government data tell us that the average individual food stamp benefit per month is about $125 – $133, for a total expenditure of about $84 billion annually according to the Heritage Foundation, or just $29 billion annually for the predicted obese (Frankly I suspect these figures are grossly, deliberately skewed low, but that is mere editorializing until I can prove it).
Last year Medicaid costs were over $475 billion, for over 70 million patients, which averages about $6,800 per patient. Studies have proposed that obesity-related costs account for over 20% of health care spending, about $ 95 billion in the Medicaid outlays. Can we use reform the food stamp program to reduce that cost? Let’s presume that all food stampers are on Medicaid, a pretty safe bet. Of the 70 million on Medicaid, 46 million are on food stamps, 35 % of which we will conservatively predict to be obese.
So 16,100,000 obese food stamp consumers X $6,800 per year = $109.4 billion. Twenty percent of their costs, the added obesity load, equals about $22 billion.
Are you still with me? Stand up stretch, grab a diet soda…here we go.
So how can we fix all this? Simple: Nutrisystem. Yep, that ubiquitous ad, non-stop slimming hype machine, that different sources claim can feed one recipient nutritionally balanced meals for about $275/month, or $3,300 per year. I’m going with the lower figure, which allows far less choices and longer shelf-stability. As noted above, the taxpayer shells out about $84 billion annually in food stamps. Going up front to Nutrisystem for 46 million at 3,300 per year will cost about $152 billion, less the $22 billion saved in reduced obesity medical costs, for a base of $130 billion. The Brookings Institute reports that food stamps cost about $5 billion in annual administrative costs, so now we are down to $125 B. Now this is a government contract for one hell of a big new purchase, so don’t tell me Nutrisystem can’t negotiate a special rate for government clients. And they can purchase in bulk, so they can achieve further savings by reducing some of the customer support, options, variety, and nicer packaging enjoyed by paying customers, and pass those savings along. If the federal wizards can food stamp 46 million for $133/month, then I think a special NutriGovernment program can do it for $150/month, which kicks in a little for shipping costs, also less because they are in greater bulk (in rural areas, shipping could be to the residence, in urban areas, it could go to a central pickup spot). That gets us down to $82.8 billion, which means I just saved us all $28.2 billion in total food and medical costs (see above). Try doing that with quality measures.
What is the rationale behind this bold initiative?
1. Our stated popular goal is that “we can’t have our citizens starving and dying in the streets”, or some variant thereof. Fine. Nutrisystem claims to provide nutritionally balanced, portion-controlled meals.
2. Many of us decry the overt fraud in food stamps (selling them or food for liquor, smokes, etc), or the indirect fraud (saving by using food stamps, in order to buy liquor, smokes, etc.)
– It will be much tougher to commit fraud with foods delivered to one’s home, as opposed to EBT cards, or selling canned hams at big discounts for cash.
3. We worry about worsening obesity effects and costs. This directly addresses the problem by preventing beneficiaries to get fat on the dole. By removing the food stampers’ ability to purchase unhealthy food and drink, the problem will automatically be reduced, along with the average caloric intake.
Complaints will include:
– “What if the recipient doesn’t know how to cook?” For minimal costs, and instruction card on recycled paper can be included in the shipment. If the recipient can’t interpret that, then they should ask a neighbor for help.
– “Beneficiaries will complain about the lack of variety, or the taste of preselected foods.” I thought the goals were to prevent starvation, and improve nutrition. The goal of food stamps should not be to provide choice, taste, or convenience: those should be reserved for those who pay the damn bills. If someone doesn’t like the diet, then they are free to purchase their own. But a compassionate society has done its part. The bottom line is that instead of in-kind payments rife with the potential for bad choices, we simply give hungry people food, and obese people better food.
“Supermarket chains will lobby against this potential loss of revenue.” Yep, and hospitals lobby against serious Medicaid reform. How has that turned out? These detractors can be overcome by getting the Big Agriculture and the NutriGovernment reps on the same page.
Disclaimers:
1. Readers here will know that I am disdainful if not contemptuous of Big Government compassion, and the notion that doctors should do good by using government to force their happy intentions upon others. Moreover, I despise crony corporatism. What I propose above embraces all of these rotten philosophies, and no I don’t need a head CT – I’m just playing to our broader misappropriations. In my opinion NONE of this should happen on a national level. All I’m doing is the taking the soup kitchen model of the Great Depression and updating it for the 21st century.
2. I am not an actuary, accountant, or economist. My calculation of the medical obesity cost might be refigured by adding 20% to the total, rather than assigning it as part of current outlays. If my methodology is faulty, I welcome constructive criticism. I did not include my customary links above, but some of the reference sites I reviewed are listed below.
http://www.cdc.gov/obesity/data/adult.html
http://www.foodstamps.org/articles/article/2014/06/09/the-average-monthly-food-stamp-benefit-per-person-is-13342
http://kff.org/other/state-indicator/avg-monthly-food-stamp-benefits/
http://www.fns.usda.gov/sites/default/files/pd/34SNAPmonthly.pdf
http://www.cnbc.com/id/48898378
http://news.cornell.edu/stories/2012/04/obesity-accounts-21-percent-medical-care-costs
http://www.usnews.com/news/articles/2015/02/24/medicaid-enrollment-surges-across-the-us
https://www.thestreet.com/story/12981045/1/strong-and-under-the-radar-nutrisystem-ntri.html
Well put together piece! I have long advocated only staple and raw foods be allowed to be purchased with BET cards- I mean EBT. I would also like to see weight checks monthly and checks for any new tattoos. Recipients should also be required to take birth control of the 3 month injected variety if they are within childbearing age PRIOR to the monthly benefits given. I believe everyone should be allowed to eat what they want and have as many children as they want, but not on the public’s dime. I had 2 children because that’s what I could afford. If you can’t provide for yourself, DON’T BREED!
Wow this makes too much sense to ever be taken seriously. I’m sure a slightly more expensive version could be found for those without kitchens. ( A week’s worth of calories can be bought for very little in the form of bulk nuts from Costco, and fruits and vegetables don’t need cooking.) I have noticed though that my laborer son needs way more calories than this just to keep the muscles he needs to be productive on his skinny frame though. Maybe a limitless protein allotment could help in those situations, or so he might say. I don’t think most of the poor would complain about those frivolous things. That kind of thinking comes from the fact that we in medicine often see the worst of the poor, but if you make housecalls you can see many of our pleasant and grateful patients are also poor.
Agree completely about the purpose of medical care though. Another huge savings could come from stopping all the population health done on a one on one basis by smart and expensive people well trained to diagnose and treat, and maybe they’d have time to do what they are trained for. Crony capitalism is the real enemy.