Our guest blogger is Danielle Moodie-Mills, an Advisor for LGBT Policy and Racial Justice at the Center for American Progress and the Director of Environmental Education at the National Wildlife Federation.

Obesity has long been framed as an issue of personal responsibility. The prevailing notion has been that if people simply stop eating junk food and start eating healthy fruits and vegetables, they will maintain a healthy weight.

And even though most Americans agree that obesity is a critical public health issue facing the nation — 83 percent of Democrats, 71 percent of Independents and 65 percent of Republicans rank it as a “serious issue” — opinions about how personal responsibility factors into the epidemic are somewhat divided along party lines. Democrats tend to believe that both the individual and government are responsible for combating the obesity epidemic, while Republicans believe the onus falls largely on the individual.

The “personal responsibility” argument assumes that people can simply avoid sugar and other unhealthy additives by staying away from fast foods. But Dr. Robert Lustig, the author of the new book Fat Chance, explained this week on MSNBC’s Morning Joe that avoiding sugar — which he believes to be a major cause of America’s weight issue — may not be as easy as it seems:

One-third of the sugar in our diets comes from soda and sweetened beverages, you can taste it. One-sixth is in desserts, you know about those as well, but half of all the sugar consumed in this country comes from food you didn’t know had sugar in it — like hamburger buns, hamburger meat, and salad dressing, for instance.

So even when people make a concerted effort to make healthy choices, there is still a great possibility that they are consuming the very product that is causing their weight gain. And the government isn’t doing enough about it.

A few years ago, a group of doctors at Mount Sinai took out an advertisement in the New York Times pressuring the government to stop subsidizing food that was making Americans sick. “High-fructose corn syrup [HFCS] now represents 40 percent of the non-calorie-free sweeteners added to U.S. foods. It is virtually the only sweetener used in soft drinks,” the research physicians wrote in their advertisement. “Because of the subsidies, the cost of soft drinks containing HFCS has decreased by 24 percent since 1985, while the price of fruits and vegetables has gone up by 39 percent.”

But after the negative comments regarding HFCS went viral, corn refiners simply released a commercial rebranding HFCS as “corn sugar,” and purporting the safety of the re-named additive saying “corn sugar or cane sugar, sugar is sugar and your body doesn’t know the difference.” Watch it:

Nearly one-third of American children and adolescents are labeled as overweight or obese, and they are expected to be the first generation who won’t live as long as their parents due to high cholesterol, diabetes, and other metabolic diseases. So will the government finally see fit to engage in the sugar debate and take a hard look at the crops they are subsidizing — or will Americans have to wait for this epidemic to reach its precipice, much like the battle against cigarettes? Let’s hope not, because the current health care system may just break under the extra weight.

Former Senator Jim DeMint, the new president of the conservative Heritage Foundation, has decried Obamacare as “a cancer” that is “is fundamentally inconsistent with liberty.” During the Senate Obamacare fight, DeMint famously declared “If we’re able to stop Obama on this, it will be his Waterloo. It will break him.”

But a new report from DeMint’s own organization suggests that, far from being incompatible with freedom, countries with health care systems with as much or significantly more government control over healthcare are the freest countries in the world.

The report in question is Heritage’s Economic Freedom Index, released annually since 1997. The report defines the concept of “economic freedom” in misleading right-wing terms, but even by those standards, it appears that universal health care systems far more expansive than Obamacare aren’t “fundamentally inconsistent with liberty.” In fact, the ten “freest” economies in 2013 by Heritage’s lights range from mandating individuals save a certain amount of money for health care to almost the entire health care system, including hospitals, being owned and operated by the government:

1. Hong Kong: The semi-autonomous city inside China has a universal, publicly run health care system: about 80 percent of Hong Kong hospitals are government owned and operated. While private supplemental insurance is available, it’s more expensive than public services.

2. Singapore: Singapore is often cited as a free-market health care system that works. But one of the centerpieces of the Singaporean model, as conservative David Frum notes, is a government mandate requiring citizens to place a certain percentage of their income in “medical savings accounts” to ensure they can pay for routine health care costs out of pocket (when their income is inadequate to pay, the government pays direct subsidies a la Obamacare’s Medicaid expansion). Hardly seems consistent with DeMint’s point that health care mandates are “slippery slopes” towards the death of freedom.

3. Australia: Australia has a single-payer system in which, like Canada, doctors are privately employed but all Australians are eligible for insurance coverage through a government-run provider called Medicare.

4. New Zealand: The Kiwi government has made most services free or nearly free to all residents; the government covers roughly 80 percent of national health care expenditures and directly owns and operates about half of all health care services in the country.

5. Switzerland: This Swiss system is closer to the American health plan post-Obamacare than most other national systems; Switzerland has both privately owned health care and privately-provided insurance together with an individual mandate to purchase health insurance. Interestingly, Swiss insurers are legally prohibited from profiting on the basic, mandatory insurance package.

6. Canada: Our northern neighbor is, of course, the most famous example of a single payer system in the United States.

7. Chile: Like Singapore, Chile mandates that individuals pay into health savings accounts to cover health care costs and supplements the accounts of poor Chileans. It also has both publicly and privately run health care services.

8. Mauritius: A tiny island nation in the Indian ocean, Mauritius has government-run health services that cover roughly 70 percent of the country’s health expenditures, with private supplemental practices making up the remainder. All government health services are provided free of charge to Mauritian citizens, which has helped the country improve quality of life for its citizens markedly in the past two decades.

9. Denmark: As in Mauritius or the United Kingdom, the Danish government owns and operates the vast majority of the health care system.

Number 10 on the list is, of course, the United States, which will finally join the rest of the top ten “most economically free nations” in providing universal or near-universal health care when Obamacare is fully implemented.

ThinkProgress has previously reported that a massive contributor to America’s annual $2.7 trillion health care expenditures is the staggering 50 percent of Americans who simply do not take their prescribed medications properly.

Now, Wonk Blog’s Sarah Kliff is reporting that corporate pharmacy giant Walgreens wants to start bucking that trend by forming “accountable care organizations” (ACOs) in conjunction with local physicians and hospitals. ACOs are coordinated care systems that are paid on the basis of their performance. If an ACO successfully provides Medicare beneficiaries with quality care while keeping costs under a year-to-year target, it is rewarded with higher Medicare reimbursements from the government by netting the savings — but if it goes over the annual target, it has to swallow the losses.

Although most ACO applications so far have been partnerships between more specialized health care providers, more convenient access to local pharmacies might make them effective venues for managing and tracking Americans’ treatments after their hospital visits:

While a pharmacy-run ACO is not the traditional model, [Walgreens' Senior Vice President Jeffrey Kang] argues it actually makes a lot of sense. Pharmacy stores are open every day of the year, making them a more accessible point of contact than most doctor offices. They have begun to handle basic health care, like vaccination and preventive check-ups, right in the store, which could prevent more costly diseases down the line.

Health care research shows that unnecessary hospital readmissions are often caused by a patient not following the prescribed medical regiment after discharge, creating another place where pharmacists could easily intervene. [...]

“The way I like to describe it is as a physician-led plan where we’re an active partner,” Kang says. “They’re the quarterback who creates the treatment plan. We can be care extenders who help implement and execute the plan.”

In order to make that active partnership work, Walgreens is working to become better integrated with its partner health care systems. While both the pharmacies and doctors, for example, already have electronic medical records, they now need to ensure that each system can interface, allowing all health care providers to track a given patients’ care.

Walgreens’ decision to venture into the coordinated care market underscores the broad innovative potential of Obamacare provisions such as ACOs. Centering medical treatment followups in pharmacies could go a long way towards making sure that Americans stay on their treatment regimens, thus reducing sickness, deaths, and costly hospital re-admissions.

However, lawmakers should make sure that pharmacies that provide more extensive services have the proper oversight, so as not to fall into the same pitfalls as laxly regulated compounding pharmacies in the wake of last year’s deadly meningitis outbreak.

The Centers for Disease Control and Prevention made it official on Friday: This year’s severe flu season is an epidemic . It passed the threshold last week, with 7.3 percent of deaths from influenza or pneumonia. Forty-seven states are now reporting widespread activity after the season got to an especially early start.

Vaccination remains the “best tool we have to prevent the flu,” and the best time to receive a vaccine is before the season even starts. Even so, well over half of Americans neglect to get their flu shots. With the season well underway, some areas are reporting vaccine shortages.

One interesting measurement of flu season trends is Google search data for flu-related terms, which has skyrocketed in recent weeks. But this chart from the CDC, showing hospital visitors with flu-like symptoms, might provide a more appropriate context:

Small businesses and individual health policy holders could face dramatic premium spikes this year, as some insurers file double digit increases and attribute the changes to the Affordable Care Act. The sticker shock is mostly the result of rising health care costs — and the prevalence of sicker beneficiaries in health insurance risk pools. The media, however, is blaming health care reform.

For instance, Friday’s Politico reported that premiums are increasing across the country as “All those new consumer benefits packed into the health reform law — birth control without a co-pay, free preventive care and limits on when insurers can turn down a customer — had to be paid for somehow.” Policy holders may experience 10 to 20 percent rate hikes, it warns, as insurers are “working the health reform law’s 2014 fees into their 2013 bills.”

So how much is Obamacare responsible for? Five, maybe eight percent? The answer is less than two.

Insurers are arguing that the costs of Obamacare’s annual fee on the industry, its requirement that companies contribute to a reinsurance program, and new benefits and regulations have to be passed down to consumers. “There’s a massive new health insurance tax that starts in 2014,” Robert Zirkelbach, the spokesman for America’s Health Insurance Plans told Politico. “For policies that are sold in 2013 and extend into next year, there’s going to be taxes imposed. … As a result, like all taxes, they will be reflected in premiums charged.”

There are new costs in 2014, but they have little to do with reform. Consider the insurers’ own rate justification filings, in which companies have to substantiate the raises. Aetna in Pennsylvania, for instance, seeks to increase rates by an average of 16.49 percent, but as it explains in its filing, 63.18 percent of the increase is attributed to the “cost of providing healthcare services to policyholders.” The Affordable Care Act is responsible for a tiny portion of the increase:

Impact of New Taxes and Fees

The Affordable Care Act (ACA) includes several new taxes and fees payable in 2014, including two that specifically apply to insured products — the health insurer fee and the reinsurance contribution. These new fees result in additional costs and are reflected in our updated rates for policies that extend into 2014. The overall impact of these costs on this filing is as follows:
* Health Insurer Fee: 1.0%
* Reinsurance Contribution: 0.5%

Washington & Lee Law School professor Timothy Jost predicted that “insurers in the individual market will benefit substantially from reinsurance payments” and will be “spared some administrative costs-notably the cost of underwriting which should be quite substantial.” ” The cost of new benefits should not be a big deal,” he continued, since “most of the costs of health insurance are for inpatient, outpatient, physician, lab, radiology, and pharmaceuticals, which virtually all insurers now cover.”

“I suspect that what is going on is a combination of legitimate concern about new costs, overestimation of what those costs will be and underestimation of offsetting savings, taking a chance to attack the ACA, and grabbing the opportunity to make some profit,” Jost added.
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Over the last several decades, U.S. national health expenditures have skyrocketed, increasing everything from the cost of treatment to the cost of coverage and the federal government’s entitlement obligations.

Experts have long held that anywhere from 30 to 50 percent of America’s $2.7 trillion annual health care spending is wasteful, either due to ineffective treatments, excess medical tests, hospital re-admissions, and medical billing fraud.

But there has been some debate over exactly how much each of these factors contributes to wasteful health expenditures. On Thursday, the nonprofit group New England Health Institute (NEHI) held a round table in which they explored exactly that, and their findings are striking: of the seven biggest factors contributing to waste, the largest by far is patients not adhering to their medication regimens. NEHI estimates that a staggering 50 percent of the 187 million Americans taking prescription drugs every year do not take them properly:

When Americans neglect to stick to their prescribed treatment regimens, they risk increasing the frequency of hospitalizations and preventable diseases and deaths. Other major factors in medical waste include the overuse of antibiotics leading to super resistant pathogen forms, as well as Americans’ woefully low rates of vaccinations.

Most of the policy solutions that NEHI explored to these problems are fairly standard for health reform advocates, including measures such as greater care coordination and case management, an emphasis on primary and preventative care, patient education, pay-for-performance for hospitals and doctors, and prospective rather than retrospective payments for patients’ care. Several of these measures — including extending access to preventative and primary care and pay-for-performance — are already slated to be implemented under Obamacare.

But another event speaker, Institute of Medicine scholar Dr. Michael McGinnis, emphasized that cost controls and expansions of access to care alone would not solve the underlying problem of wasteful spending — as evidenced by the study’s findings. Doctors and patients alike have to find incentives for effectively tracking and treating diseases, and get a handle on illnesses before they become more complex and expensive to treat. “We need to have a multi-faceted approach,” Dr. McGinnis said. “We need a change in prices, a change in culture, a change in health care delivery.”

Vice President Joe Biden, chair of the White House working group on gun law reform, announced on Thursday that the Obama administration would likely propose reforms to a series of little-known, National Rifle Association (NRA) supported regulations that severely restrict the use of federal money to support research on gun violence. According to the Washington Post, Biden’s comments highlighted the serious gaps in medical and epidemiological knowledge about guns caused by the current restrictions:

Biden also mentioned strengthening the ability of federal agencies to conduct research about gun violence. He drew a comparison between current limits on federal gathering of data about gun violence and 1970s-era restrictions on federal research into the causes of traffic fatalities. Biden stressed a need for the government to collect information about “what kind of weapons are used most to kill people” and “what kind of weapons are trafficked weapons.”

The anti-science restrictions Biden is discussing date back to the 1990s. Alarmed by growing scientific research on the health risks created by the widespread prevalence of guns, the NRA and its Congressional allies stripped all funding for the Center for Disease Control’s gun research budget. They also inserted a provision into the CDC appropriation bills that said “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control,” deterring the CDC from providing significant funds to gun research ever since. As a result, the New York Times reports, “the amount of money available today for studying the impact of firearms is a fraction of what it was in the mid-1990s, and the number of scientists toiling in the field has dwindled to just a handful as a result.” This has meant in practice that “there is no scientific consensus on the best approach to limiting gun violence, and the N.R.A. is blocking work that might well lead to such a consensus.”

A letter sent to the White House working group warned of the tragic health consequences of this research dearth, noting that “medical treatment of gunshot wounds costs an estimated $2 billion annually, half of which comes from taxpayer dollars” and that the “total costs of gun violence to American society are on the order of $100 billion per year.” Moreover, as the Center for American Progress’ Jonathan Moreno points out, “Taxpayers support the CDC because its job is to reduce Americans’ deaths and injuries, but though gun violence is the leading cause of death of African Americans ages 15-24, its website doesn’t even link to information about firearm violence prevention.”

The few intrepid researchers who have been able to find funding outside the government have perhaps discovered why the NRA is so afraid of more research in this area. Scholars at Harvard University have put together strong evidence that more guns mean more deaths, while researchers at Johns Hopkins University have developed a clear, evidence-based set of policy proposals for common-sense reforms to America’s gun laws.

Today marks the deadline for Mississippi’s sole remaining abortion clinic, the Jackson Women’s Health Organization, to comply with the restrictive, unnecessary restrictions that the state’s Republican legislators imposed last summer. The new regulations require the clinic’s doctors to secure hospital admitting privileges, but all seven hospitals in the surrounding area have so far denied them. A Bush-appointed federal judge temporarily blocked the law to give the doctors more time to secure the privileges they need, but that order expires today.

In public, anti-choice advocates claim they support enacting additional regulations for abortion clinics as an important measure to protect women’s health and safety. But when Mississippi Gov. Phil Bryant (R) attended an anti-abortion event on Thursday, he didn’t feel the need the sugarcoat his real motives for signing the restrictive measure into law last year:

“My goal of course is to shut it down,” Gov. Phil Bryant said after addressing a group of pastors attending a pro-life luncheon Thursday in Jackson.

The governor doesn’t have that authority. Instead, by Friday lawyers representing the state must file a response in federal court to a motion by the Jackson Women’s Health Organization.

Bryant himself doesn’t have the authority to ensure that women in Mississippi are forced to go without a single abortion clinic, but he certainly can move closer to his goal by imposing “Targeted Regulation of Abortion Providers” (TRAP) laws with the sole intention of indirectly restricting women’s reproductive rights. TRAP laws have been a successful method of targeting abortion providers in other states, since clinics are often forced to close when they are unable to meet the complicated new standards.

Bryant isn’t the first politician to suggest that TRAP laws are nothing more than a politicized attack on women’s constitutional right to an abortion. After Virginia imposed similar restrictions on its abortion clinics last year, the state’s health commissioner saw right through them — and resigned in protest of the Virginia Board of Health’s anti-choice agenda.

Unfortunately for the women of Mississippi, Bryant’s move toward accomplishing his goal could have dire consequences for them. The state already has high rates of teen and unintended pregnancy, statistics that Bryant chooses to blame on teenagers rather than accept responsibility for his own policies that promote ineffective, medically inaccurate abstinence education in schools.

The craft store Hobby Lobby has been embroiled in a legal fight against Obamacare’s contraception mandate since September, when the chain’s conservative evangelical owners first sued for the right to deny their employees access to affordable contraceptives. Even though a federal judge ruled last month that Hobby Lobby must follow federal law and provide birth control coverage for its estimated 13,000 employees, the company’s owners announced that they will break the law rather than provide contraception — and now they’re also hoping to dodge the consequences for that decision.

Hobby Lobby may be subject to penalties of up to $1.3 million per day if the business doesn’t comply with Obamacare, which requires employers to cover contraceptive services without a co-pay to help eliminate the gender imbalance in health care costs. To avoid paying those fees, however, Hobby Lobby has announced it will now attempt to shift the beginning of its employees’ health plans:

A representative for Hobby Lobby declined to elaborate on how long the company will have before its new plan year will start — when the federal mandate on emergency contraceptives coverage would kick in.

“Hobby Lobby does not provide coverage for abortion-inducing drugs in its health care plan,” corporate general counsel Peter Dobelbower said in a statement. “Hobby Lobby will continue to vigorously defend its religious liberty and oppose the mandate and any penalties,” he said.

In fact, Obamacare’s contraception mandate doesn’t require Hobby Lobby to provide coverage for any of the “abortion-inducing drugs” that its owners so vehemently oppose. Under the health reform law, employees are guaranteed coverage for emergency contraception, commonly known as Plan B, which does not actually induce abortion.

Nevertheless, Hobby Lobby won’t simply stop at breaking the law and risking incurring $474.5 million in annual fines — far more than the cost of simply providing health plans without co-pays for birth control. The craft store also doesn’t want to be held accountable for the consequences of its decision to play politics with its employees’ health coverage.