OCW2020: Health and Obesity Care Behind the Velvet Rope

The future for health and obesity care looks bright. Or dismal. It all depends on the velvet rope that governs access to care. This is why we’re focusing today for Obesity Care Week on the access to health and obesity care. Because if you have good access to care, you’ve got options and they’re getting better all the time. If not, then those options are meaningless.

The Velvet Rope Economy Meets Healthcare

In general, we see a lot of angst about the velvet rope economy. This is the concept that life is good if you’re inside the velvet rope. You can ride in comfort on a plane. You can even have your own airport terminal at LAX. If not, let’s just say you get less. You’re in boarding group nine. You’re not buying a spot for boopsie at an elite university.

Indeed, the velvet rope economy has become a big business, writes Nelson Schwartz:

There has always been a gap between the haves and have-nots, but what was a tiered system in America is morphing into a caste system. As the rich get richer and more businesses focus exclusively on serving them, there is less attention and shabbier service for everybody who’s not at the pinnacle.

The richest 1 percent of Americans live nearly 15 years longer on average than the poorest 1 percent, according to a 2016 study in JAMA. And that disparity is increasing.

Back of the Line

For a time, access to healthcare insurance was improving. Under the Affordable Care Act, approximately 20 million Americans gained health insurance who never had it before. Experimental evidence gave us reason to believe that more insured lives meant fewer lives lost.

However, the trend stopped in 2016. After that, the number of people without health insurance began to rise and hit a four-year high in late 2018. The number of children without health insurance is spiking, too.

On top of this gloomy picture for health insurance generally, the story for obesity care is worse. Most decent health plans cover the expensive complications of untreated obesity: diabetes, heart disease, liver disease, cancer, and a long list of other ailments. But obesity care, not so much. The system treats it like a luxury. Go to the back of the line.

Health and obesity care will share the same fate. If we continue to neglect needed care for obesity, the burden of other chronic diseases will continue to grow. Health insurance will become ever more unaffordable. People will suffer and die needlessly.

The Inside View

Inside the velvet rope, though, it all looks good. Medical technology advances. Obesity care improves. Bring the money and you’ll live a longer and healthier life. Except for one thing – it’s unsustainable. As disparities grow, people grow angrier. Civic life becomes messy. Extreme politics flourish and disruption becomes inevitable.

Can we find a smoother way to deliver better access to care for the masses? We hope so. The alternatives are ugly.

Click here for a look back at the effects of the Affordable Care Act in Health Affairs and here for more on access to care for obesity. For perspective on the standard of care for healthcare providers and payers, click here.

Velvet Rope, photograph © Lori / flickr

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March 5, 2020