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Zack Cooper

Zack Cooper

Posted: August 21, 2009 07:09 AM

Want to Lower The Healthcare Price Tag? The Insurance Debate is Just the Beginning


All the brouhaha over insurance co-operatives, the public plan, and Sarah Palin's fictitious death panel creates the false impression that our healthcare system is the sole determinant of our health. It's not. Our individual behavior --- how much we smoke, drink, and exercise --- rather than the way our healthcare system is structured, is what is really going to determine whether our healthcare system is financially sustainable over the next 50 years.

It turns out that about 40% of deaths in the US are caused by some of our less than perfect behaviors like eating foods that are high in trans fats, smoking too much, having unprotected sex or not exercising enough. By contrast, shortcomings in medical care and limited access to healthcare are only responsible for about 10% of our deaths. As a result, trying to reduce healthcare spending by focusing exclusively on insurance coverage and healthcare provision is like trying to halve the murder rate by chasing after bullets once they've already left the gun.

It is abhorrent that not everyone in the US has access to quality, affordable medical care, but that is not why we're spending more money on healthcare than any other industrialized nation. We spend more on healthcare because of our bad habits. While proving universal healthcare coverage is a moral imperative, we need to realize that it is not a silver bullet for reducing costs.

This reality was made crystal clear last week when Britain's National Health Service entered the US healthcare debate. When it came to quality, the American system was clearly better. According to the most recent OECD data, five-year breast cancer survival in Britain was 77.8% compared to 90.1% in the US. Five year-prostate cancer survival in Britain was 51.1%, compared with 91.1% survival in the US. Likewise, the death rate for heart attacks in the US was significantly lower too. Nevertheless, the British have a higher life expectancy, a lower rate of coronary heart disease, spent less money on healthcare and were in better overall health.

So why aren't we talking more about ways to improve our underlying health? Politics, of course. Addressing our underlying health means spending extra money and altering our behavior now, which will result in health benefits in the future. If you thought the debate over the public plan got rough, wait until you see town hall meetings over a federal ban on deep fryers. Tackling the behaviors that lead to poor health and high spending also means developing policies that tread very close to our individual choices, values and culture. It raises what they refer to in Britain as the nanny-state issue. Do we really want to see the federal government telling us we can't eat certain foods, need to exercise more and shouldn't smoke?

While we're uncomfortable with the nanny-state, we've already started to see some laws that tackle the causes of ill health. A number of states have banned smoking in restaurants. Connecticut has recently passed a law that requires chain restaurants to publish the calories in the items on their menus. And New York City has passed a law banning trans fats from being used in restaurants. This trend teaches us an important lesson - many of the legislative steps necessary to improve our underlying health and slow health spending are probably going to need to start locally.

We've also seen healthcare providers and the business community begin to focus on health improvement. At the Henry Ford Medical Center, staff are teaching patients how to cook healthier foods alongside providing medical care. At the Cleveland Clinic, the CEO has banned trans fats from their cafeteria, eliminated sugared beverages from their vending machines and he has gone so far as to refuse to hire smokers. These steps aren't just the result of the goodwill of employers; instead they stem from strong business savvy. Research by Kevin Volpp and his colleagues has shown that when private companies financially reward employees for staying healthy, it's good for the employees and the employers.

These types of health improving policies are ultimately going to have a bigger impact on bringing down the costs of healthcare than what is being proposed in the current reforms. That's not to say that we shouldn't seek universal coverage and make the insurance market more competitive, but it does suggest the Federal government needs to be more proactive creating incentives for states, local governments, private companies and insurers to offer these types of health-improving programs.

As the healthcare debate rages on, it is important to keep in mind the limits of what our healthcare system can accomplish. Right now, 95% of American healthcare dollars go towards paying for medical care and only about 5% go towards proactive measures to improve public health. If we really want to see a significant change in how much we spend on healthcare per year, that 95% to 5% ratio will have to change dramatically.