I am no expert in health care policy but I do know what it cost to be fat and sick. I know that if I did not have health insurance it would cost a lot more and I would be in much worse shape than I am now. I think that healthcare policy requires a more comprehensive common sense approach only made complicated by the lobbyist for this industry.
I also know that in this country there is less emphasis on preventative care and a major emphasis on medicinal maintenance when someone becomes ill. There is a pill (and profit) connected to every conceivable condition – conditions that by and large can be avoided if we had a different relationship to food and health. In 2009, health care accounted for 16% of America’s Gross Domestic Product (GDP) with the expectation that this will increase by nearly 10% by 2025. We have a population that is living longer with chronic conditions driving up overall costs associated with health care. Overall, we have a more obese and less healthy overall population in this country. And the health care lobbying efforts have ensured that our leaders continue health care policy to place emphasis on maintenance rather than prevention.
Prevention advocates argue that using such an approach in the context of healthcare policy would result in reigning in increasing healthcare costs and creating a more healthy society. “The Trust for America’s Health reported that prevention programs could save the country more than $16 billion annually within five years, a return of $5.60 per dollar invested. The Commonwealth Fund estimated that reduced tobacco use and decline in obesity would lower national health expenditures by $474 billion over ten years.” At a time where we are talking about reducing deficits and spending, this is an opportune time to really focus on this issue.
Unfortunately, though many Americans are indoctrinated to eat and drink to excess the wrong things, the real problem is that our policies and national leaders protect the very companies that benefit financially from our illnesses; this means the capacity to advocate for a sensible approach to health care policy against these powerful corporations is more than difficult. For example, according to the Center for Responsive Politics, in 2005 there were 535 members of Congress compared to 2,084 health care lobbyist; this means for every member of Congress, there was approximately 3.8 lobbyist lobbying them on behalf of various drug and health insurance companies. Further, according to OurFuture.org, in 2004 the health industry was credited with giving approximately $14M to 11 members of Congress who were created with negotiating the Bush Medicare Plan.
So what are the costs associated with chronic disease in America? Let’s take my personal favorite chronic illness, diabetes.
There are a total of 25.8 million children and adults in the United States which means that 8.3% of the population has diabetes with approximately 7 million undiagnosed. As of 2010, 1.9 million new cases of diabetes were diagnosed in people 20 and over. This is part of the reason why there has been a substantive increase in the number of diabetes related advertising and why we’ve begun to experience a sense of “normalcy” relative to diabetes. Rather than focus on preventing Type 2 which is largely tied to weight, we are being socialized to learn to live with it. There are approximately 79 million pre-diabetics in the United States; for diabetes drug companies and companies that produce lancets, blood glucose readers, and diabetes related products, that’s a lot of potential customers and money.
After adjusting for population age differences, a 2007-2009 national survey data for people diagnosed with diabetes, age 20 years or older showed that 7.1% were non-Hispanic Whites, 8.4% were Asian Americans, while non-Hispanic Blacks and Hispanics made up 12.6% and 11.8% respectively of those diagnosed.
There are a host of other related conditions associated with diabetes including:
Heart disease and stroke
- In 2004, heart disease was noted on 68% of diabetes-related death certificates among people 65 years or older.
- In 2004, stroke was noted on 16% of diabetes-related death certificates among people 65 years or older.
- Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
- The risk for stroke is 2 to 4 times higher among people with diabetes.
High Blood Pressure
- In 2005-2008, of adults aged 20 years or older with self-reported diabetes, 67% had blood pressure greater than or equal to 140/90 mmHg or used prescription medications for hypertension.
- Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.
- In 2005-2008, 4.2 million (28.5%) people with diabetes 40 years or older had diabetic retinopathy, and of these, almost 7 million (4.4% of those with diabetes) had advanced diabetic retinopathy that could lead to severe vision loss.
- Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008.
- In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease in the United States.
- In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States.
- About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.
- More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
- In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes.
Morbidity and Mortality associated with diabetes:
In 2007, diabetes was listed as the underlying cause on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths.
Cost of Diabetes
The total cost of diagnosed diabetes in the United States in 2007 was $174 billion, with $116 billion for direct medical costs, and $58 billion for indirect costs (disability, work loss, premature mortality). After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes. Does anyone see the economic benefit for prevention here?
The American Diabetes Association created a Diabetes Cost Calculator that takes the national cost of diabetes data and provides estimates at the state and congressional district level. Factoring in the additional costs of undiagnosed diabetes, prediabetes, and gestational diabetes brings the total cost of diabetes in the United States in 2007 to $218 billion. In my lovely borough of Brooklyn, in the 11th Congressional district where I live, the total cost of diabetes for people in Congressional District 11 in 2006 is estimated at $551,100,000. This estimate includes excess medical costs of $376,200,000 attributed to diabetes, and lost productivity valued at $174,900,000. For the entire state of New York in 2006, the cost is estimated at $12,860,000,000. This estimate includes excess medical costs of $8,676,000,000 attributed to diabetes, and lost productivity valued at $4,188,000,000. So clearly, this is a chronic disease that can wreck havoc on someone physically if they aren’t maintaining it, but the costs associated with this disease is astronomical.
I could have used cancer, heart disease, or some other chronic diseases in the same vein to prove what should be obvious to everyone. It cost so much more to our government and our society to be chronically ill than to take a comprehensive policy approach to preventative healthcare in this country. The Obamas have worked hard to create an awareness of this through Mrs. Obama’s “Let’s Move” initiative, but we have to do more as leaders. As Americans we need to change our mindset and relationship to food and we need to demand that our leaders on both sides of the aisle engage in real leadership by reforming how health care policy is done in America.