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Dorian Venable, M.Ed, RD, LD, CHES, NASM-CPT, ACE-CFI

Abstract

A growing number of youth are becoming vulnerable towards chronic diseases in our community. Identifying childhood obesity is vital to prevent these high-risk groups from developing into comorbidity conditions, which are multitudes of chronic ailments. In the past, social economical factors leading to haphazard planning were considered responsible for poor nutritional outcomes and overweight issues. Current research indicates that comorbidity is more complex and requires educational preventive tools to overcome obesogenic environments. A series of relevant prevention protocols requires that each person find: valid awareness of obesogenic diseases, risk factors, and behavior modifications (16) (8).  Identify childhood obesity, as non-cosmetic problem is the first true step of preventing premature childhood development of chronic diseases.  The next step is to properly address childhood obesity as a critical point to prevent comorbidity, psychological, and social barriers within the community (27).  By implementing specific procedures to overcome diverse health disparities and help reduce health costs in both rural and urban communities (16) (18). Comorbidity conditions are directly connected to multiple morbidity and aggressive mortality. The more overweight the person the higher the risk factor of Comorbidity conditions. Comorbidity consists of the most common and challenging experiences pertaining to Hypertension, Coronary Heart Disease, and Non-Insulin Dependent Diabetes Mellitus. These three conditions develop simultaneously at a young age and are detrimental to ones health. 

Key Words

Comorbidity, Diabetes, Cardiovascular disease, Hypertension, and Childhood obesity

Introduction

The prevalence of childhood obesity in The United States had significantly increased. In the past two decades, the prevalence of adolescent children exposed to obesity status has tripled (23). In 1999, it was reported that the childhood obesity cost 7 million dollars (28). Comorbidity was one of the major reasons that contributed to healthcare cost. When childhood obesity occurs there is a higher risk of the development of more problematic and severe health conditions. These conditions will consist of Hypertension (HTN), Coronary Heart Disease (CHD), Non-Insulin Dependent Diabetes Mellitus (NIDDM), Dyslipidemia, and some forms of cancer. In addition, more immediate concerns of childhood obesity include sleep apnea, slipped capita femoral epiphysis, pseudotumor cerbri, and polycystic ovarian disease. Furthermore, in 1979-1999, as obesity rates tripled, there were more reported childhood cases of gallbladder diseases (28). There is a great concern of the obesity rate in children because it begins in childhood and continues into adulthood. Obesity is harder to control as it steeply increases in related incidents (4). This contributes to the total obesity problem in all ages, which brings about a total of billion dollars a year directly towards healthcare costs (18).  When controlling childhood obesity it is important to identify the different aspects of comorbidity in order to provide a clear path of prevention (19).

Comorbidity awareness starts with addressing the early stages before multiple chronic illnesses become evident. The first step is to create awareness of the multitudes of obesogenic diseases and all of its noncommunicable diseases pertaining to comorbidity (8).  The second step is to acknowledge the importance of interpersonal positive behavioral choices and how they are applied on a daily basis to prevent comorbidity from evolving into full-blown development (2).

 
The Problem

Each comorbidity condition is directly connected to being overweight. There are multiple calculations and measurements to determine if a person is at risk of being overweight such as Percentage of Ideal Body Weight (%IBW), Body Mass Index (BMI), Waist to Hip Ratio (WHR), waist circumference, and skin fold measurements. However, the physical growth chart is the best weight assessment tools for children to help measure their weight status category and percentile range (31). Figure 1 illustrates the different category of weight status according to the percentile range, which will help families to understand the results of physical growth chart. In America the majority of children today are above the 85th percentile for age (26). This indicates that the prevalence of children is at risk of being overweight

There are two reasons why a person would be at a higher risk factor for comorbidity. The first reason consists of a longer time span of remaining overweight. The second reason pertains to the amount of additional weight the person accumulated in a time period. Both reasons lead to negative conditions, which have preventable risk factors. These diverse negative conditions are aspects of comorbidity that consist of common and challenging experiences such as HTN, CHD, and NIDDM.

HTN establishes when blood pressure consistently remains elevated at high levels of 140/90 mmHg or higher. This condition could increase a person’s risk of heart disease and stroke. The damaging effects of high pressure exert stress along the small arteries, and make the blood vessels rough. These arteries (arterioles) become less elastic and thicker as LDL builds up resulting in Arteriosclerosis, which causes primary hypertension. (1) (32). 

A related cause of CHD is Atherosclerosis; a condition of plaque building up on the arterial walls. The arterial walls will become hardened and thickened over a period of time. Formation of plaque will causes blood clots to form, and decreases the blood flow of circulation. After the blood clot breaks free and start circulating, a hazardous condition known as embolus. When the embolus reaches the brain, it results in a blockage and forms a thrombus occurs. This is a blockage within the head, contributing to the development of an Ischemic stroke. Furthermore, a hemorrhagic stroke is caused by an aneurysm, which is a blood vessel rupturing in the brain from a weakened state (6).

NIDDM, better known as type 2 diabetes, is one of the major chronic diseases among Americans (20). Adolescent children who are diagnosed with NIDDM makeup 45% of all reported cases (28). NIDDM is a chronic disease that usually develops in adults at middle age or older. This condition affects younger age groups each year. Patients that have NIDDM are unable to effectively absorb glucose and utilize insulin. This condition is caused from elevated fat tissue that blocks the efficiency of insulin.  The American Diabetes Association (ADA) recommends a healthy diet, which helps control Blood Glucose Serum (BGS) and a person’s weight condition. 90% of all diabetics experience insulin resistance (17). This condition causes glucose to enter the cells at a slower rate. When insulin is present in the bloodstream some of the glucose goes back to the liver and is converted into triglycerides for adipose storage (fat cells). This action causes additional chronic weight gain.  Therefore, it is important that all diabetic diets incorporate lower fat as well as cholesterol dense food items (22).

Uncontrolled diabetes consists of hyperglycemia and hypoglycemia. These are conditions where BGS is above or below the normal optimal level. Patients experiencing extreme hyperglycemia are at risk of Hyperosmolar Hyperglycemic Non-Ketotic (HHNK). This is a condition that occurs when the BGS is above 600 mg/dl. In addition, uncontrolled diabetes promotes risk factors of multiple chronic diseases, such as macrovascular and microvascular diseases. Macrovascular diseases consist of cardiovascular complications, such as Coronary Heart Disease (CHD). Microvascular diseases consist of organ complications, such as optical atrophy (Retinopathy), nervous system atrophy (Neuropathy), and kidney atrophy (Nephropathy) (17) (3).

            Documented cases of children ranging from five to seven years old show the ability to increase the number of fat cells rapidly in that time period, which is known as advance hyperplastic development (21). In another related study, girls were observed and documented for being at risk of becoming overweight at five years of age, and had a tendency of remaining overweight. In addition, they were prone to self-initiated fad based diets that resulted in further increased weight gain. Girls who are at risk of obesity experience early puberty from being overweight or from rapid weight gain (15). As a result of increased need of proper dietary intake, the U.S. secretary of Agriculture and Health and Human Services introduced the Dietary Guidelines for Americans in 2005. This will help improve dietary intake of children to help manage weight issues and blood lipid serums.

These irregular blood lipid serums are contributed from plausible influences and growing challenges of hyperplastic and hypertrophic obesity. Hyperplastic obesity is the increased number of fat cells. Hypertrophic is an increased size of fat cells.   These conditions are biological factors contributing to elevated visceral fat and lipid bilayer.

 It is vital to help initiate the breakdown of obesogenic built environments in order to help prevent hyperinsulinemia, hypercholesterolemia, and leptinemia from forming and developing into comorbidity conditions (27).

Hyperinsulinmia is another possible factor that children face when they are over weight or obese. This type of metabolic complication provides excessive insulin in the response of glucose. It is due to the abundance of adipose cells interfering with the transfer of insulin to glucose. This puts the person at risk of insulin resistance, which is also known as NIDDM (27). In the mid-1990s there were new multiple cases of adolescent children being diagnosed with NIDDM (26). These new cases contribute to alarming statistics of children being exposed to hyperinsulinemia conditions.

Hypercholesterolemia is a form of dyslipidemia in which elevated LDL- cholesterol concentration becomes apparently chronic. Cross sectional data indicates a strong correlation between cardiovascular disease (CVD) and hypercholesterolemia. Another strong association of hypercholesterolemia is found in the development of children with obesity, which increases the risk factors of CVD. By the time the young child becomes an adolescent child their risk of CVD has significantly increased. By the time they reach adulthood CVD becomes a dominant factor for premature morbidity and mortality (29).

            Leptinemia occurs when fat cells become dense within the body. It acts as a hormone (chemical messenger), which effects proper energy regulation making the body more efficient in storing calories and less efficient in burning calories. Past research indicates that higher levels of fat were found in females, therefore higher risks of leptin concentration are found in females compared to males (31).  

Literature Review

A twenty-year span of research observation recorded drastic socioeconomic environmental changes of individuals who relocate to new areas. An example of this is when a person moves to another place without close positive social influences and routines, which causes the person’s dietary and physical activities to become significantly hindered (23).  This is known as an obesogenic environment, which is due to the complex socioeconomic factors, such as community, family, school, peers, and media that influence our daily quality of positive nutritional intake and physical activities (20). Building strong positive socioeconomic procedures is vital to overcoming an obesogenic built environment. Early prevention will help reduce the numerous physical ailments that originated from obesity, which affects healthcare costs (8). However, there are abundant psychosocial consequences from being obese, such as the indirect costs and long-term effects, which are harder to evaluate (23).  Some health professionals are facing childhood obesity by providing bariatric and liposurgery, which are acute procedures that are not meant for long-term results (7) (24).

A large national nutrition survey was used to analyze young children’s eating patterns. It identified that parents are in need of being better educated so they could provide a balanced meal for their children. The survey did not find a significant amount of children at any age that had a consistently balanced or moderate diet. Recent statistics indicate that the lack of nutritionally competent parental supervision has contributed to childhood obesity. Three decades ago, 5% of young children ranging in age two to five were becoming overweight by 2002 (5). That number had more than doubled, resulting in 10.4% of young children becoming overweight. Another study shows 16% of adolescent children ranging twelve through nineteen years of age are overweight and of those adolescent children 50% to 77% of will become overweight adults (30).

The absence of recent elevation of obesity rates indicates genetics is not dominantly responsible. A large national nutritional survey indicated negative findings of children not meeting Food Guide Pyramid and Dietary Guidelines for Americans (15).  The promotion of nutritional facts will help build a stronger nutritional foundation for young and adolescent children (12). Research indicates children with family history of cardiovascular disease eat about the same cholesterol and mean total fat intake as the other children. However, all the children in the study had over consumed cholesterol and total fat from their natural diets by 80 grams per day (13). An increase of cholesterol and total fat intake by children was contributed to lower parental education levels (14).  Over 60% of young and adolescent children had poor dietary habits of consuming elevated amounts of fat especially from saturated fat contents (28).

When utilizing the basic nutritional strategies there are six steps. First step is to establish strong eating patterns for meals and snack time. Second step is to focus on portion size control. Third step is to control better food choices to improve the quality of food intake. Fourth step is to eat less fat and fewer amounts of fried food items (14).  Fifth step is to provide early prevention through building strong parent-child-feeding relationships, which will influence later dietary habits (18). Sixth step is to construct early positive childhood food preferences, which will provide long-term effects on future food choices (25).

The World Health Organization (WHO) recommends and encourages high-fiber foods items as a part of healthy weight management strategy (20). One of the objectives for Healthy People 2001 consists of any person two years of age and older consuming six servings of all types of grain products ever day (11). 39% of children in America consume an adequate amount of fiber (28). In 2003, 22% of all students in America integrated at least 5 or more servings of vegetables and fruits into their dietary routine (28).  A good fiber source is whole-grain food products, which may provide significant reduction in risk of NIDDM, CHD, and certain cancers.

Epidemiologic evidence indicates whole grain helps control cholesterol serum levels and improves mortality rates (11). The second part of healthy weight management strategy is the avoidance of high caloric and fatty food items. It is essential to prevent consumption of any obesogenic agents, such as sweetened beverages or any caloric dense liquid based compound (20). It is also equally important to avoid any foods with high Glycemic index laced with fat, such as potato chips and any other vending machine food items. The majority of young and adolescent children consume about 18% to 20% total calories from additional sugar intake (28). A healthy drink to consume on a daily bases is milk. However, only 17% of American students consume three glasses of milk or more routinely per day (28). Sound nutrition will help young as well as adolescent children to prevent chronic diseases and improve growth and health (16). A family member is capable of logging onto the My Pyramid webpage to learn about the individual needs of each child to help prevent poor nutritional choices and increase healthy food intake. However, if families do not have access to the Internet they could utilize the traditional food guide pyramid to ensure their child is receiving daily proper food servings as seen in figure 2. 

Another important aspect consists of physical activities such as exercise, hobbies, leisure walks, or planned sports. However, today’s children spend more time in stationary non-physical activities compared to other children in the past (28). This accounts for over 75% of all children in America who get only twenty minutes or even less from brisk physical activity ever week. Wolf et al documented an inverse relation between increase BMI and decrease of activity levels in girls ranging in age of five to twelve year olds (9).

As a result, after-school programs, daycare settings, and school physical education programs have become more focused for quality physical activities (28).

There are four basic steps to assess children in physical strategy. The first step is to find fun physical activities, such as after school sports, neighborhood bicycling or jogging, and family outdoor games that could appeal to the children. The second step is to limit stationary activities, such as watching television, playing videogames, or any other activities involving electronic devices. The third step is to find activities that are safe and time appropriate to avoid injuries and increase compliancy (20). The last step is to follow the exercise pyramid. It consist of lifestyle activities, active aerobics, active sports and recreation, flexibility and muscle fitness exercise, and avoidance of sedentary activities, all of which will help to increase a child’s healthy lifestyle as seen in Figure 3(28).

Conclusion

The prevalence of childhood obesity in the United States has been increasing as well as contributing to adulthood obesity. Genetic susceptibility, environmental influences, and interpersonal behavioral choices are complex interrelated factors of pediatric obesity lifestyles (2). The multitudes of diverse long-term nutritional health education could help decrease the massive amount of children who are ill prepared and need medical assistances. Reinforcing positive lifestyle changes will help to prevent development of further comorbidity types of diseases. When providing better prevention techniques through dietary and physical guidelines, healthier lifestyles are inevitable for children to adhere to and help prevent the cycle of obesity. 

Reference:

1)      Alexander LL, LaRosa J H, Bader H, et al. New dimensions in

women’s health. 3rd ed. Massachusetts: Jones and Bartlett. 2004.

2)      Bacon L, Stern J, Loan D, et al. Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc. 2005; 105 (6): 929-936.

3)      Bloomgarden Z. Diabetes and hypertension. J Diabetes Care. 2001; 24(9): 1679-1684.

4)      Chu, NF, Rimm EB, Wang DJ, et al. Clustering of cardiovascular disease risk factors among obese schoolchildren: the taipei children heart study. Am J Clin Nutr. 1999;69(1):1202-1208.

5)      Edmonds L, Woelfel M, Dennison B. Overweight trends among

children enrolled in the New York state special supplemental nutrition program

for women, infants, and children. J Am Diet Assoc. 2006; 106 (1) 113-117.

6)      Escott-Stump S. Nutrition and diagnosis-related care. 5th ed. Philadelphia: Wolters Kluwer Co.; 2002.

7)      Farooqi S, Jebb SA, Langmack G, et al. Effects of recombinant leptin therapy in a child with congenital leptin deficiency. 1999;341(12):879-883.

8)      Gordon L. Facing racial and ethnic health disparities. J Am Diet Assoc. 2004; 104 (12): 1779-1780.

9)      Hanley AJ, Harris SB, Gittelsohn J, et al. Overweight among children and adolescents in a native Canadian community: prevalence and associated factors. Am J Clin Nutr. 2000;71(1):693-700.

10)  Harnack L, Walters SA, Jacobs DR. Dietary intake and food sources of whole grains among us children and adolescents: data from the 1994-1996 continuing survey of food intake by individuals. J Am Diet Assoc. 2003;103(8):1015-1018.

11)  Human Kinetics, Inc. Fitness for Life Physical Activity Pyramid for Teens Poster: United States, 2003. Available at: http://www.humankinetics.com.  Accessed October 4, 2006.

12)  Johnson D, Gerstein D, Evans A, et al. Preventing obesity: a life cycle perspective. J Am Diet Assoc. 2006; 106 (1):97-100.

13)  Kelley C, Krummel D, Gonzales EN, at el. Dietary intake of children at high risk for cardiovascular disease. J Am Diet Assoc. 2004;104(2):222-225.

14)  Kirk S, Scott BJ, Daniels SR. Pediatric Obesity Epidemic: Treatment Options. J Am Diet Assoc. 2005;105(5):S44-S50.

15)  Knol ll, Haughton B, Fitzhugh EC. Dietary patterns of young, low-income U.S. children. J Am Diet Assoc. 2005;105(11):1765-1772.

16)  Kronsberg SS, Obarzanek E, Affenito G, et al. Macronutrient intake of black and white adolescent girls over 10 years: the NHLBL growth and health study. J Am Diet Assoc. 2003;103(7):852-859.

17)  Mahan LK, Escott-Stump S. Krause’s food, nutrition, & diet therapy

10th ed. Pennsylvania: W.B. Saunders Companies; 2000.

18)  Melgar-Quinonez HR, Kaiser LL. Relationship of child-feeding practices to overweight in low-income Mexican-American preschool-aged children. J Am Diet Assoc. 2004;104(7):1110-1117.

19)  McKenzie JF, Pinger RR, Kotechi JE. An Introduction to Community

Health. 5th Ed. Massachusetts: Jones and Bartlett Publishers; 2005.

20)  Ritchie LD, Welk G, Styne D, et al. Family environment and pediatric overweight: what is a parent to do? J Am Diet Assoc. 2005;105(5):S70-S76.

21)  Schlenker ED, Feurig JS, Stone LH, et al. Nutrition and health of older people. Am J Clin Nutr. 1973;26(1):1111-1119.

22)  Schrefer S, Como D, Myers TA, Joiner P. Mosby’s medical, nursing, &

allied health dictionary. 6th ed. United States: Mosby, Inc.; 2002.

23)  Shepherd LM, Neumark-Sztainer D, Beyer KM, et al. Should we discuss weight and calories in adolescent obesity prevention and weight-management programs? perspectives of adolescent girls. J Am Diet Assoc. 2006;106(9):1454-1457.

24)  Shunk JA, Birch LL.Girls at risk for overweight at age 5 are at risk for dietary restraint, disinhibited overeating, weight concerns, and greater weight gain from 5 to 9 years. J Am Diet Assoc. 2004;104(7):1120-1125.

25)  Skinner JD, Carruth BR, Bounds W. Children’s food preferences: A longitudinal analysis. J Am Diet Assoc. 2002;102(11):1638-1646.

26)  Styne DM. A plea for prevention. Am J Clin Nutr. 2003;78(1):199-200.

27)  Sullivan CS, Beste J, Cummings DM, et al Prevalence of Hyperinsulinemia and clinical correlates in overweight children referred for lifestyle intervention. J Am Diet Assoc. 2004;104(3):433-436.

28)  Telljohann SK, Symons CW, Pateman B. Heath education elementary and middle school applications 5th ed. New York, NY: McGraw-Hill Companies; 2007.

29)  Tershakovec AM, Jawad AF, Stouffer NO, et al. Persistent hypercholesterolemia is associated with the development of obesity among girls: the Bogalusa heart study. Am J Clin Nutr. 2002;76(1):730-735.

30)  Townsend M. Obesity in low-income communities: prevalence, effects, a place to begin. J Am Diet Assoc. 2006; 104 (1): 34-36.

31)  Yeh SS, Schuster MW. Geriatric cachexia: the role of cytokines. Am J Clin Nutr. 1999;70(1):183-197.

32)  Whitney E, Rolfes S. Understanding nutrition 8th ed. California:

Wadsworth Publishing Companies; 1999.

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$ 1 billion for Head Start programs

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Edit:

G: Let me do some basic math for you…since you OBVIOUSLY never thought to do it yourself.

Obama’s stimulus according to him is supposed to “Create or Save” 3 to 4 million jobs. OK, first off…he’s lying..but let’s set that aside. How can one quantify a “Saved” job? You can’t meaning, even if unemployment goes to 30%…Obama can claim…and you would likely believe him that he “Saved” 4 million jobs.

But I will even set that aside for a moment and let’s deal with the straight math. Let’s say the plan works perfectly and Obama’s created 4 million jobs that we spent $ 790 BILLION DOLLARS to create.

$ 790 BILLION DOLLARS divided by 4 million jobs = $ 197,500.00

That means that each of those “Sweet Government Jobs” that you love so much cost the US Taxpayer (That would be me) $ 197,500.00 EACH to “Create” and that is if Obama’s plan works absolutely flawlessly and does the absolute MAXIMUM that Obama predicts. But don’t forget, Joe Biden even says this plan
has a 30% chance of failure and guess what…MOST ECONOMISTS AREN’T EVEN THAT OPTOMISTIC!

Finally, can you tell me the last time Amtrack actually made a profit? I’ll give you a hint…Woodstock hadn’t happened yet! In fact…the Beatles hadn’t come to America yet either!
Edit 2:

G: 1. I don’t get my information from Rush.

2. He did in fact sign the executive order.

3. You obvioulsy cannot understand basic concepts…like the silliness of spending nearly $ 200,000.00 of taxpayer (That’s me) money to create a job that MIGHT pay $ 30,000.00!
C.N.: Guess what…disagreeing with that IDIOT Barack Hussein Obama is NOT a crime! Passing this Pork Burrito disguised as a so called “Stimulus plan” IS A CRIME. Being ignorant enough to actually believe in this plan…should be punishable by death.
G:

If you actually believe Obama’s plan is focused on creating jobs and helping the economy…I feel bad for you.

As far as Amtrak goes, it’s only purpose seems to be wasting trillions of taxpayer, (that’s me…obviously not you), dollars, because that is all it EVER accomplishes!

I feel bad for you…I really do. Obviously you have been brainwashed into believing that in spite of what your eyes, ears and even common sense tells you…you believe in Obama’s plan for no toher reason than he told you to.
G:

If you actually believe Obama’s plan is focused on creating jobs and helping the economy…I feel bad for you.

As far as Amtrak goes, it’s only purpose seems to be wasting trillions of taxpayer, (that’s me…obviously not you), dollars, because that is all it EVER accomplishes!

I feel bad for you…I really do. Obviously you have been brainwashed into believing that in spite of what your eyes, ears and even common sense tells you…you believe in Obama’s plan for no other reason than he told you to.
Here’s your source..and it’s not even from Rush Limbaugh! HAHAHAHA

http://news.yahoo.com/s/ap/obama_labor

The order encourages federal agencies to have construction contractors and subcontractors enter project labor agreements. Those agreements require contractors to negotiate with union officials, recognize union wages and benefits and generally abide by collective-bargaining agreements.
It’s not a “Signing order”…it’s an Executive Order…Big Difference! You really should learn what these things are and what wieght they carry before you decide to debate me on them and their purpose.

Best answer:

Answer by Hobo Bob
Can you say sham??

Of course it wouldn’t be possible without a nation full of sheep.

WE THE PEOPLE are supposed to keep the government in check, WE ARE FAILING MISERABLY………

Add your own answer in the comments!

until I realized how much of my tax dollars go to “education” Money is being thrown left and right in the name of education. TOO MUCH and people are getting stupider

I’m opposed to a raise in taxes. We just need to sift through all the programs we have now and get rid of a lot of them to make way for a healthcare plan for ALL Americans, not just the poorest ones.

Any other Republicans agree with me on this issue? Why or why not?
I thought I would also ask independents as well. I don’t like to identify with any party but I used to call myself Republican
I TOTALLY agree about medical malpractice lawsuits
Buck J – I would prefer that my tax dollars go toward health care rather than education and related programs. I have no kids so I have no way to benefit from them.
I also want to add that the “poorest ones” benefit the most from government programs because only they qualify.
bereal1 – Thank you, I did not know there was a Republican plan

Best answer:

Answer by racingdiego@sbcglobal.net
The costs of healthcare would be reduced if the ‘Trial Attorneys in Congress’ would ease up on medical malpractice lawsuits.
Also, gettting rid of illegals MUCKING UP our system with having THEM accessing it.
But that wont happen. Because CONGRESS RUNS THE COUNTRY!!

What do you think? Answer below!

That’s the estimated share of Americans younger than 65 who’d sign up for the public option plan under the health care bill that Speaker Nancy Pelosi, D-Calif., is steering toward House approval.

The underwhelming statistic is raising questions about whether the government plan will be the iron-fisted competitor that private insurers warn will shut them down or a niche operator that becomes a haven for patients with health insurance horror stories.

Some experts are wondering if lawmakers have wasted too much time arguing about the public plan, giving short shrift to basics such as ensuring that new coverage will be affordable.

“The public option is a significant issue, but its place in the debate is completely out of proportion to its actual importance to consumers,” said Drew Altman, president of the nonpartisan Kaiser Family Foundation. “It has sucked all the oxygen out of the room and diverted attention from bread-and-butter consumer issues, such as affordable coverage and comprehensive benefits.”

The Democratic health care bills would extend coverage to the uninsured by providing government help with premiums and prohibiting insurers from excluding people in poor health or charging them more. But to keep from piling more on the federal deficit, most of the uninsured will have to wait until 2013 for help. Even then, many will have to pay a significant share of their own health care costs.

The latest look at the public option comes from the Congressional Budget Office, the nonpartisan economic analysts for lawmakers.

It found that the scaled back government plan in the House bill wouldn’t overtake private health insurance. To the contrary, it might help the insurers a little.

The budget office estimated that about 6 million people would sign up for the public option in 2019, when the House bill is fully phased in. That represents about 2 percent of a total of 282 million Americans under age 65. (Older people are covered through Medicare.)

The overwhelming majority of the population would remain in private health insurance plans sponsored by employers. Others, mainly low-income people, would be covered through an expanded Medicaid program.

To be fair, most people would not have access to the new public plan. Under the House bill, it would be offered through new insurance exchanges open only to those who buy coverage on their own or work for small companies. Yet even within that pool of 30 million people, only 1-in-5 would take the public option.

Who’s likely to sign up?

The budget office said “a less healthy pool of enrollees” would probably be attracted to the public option, drawn by the prospect of looser rules on access to specialists and medical services.

As a result, premiums in the public plan would be higher than the average for private plans. That could nudge healthy middle-class workers and their families to sign up for private plans.

Best answer:

Answer by Paul
Again, another Democratic “steal from the rich and give to the poor” program that is a complete waste of time.

VOTE INDEPENDANT!

Give your answer to this question below!