Friday, September 25, 2009
Preventable Chronic Disease
The United States cannot drive down the cost of health care if nothing is done to address preventing many of the preventable chronic diseases that account for a large percentage of the health care costs in this country. According to the CDC "The medical care costs of people with chronic diseases account for more than 75% of the nation’s $2 trillion medical care costs". Lifestyle choices result in many preventable chronic diseases, and result in the associated medical care costs. The prevention of these chronic diseases cannot be medical intervention alone, but must include lifestyle change if health care costs are to be driven down. None of the health care reform proposals being considered address encouraging life style change, or penalizing poor choices with respect to one's health, and perhaps they should not. But without such changes, won't health care costs continue to rise? So, should the legislature attempt mandate personal responsibility? Can it?
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No, you cannot legislate personal responsibility. But you can always tax the bad, like cigarettes or junk food.
ReplyDeleteAlso, some 30 years ago (this is according to Michael Pollan) food labeling laws were changed. Before those changes you had to call out that the particular food was "imitation" this or "imitation" that. We do not have this anymore. So in many cases you think that you are eating bread, whereas it is just an "edible food like substance", what was formerly called "imitation bread". Maybe eating real food would be part of the solution.
Cheers, Andras
Tonya, I agree with most of what you’re saying. The statistic of 75% of costs sounds high, but within the realm of believability (and the CDC is a pretty reliable source). Chronic diseases are expensive to treat, even when consistently and humanely treated, and we have multiple major epidemics underway in our country. And our employer-based insurance system tends to force out anybody whose disability is severe enough that they can’t work, so lots of cases get more expensive as the victims go untreated or go bankrupt.
ReplyDeleteThe statistic you cite doesn’t break out preventable chronic diseases, and within that, lifestyle-related preventable chronic diseases. These distinctions are subjective and controversial, but should be considered to complete the picture.
But even after we strip away all the others, we are left with a huge portion of our medical costs associated with preventable, lifestyle-related chronic disease. Now, what do we do? And in all fairness, what can/should we expect of either a private or public medical insurance system? What level of interference will people tolerate? If you think people ‘cling to their guns’, just try coming after their five-layer burrito.
I have a good friend who is a hospital dietician, working with diabetics. Overweight kids come in for consultation, accompanied by a parent who is even more overweight, doesn’t know a damn thing about good eating and fitness habits. Most are addicted to unhealthy foods (and I use the term ‘food’ loosely). It’s a real uphill climb to change someone’s eating habits.
And speaking of uphill climbs … encouraging people to exercise is no picnic either. In Germany and France—where much of the food is high in fat—the towns are set up so that most things are within walking distance. You walk to the store. And since you’re walking, you only buy what you can carry, so most day’s you shop just for one or two days. Of course most Americans come back from there griping about the (non-‘Super’) portion sizes. So you get a little exercise, and maybe eat a bit less.
Among some of the other disproportionately American epidemics (lymphomas, blood cancers, asthma, food allergies), the association to lifestyle and voluntary environmental choices is less clear. Our use of pesticides, both on our lawns and in our houses, and on our foods is not the norm most other places. I remember when I was a kid, there was something called a Shell ‘no-pest strip’, that essentially kept a low dose of pesticide in your house all the time; killed the bugs – I wonder how much it increased the incidence of various cancers among the residents.
We have to deal with this whether we reform the funding model or not. The question isn’t entirely separate, but not conditional for reform.