Obesity and Health Costs

By Tom Colin, CQ Researcher Managing Editor
July 29, 2009

It occurs to me that when you’ve been in the news biz as long as I have (don’t ask, and I won’t tell) there is one phrase in French that’s indispensable because it sums up so much of what we do: “Plus ça change, plus c’est la même chose” – “The more things change, the more they stay the same.”

Take the just-released report on the link between obesity and soaring health-care costs. Among its mind-blowing findings:

*Americans who are 30 or more pounds over healthy weight cost the country an estimated $147 billion in weight-related medical bills in 2008;

*Obesity accounts for 9.1% of all medical spending, up from 6.5% in 1998;

*Overall, an obese patient has $4,871 in medical bills a year compared with $3,442 for a patient at a healthy weight.

*About 34% of adults—more than 72 million Americans – were obese in 2006.
Indeed, as CQ Researcher health-care specialist Marcia Clemmitt reported last year in “Heart Health” (Sept. 12, 2008):
With obesity rates rising steeply, waves of high-cost heart-disease patients will drive health-system costs sky-high over the next few decades, according to David Herrington, a professor of internal medicine at the Wake Forest University School of Medicine in Winston-Salem, NC. High costs of caring for the first wave, made up of baby boomers, will begin hitting the system in the next few years. Among boomers, the number of heart-disease patients is "astronomically large," said Herrington.

The second wave will hit around 2030, as baby boomers' children, to date the most obese generation the United States has seen, begins aging into heart disease and other obesity-related chronic ills. At that point, "the lid is going to blow off vascular diseases, and it could bankrupt society," according to William Boden, a professor of medicine and public health at the State University of New York at Buffalo.
Which brings us back to “Plus ça change”….., because that’s pretty much what we have reported in several other previous CQ Researcher reports, including:

Rising Health Costs” (Marcia Clemmitt), April 7, 2006; and “Obesity Epidemic” (Alan Greenblatt), Jan. 31, 2003.

We’ll have the latest on rising health costs soon, in Marcia's forthcoming report on “Health Care Reform,” August 28.

Tom Colin
Managing Editor

Energy and Climate

Below are the Introduction and Pro/Con sections from the "Energy and Climate" report by Marcia Clemmitt, July 26, 2009.


Congress and the Obama administration are advancing policies directly aimed — for the first time — at cutting emissions from burning carbon fuels. The Environmental Protection Agency plans to regulate greenhouse-gas emissions, which scientists link to global warming. The House recently passed a comprehensive energy bill that would institute a “cap-and-trade” system imposing an increasingly tight cap on carbon emissions by requiring polluters such as electric-power companies to buy emission permits or switch to cleaner energy sources. The legislation is backed by most major energy and environmental groups. Some critics say the bill is fatally flawed, however, partly because the trading market in which big carbon-emitting companies may buy unused pollution permits will make carbon-fuel prices too unpredictable and open to manipulation. It's also unclear whether public support for regulating carbon will continue if the effort significantly raises prices for electric power and manufactured goods.

The Issues:
* Are climate-focused energy proposals too costly?
* Will the Waxman-Markey bill help reduce climate change?
* Will Democrats' alternative-energy policies produce enough energy?


Will the Waxman-Markey bill harm the economy?


Rep. Fred Upton, R-Mich. Ranking Member, Energy and Commerce Subcommittee on Energy and Environment. Written for CQ Researcher, July 2009

Our economy continues to struggle. We shed 467,000 jobs in June and have hemorrhaged 3.2 million since Jan. 1. In Michigan, unemployment has soared to 15.2 percent. Yet, despite our economic maladies, Democratic leaders are pursuing a reckless climate bill that would bankrupt America's working families with no guarantee of helping the environment.

The carbon mandates under cap and tax would mean the United States could not emit more in 2050 than we emitted in 1910, essentially requiring us to scale back emissions to a per capita level equivalent to those of the tiny coastal nation of Belize.

Study after study has predicted cap-and-tax will result in skyrocketing energy bills and massive job losses. The Congressional Budget Office conservatively estimated that meeting the mandated reductions would cost $864 billion, while some anticipate closer to $1.5 trillion. CBO predicted gasoline costs would increase by 77 cents per gallon and diesel by 88 cents.

It is not just inside-the-Beltway analysts forecasting exorbitant costs to families. In Michigan, Consumers Energy predicts hefty rate increases — in excess of 38 percent over the next 15 years — just to comply with cap and tax. The increases will surely be higher as Consumers did not take into account inflation or rising fuel and construction costs. Some Michigan manufacturers say they will solely operate at night, when electric rates are cheaper.

Efforts to improve the legislation with constructive amendments were blocked every step of the way. We sought to add consumer protections to safeguard working families, but were rebuffed. Efforts to include the world's leading emitters in the legislation were also thwarted.

Meaningful climate legislation requires global participation, especially by India and China. According to the July 16 edition of The New York Times, Energy Secretary Steven Chu said that if China's emissions of global warming gases keep growing at the pace of the last 30 years, the country will emit more such gases in the next three decades than the United States has in its entire history.

Without international participation, jobs and emissions will simply shift overseas to countries that require few, if any, environmental protections, harming the global environment as well as the U.S. economy.

We should take an “all of the above” approach to reducing emissions, with an emphasis on renewable sources of energy like wind and solar, as well as nuclear power. We can simultaneously preserve our environment and create jobs.


Daniel A. Farber Professor of Law, University of California Berkeley School of Law. Written for CQ Researcher, July 2009

In the short term, climate-change legislation will cause modest increases in energy costs but will help cut the federal deficit a bit. In the long run, it will safeguard us against dangerous changes in climate and help Americans become leaders in the emerging clean-tech industry.

One reason for the modest cost is that the legislation will create a cap-and-trade system rather than directly telling companies how much to reduce their emissions. Cap and trade is the brainchild of economists who believe conventional environmental regulation is too expensive. The whole purpose is to cut industries' costs. Companies will get “allowances” for each ton of carbon dioxide they emit. The total number of allowances is the “cap.” Companies can use the allowances themselves or sell them to other companies. That's the “trade” part of cap and trade, and it makes the program more cost-effective.

Under the bill that passed the House of Representatives, most allowances would be given away, but some would be auctioned. Auction proceeds would pay for government programs like vouchers for buying fuel-efficient vehicles and energy rebates for low-income consumers.

How much would this cost? The most reliable cost estimates come from the nonpartisan Congressional Budget Office rather than ideological advocates like the American Enterprise Institute.

A few weeks before the House passed the climate-change bill, the CBO estimated utilities would pay $15-$26 per allowance from 2010–2019. The impact on consumers would be small — a $20 charge per ton of emissions amounts to 1.4 cents per kilowatt-hour of electricity. CBO later admitted that its cost estimate had been on the high side, because it ignored other ways that companies could reduce their compliance costs.

When CBO's original report was released, opponents of the legislation squawked that the legislation would “cost” the government over hundreds of billions of dollars. It turns out that what the CBO meant was simply that the government was losing out on potential revenue by giving most of the allowances away instead of auctioning them. According to economists, auctioning permits is better.

And what about the deficit? CBO estimates that climate legislation would decrease the national debt by $24 billion over the next decade by allowing the federal government to earn income from auctioning allowances.

In short, climate-change legislation is not the huge economic burden claimed by opponents. It's a cost-effective way of combating a serious threat to our long-term well-being.

To view the entire report, login to CQ Researcher Online [subscription required], or purchase the CQ Researcher PDF.

From the CQ Researcher Archives: "Sickness Insurance", July 9 1934

Below are excerpts from the July 9, 1934 issue of CQ Researcher on "Sickness Insurance and Group Hospitalization"
New Plans for Meeting the Burdens of Sickness

Appointment by President Roosevelt on June 29. 1934, of a committee to formulate plans for a comprehensive system of social insurance, including insurance against sickness, has enhanced the likelihood that such protection will be made available to the people of the United States at the next regular sessions of Congress and the state legislatures, scheduled to meet in January, 1935.

The problem of providing against sickness and accident, always a difficult one for persons of small means, has been rendered more acute by the long-continued depression. Wide interest in group hospitalization plans and advance provision for medical services through fixed periodic payments has been stimulated meanwhile by the reports of the Committee on the Costs of Medical Care.

Present tendencies in the direction of group hospitalization and sickness or health insurance have disclosed sharp differences of opinion on these subjects in the ranks of the medical profession. The American Medical Association, the most representative body of American physicians, maintains its traditional attitude of hostility to group practice and health insurance, insisting that the present relationship between doctor and patient must not be disturbed. The American College of Surgeons, on the other hand, has recently assumed leadership in the movement for health insurance, recognizing that there are important groups in the population for whom adequate medical services are not now available.

Roosevelt on Need for Comprehensive Social Insurance

The importance of the problems raised by the high costs of medical care and the maldistribution of medical facilities were recognized by President Roosevelt while serving as governor of New York. “Because large groups of the population seem unable to provide themselves with adequate medical services,” he wrote in 1932, “the problem was of major importance five years ago.” Its importance had been vastly increased, he said, by the change in the economic situation since 1929.

In a special message to Congress. June 8, 1934, the President announced his conviction that a comprehensive system of social insurance was needed to provide security for the people of the United States. Fear and worry based on unknown danger contributed, he said, to social unrest and economic demoralization. It was the plain duty of the federal government under the Constitution to promote the general welfare by providing for that security upon which welfare depends. The great task of furthering the security of the citizen and his family through social insurance might well be undertaken next winter. This was not an untried experiment, for lessons of experience were available from states, from industries, and from many nations of the civilized world.

I believe there should be a maximum of cooperation between states and the federal government [Roosevelt continued]. I believe that the funds necessary to provide this insurance should be raised by contribution rather than by an increase in general taxation, Above all, I am convinced that social insurance should be national in scope, although the several states should meet at least a large portion of the cost of management, leaving to the federal government the responsibility of investing, maintaining and safeguarding the funds constituting the necessary insurance reserves.
In a radio speech on June 28, the President again asserted that the agencies of government should help provide “sound and adequate protection against the vicissitudes of modern life—in other words, social insurance.” He took the initial step the following day by creating the President's Committee on Economic Security to collect and coordinate information and formulate a program under which state and local governments might cooperate under federal leadership in solving the problem of insecurity.

The White House statement announcing appointment of the committee said that facts would he gathered and analyzed with regard to unemployment compensation, old age pensions, workman's compensation, health insurance, mothers' pensions, maternity benefits, and insurance against the special hazards of self-employment in small business and agriculture. Hearings will be held to obtain the views of labor, business, agricultural, social welfare, governmental, and other interests. “It is expected,” the White House statement concluded, “that the compilation of existing information, supplemented by newly-gathered facts, buttressed by national opinion revealed by the hearings, and summed under a final analysis, will constitute the most comprehensive treatment of the problem of economic and social well-being ever presented to the people.”

Opposition of American Medical Association to Insurance

A report submitted to the house of delegates by the Association's Bureau of Medical Economics asserted that “existing systems of insurance have failed to solve the problem of medical care for the people and have brought a great many evils along with some benefits.” Evidence was cited to indicate that the huge sums necessary for insurance might be expended in other forms of health care with much greater effect.
It is shown by documented evidence [the report declared] that insurance has nowhere reduced morbidity, that no actuarial basis has ever been set up that has not been proved defective, and that the vast sums required for insurance and the dominance of such systems in the political and social life of a country tends to focus attention on insurance to the exclusion of other forms of effort and therefore indicates that it is not the most effective method of meeting the problems of medical care for the mass of the people.
The Bureau cited a large number of recent writers to show that there was a widespread movement in insurance countries to substitute for sickness insurance some form of compulsory saving with payment of an immediate sum for medical services and the return of a portion of the unused savings for insurance needs. Fishbein has asserted that, after carefully scanning examples of socialized medicine in 23 European countries, he has found that “not one of them had been established as a success.”

In his recent volume on social insurance, I. M. Rubiuow expresses amazement that the medical profession is “so ignorant of the nature of health insurance.” Physicians could easily ascertain, Rub now asserts, that

1. Compulsory health insurance is not tied up with any specific plan for organization of medical aid.

2. That among all the various plans for providing medical aid under a compulsory health insurance system, the method of salaried full-time service—so hateful to the American tradition—is the least popular.

3. That medical organization under health insurance is almost the direct opposite to “state medicine,” and

4. That a system of free “state medical service” is an alternative that will eventually be forced upon the United States, if the working masses are not given the opportunity to pay for their medical needs collectively through the insurance method.

The only present alternatives for low-income groups, Rub now declares, are to go without necessary medical aid, or to receive it as an act of charity from a benevolent, profession. Both of these he believes to be unacceptable to the American people.

To view the entire report, login to CQ Researcher Online [subscription required]

Examining Forensics

Are new research and oversight needed?
By Kenneth Jost, July 17, 2009

Crime-scene investigations play an important role in gathering evidence for criminal trials — from fingerprints and blood samples to DNA and digital data. But expert witnesses known collectively as forensic scientists or criminalists must analyze the evidence to help the judge and jury determine a defendant's guilt or innocence. A congressionally mandated study, however, says major changes are needed to strengthen forensic science. The reliability of some identification techniques used in court is unproven, the report says, and even established techniques such as fingerprint analysis are less certain than commonly believed. In addition, crime laboratories are underregulated, underfunded and understaffed — and may have a conflict of interest because they are tied to law enforcement agencies. Criminal-defense lawyers are applauding the report, as are some forensics experts. But resistance from law enforcement agencies and crime labs themselves may slow or block reforms.

The Issues
* Does misuse of forensic evidence contribute to wrongful convictions?
* Should judges adopt stricter standards on the use of forensic science?
* Should crime laboratories be independent of law enforcement agencies?

To read an excerpt of the report click here.

To view the entire report, login to CQ Researcher Online [subscription required], or purchase the CQ Researcher PDF.

Overview of the report on Examining Forensics, July 17, 2009

By Kenneth Jost

George Rodriguez spent 17 years in a Texas prison for a rape he did not commit. Scientific evidence helped put him behind bars. Scientific evidence got him out.

Now, Houston is being ordered to pay Rodriguez $5 million for a wrongful conviction that a federal court jury blamed on “deliberate indifference” to systemic problems at the city's crime laboratory. It was erroneous testimony from the director of the crime lab's biology unit, James Bolding, that helped convict Rodriguez in 1987 of the kidnap-rape of a teenage girl. And it was DNA testing years later that helped prove Rodriguez was innocent and another suspect — wrongly cleared by Bolding's evidence — possibly the perpetrator. [1]

The June 25 verdict and seven-figure damage award in Rodriguez's civil trial came after years of controversy over mismanagement and alleged misconduct at the Houston crime laboratory. “They had a policy of inadequate supervision and training,” says Mark Wawro, one of Rodriguez's attorneys in the eight-day civil trial. “It was an absolute mess.”

The trial also played out against the backdrop of a larger national debate not only about crime labs but also about the role that scientific evidence plays in criminal trials. Crime labs around the country, understaffed and overworked, are facing criticism for being too closely tied to law enforcement. At the same time, many of their techniques — including seemingly well-established methods such as fingerprinting and ballistics analysis — are being critically examined as inadequately grounded in true science and routinely presented to juries and courts as more precise and more reliable than they actually are.

In a 255-page report released in February, the National Academy of Sciences' National Research Council (NRC) called for major changes in the way that forensic science is practiced, studied and governed in the United States. The report calls for:

*Mandatory accreditation of forensic science laboratories;
*Removal of public forensic laboratories from administrative control of police or prosecutors' offices;
*Individual certification of forensic science professionals;
*New standards and quality control procedures; and
*Creation of an independent National Institute of Forensic Science to help fund research and oversee the profession. [2]

Forensic science — derived from the Latin word for “forum” to refer to the use of scientific evidence in court — is receiving increased attention in the United States these days thanks to the highly rated “CSI” family of television shows focusing on crime-scene investigations in Las Vegas, Miami and New York City. The mastery of forensic techniques used by TV crime lab examiners to unravel the most puzzling of crimes has led prosecutors and defense lawyers alike to talk of the “CSI effect” in criminal trials. The supposed effect is said either to help prosecutors if they present convincing forensic evidence as part of their case or to help the defense if the prosecution's case is short of the kind of compelling evidence found on the fictitious TV shows.

The NRC's report notes that advances in forensic science — especially DNA technology — have helped law enforcement identify and convict many criminal offenders. But it also says that in some cases “faulty forensic analyses may have contributed to wrongful convictions of innocent people.”[3]

Rodriguez is one of four men released from prison in recent years because of belatedly found errors in trial testimony by Bolding or other Houston crime lab examiners. In 1987, Rodriguez was one of two suspects Houston police were investigating for the abduction and rape of a teenage girl after one of the assailants confessed but refused to identify his accomplice.

Forensic Science      Disciplines

Police charged Rodriguez after Bolding said an analysis of pubic hair found on the victim excluded the other suspect, Isidro Yanez, but not Rodriguez. Bolding later testified to the same effect in Rodriguez's trial.

That testimony, Bolding conceded during Rodriguez's civil trial for damages, was wrong, but he claimed he thought it was right at the time. Rodriguez's lawyers argued that it was more than wrong. They contended there was no scientific basis for excluding the other suspect — blood-typing analysis is not that precise — and that Bolding had to have known that at the time.

Fifteen years later, the Innocence Project took up Rodriguez's case. The New York City-based legal center has led the efforts to apply DNA testing to exonerate death-row inmates and other prisoners wrongfully convicted in the years before the more sophisticated identification technique became widely available. Tests showed the DNA evidence in the case did not come from Rodriguez but could have come from Yanez. Based on that evidence, Rodriguez was freed from prison in 2004 and his conviction set aside by the Texas Court of Criminal Appeals the next year. [4]

Representing Rodriguez in the civil trial, Wawro and Innocence Project co-founder Barry Scheck argued the city was blind to the risk of constitutional violations from shoddy work by the crime lab. Lawyers for the city blamed the wrongful conviction on Bolding, who resigned his post in 2003, as well as on bad lawyering by both the prosecutor and Rodriguez's attorney in his criminal trial.

After initially reporting a deadlock, the eight-person jury agreed that the city had been “deliberately indifferent” to the risk of constitutional violations from problems at the crime lab. The $5 million award to Rodriguez, 48, who is now working in construction in Houston, represented compensation for lost earnings and pain and suffering. The city's lawyers say they will review the trial transcript before deciding whether to appeal.

William C. Thompson, a professor of law and criminology at the University of California-Irvine who investigated problems at the Houston crime lab for the local television station KHOU, calls the verdict “a costly but important lesson” for the city and for other crime labs. “Verdicts of this type show government officials that failure to maintain oversight and quality control can be expensive,” he says.

Like Thompson, many other legal experts on forensic science are praising the National Research Council's (NRC) report for focusing attention on problems in the field that many practitioners have either minimized or denied. “There's quite a lot of problematic forensic science,” says Jennifer Mnookin, a professor at the University of California-Los Angeles (UCLA) Law School and coauthor of a recently published legal treatise on expert evidence. “We need a significantly more substantial research basis for all this science.” [5]

The president of the American Academy of Forensic Science agrees. “A number of very important forensic theories and methods that have been sending people to prison have never been scientifically validated,” says Thomas Bohan, a forensic science consultant in Peaks Island, Maine. But Bohan is also quick to note that forensic science practitioners were among those who called on Congress in 2005 to ask for the National Research Council study.

Bohan agrees with many of the recommendations in the report, including the removal of forensic science laboratories from control by law enforcement or prosecutorial agencies. The controversy in Houston has led to proposals, unacted on so far, to create an independent, regional crime laboratory. “It would be a good thing to get them out of police departments,” Bohan says, “but I don't think it's going to happen.”

Criminal defense lawyers are also praising the NRC report. “It's a great report,” says Betty Layne DesPortes, a lawyer in Richmond, Va., and vice chair of the National Association of Criminal Defense Lawyers' forensic evidence committee. “It's a strong call for reforms.”

Crime lab directors and prosecutors, however, temper any praise for the report with sharp criticism of many of its recommendations. “Overall, the community really embraces the report,” says Dean Gialamas, director of forensic science services for the Orange County (Calif.) Sheriff-Coroner's Office and president of the American Society of Crime Laboratory Directors. But he disagrees with the report's call for more scientific validation of forensic techniques now used in courtrooms. “The community feels that there's enough science in what we do,” he says.

“There are many, many good and positive things that can come from the report,” says Scott Burns, executive director of the National District Attorneys Association. But Burns says some of the proposals would be “crippling to the criminal justice system.” And he strongly defends the integrity of crime labs. “I very much disagree with the conclusion that they are not independent, not efficient, not professional or well-regulated,” Burns says. “I would say they are all of these things.”

Case Backlogs at U.S.      Crime Laboratories, 2002–2005

The two opposing criminal-law groups differ on the role forensic science has played in the wrongful convictions that have been uncovered in the past — more than 200 of them as a result of DNA testing. They also differ on the need for judges to be more assertive in policing the use of forensic evidence in criminal trials. The report faults judges for allowing the use of forensic evidence without “fully understanding” the limitations of some forensic science disciplines. But it also concludes, “Judicial review, by itself, cannot cure the infirmities of the forensic science community.”

The Issues

*Does misuse of forensic evidence contribute to wrongful convictions?
*Should judges adopt stricter standards on the use of forensic science?
*Should crime laboratories be independent of law enforcement agencies?

[1]For coverage, see Roma Khanna, “Jurors: 17 years worth millions,” The Houston Chronicle, June 26, 2009, p. A1. Some background drawn from daily trial coverage by Khanna or Mary Flood. For background on the Houston crime lab, see Jim McKay, “Houston PD Crime Lab Upgrades After Critical Investigation,” Texas Technology, April 28, 2008, http//www.govtech.com/tt/articles/301675?printall.

[2] “Strengthening Forensic Science in the United States: A Path Forward,” National Research Council, National Academies Press, February 2009, http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12589. For coverage of the report, see Jason Felch and Maura Dolan, “Report urges overhaul of crime lab system,” Los Angeles Times, Feb. 19, 2009, p. A9.

[3] Ibid., p. S-3. For background, see these CQ Researcher reports: Steve Weinberg, “Wrongful Convictions,” April 17, 2009, pp. 345–372 and Kenneth Jost, “DNA Databases,” May 28, 1999", pp. 449–472.

[4]The Innocence Project's account is at http://www.innocenceproject.org/Content/246.php.

[5]David H. Kaye, David E. Bernstein and Jennifer L. Mnookin, The New Wigmore: A Treatise on Evidence: Expert Evidence (2004).


To view the entire report, login to CQ Researcher Online [subscription required], or purchase the CQ Researcher PDF.

Treating Depression

Is effective treatment available?
By Marcia Clemmitt, June 26, 2009

Depression and suicide always increase in tough economic times, as indicated by a rash of suicides by men despondent over their families' financial troubles. Meanwhile, a wave of suicides and mental disorders — mainly post-traumatic stress disorder (PTSD) and depression — has hit military personnel returning from repeated deployments in Afghanistan and Iraq, swamping military health-care systems. Depression, the most common serious mental illness, is sometimes caused by genetics, but it also can be triggered by stress or trauma. Access to treatment has expanded in recent years, as more and more primary-care doctors screen for the disease. And a new mental-health-care “parity” law passed by Congress in 2008 is expected to increase insurance coverage as well as access to mental-health services. But many people with severe depression remain uninsured and dependent on public health-care programs, which recession-plagued states are cutting back as revenues dwindle.

To view the entire report, login to CQ Researcher Online [subscription required], or purchase the CQ Researcher PDF.