While our politicians remain polarized on health care reform -- and as the U.S. Supreme Court decides on the constitutionality of the Patient Protection and Affordable Care Act -- perhaps the rest of us should look more closely at our health.
After all, the excessive cost of health care in America is the symptom of an underlying disease. And while changing the system of how health care coverage is provided, purchased, and paid for may help alleviate some of the symptoms, it won't eradicate the fundamental sickness.
That requires a broader, much more deep-seated approach -- one that takes a harder look at how medicine in America is practiced and at how we choose to live. It is, in the end, our nation's almost exclusively reactive approach to medical care -- atop a pervasive epidemic of physical inactivity and unhealthy lifestyles -- that has infected our health care system.
In their recent study projecting the future cost of health care, Richard A. Young and Jennifer E. DeVoe pointed out:
It is also well-known that the United States spends more on healthcare costs than any other country in the world but has worse health outcomes than all other developed nations.
That's not surprising. After all, our health care system isn't truly a health care system at all. It's a "sick care system" focused on addressing symptoms and treating illness, with little intent on keeping people well in the first place.
If America is to hold back the cascade of medical spending, dig out of the debt we currently are under, and improve our potential for global economic competitiveness, we must realign the fundamental philosophy of how health care is practiced in America and establish public policies and community programs that promote and support primary prevention.
To be clear, when I speak of primary prevention, I am referring to beneficial lifestyle behaviors that deter the onset of disease before they occur -- behaviors such as regular exercise, healthy eating, avoidance of tobacco and other controlled substances, stress management, and routine medical exams.
According to the Partnership to Fight Chronic Disease (PFCD), almost one of every two adults has at least one chronic illness. People with chronic conditions account for 81 percent of hospital admissions, 91 percent of prescriptions filled, and 76 percent of all physician visits.
To help put those numbers in perspective in terms of tax-payer dollars, consider these PFCD figures: federal spending in 2008 in Medicare and Medicaid on patients with one or more chronic condition was 32 times the amount of money given to automakers in the 2008 congressional bailout and eight-tenths of the amount of money given to U.S. banks by Congress that same year.
Yet, according to the Centers for Disease Control and Prevention, chronic diseases -- like heart disease, stroke, cancer, diabetes and arthritis -- are among the most preventable. In fact, they are largely attributable to four modifiable risk behaviors: physical inactivity, poor nutrition, tobacco use, and excessive alcohol consumption.
In a recent study, Michael O'Grady and James Capretta examined and underscored the costs of obesity in the United States. According to 2008 statistics cited in their study, roughly one-third of U.S. adults are overweight, one-third are obese, and 6 percent are extremely obese, putting estimated obesity-related medical costs in the United States at almost 10 percent of all medical spending each year. When you add in lost productivity, employees on full disability, and absenteeism, the costs jump even higher.
It's not startling, then, that researchers who recently published their work in the Journal of Occupational and Environmental Medicine found that obese workers now have even higher health care costs than smokers.
Primary prevention is the way forward for America -- in the physician's office, in schools, in the homes of families across America, in small and large businesses alike, and in how politicians determine our public policies and publically funded community programs and planning.
In their study, O'Grady and Capretta describe how Congressional Budget Office (CBO) cost estimates, which generally cover a ten-year period, don't capture the costly complications of chronic diseases, including those associated with obesity -- complications that often take more than ten years to manifest themselves. They suggest that a 25-year budget window would be more appropriate and effective.
O'Grady and Capretta's argument is just one example of the new approach America must take in caring for our health. But every sector of society must take part in creating this new paradigm of care.
America is currently tied up in knots, feverishly awaiting a decision on the Patient Protection and Affordable Care Act. But regardless of whether or not President Obama's attempt at health care reform withstands the U.S. Supreme Court's scrutiny, the health of America still must be brought under control. If we fail, it is unlikely that we will ever regain our financial health.
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John Hoffman: Eat More, Move Less: What's Driving the Obesity Epidemic
The author promotes preventative medicine, and points out we actually have a sick care system. In this system, those without health insurance have an additional motive to practice preventative medicine that the insured do not. Giving insurance to all removes this extra motive, which will consequently reduce the practise of preventative medicine, ceteris paribus.