June 11, 2015
years ago, Michigan State University’s Mathew J. Reeves documented
Americans’ unbridled self-destructiveness.
epidemiologist looked at our commitment to four health habits: regular
exercise, eschewing cigarettes, consuming fruits and vegetables daily, and
maintaining a respectable body mass index.
portion of the population that practiced all four behaviors? Three percent.
Reeves called his findings “pretty remarkable,” noting that eating right,
moving muscles, and avoiding coffin nails is “really just a basic lifestyle
pattern. We aren’t asking anyone to climb Mount Everest here.”
later, not much has changed. There’s been some progress on smoking. But obesity
has gotten worse. According to the latest report from the CDC,
U.S. adults “consume fruit about 1.1 times per day and vegetables about 1.6 times
per day” -- far short of the U.S. Department of Agriculture’s recommendation of
five to nine servings daily. And exercise
remains anathema to a huge share of the populace.
refuse to get right with their health, and it’s paving the way for the next
phase of Obamacare: prevention.
year, the Bipartisan
Policy Center launched “a Prevention Task Force to focus on opportunities
for investing in prevention as a way to improve health outcomes and reduce
health care costs. The task force included a diverse group of experts to review
the evidence on prevention and to frame a strategy for better integrating
prevention in the nation’s approach to health and health care.”
Prevention Prescription for Improving Health and Health Care in America,”
issued last month, lamented that “for many citizens, the U.S. health care
system fails not only to deliver cost-effective, high-quality care, but also to
enhance overall population health as well.” What’s needed is “a more integrated
approach to health and health care” that can release “the potential of
prevention strategies to help more Americans enjoy longer, healthier, and more
productive lives while also reducing overall health care spending.”
increasingly accomplished. Revenue is starting to flow to the campaign to, as
the BPC report puts it, “embed prevention in the U.S. health care delivery
system.” Obamacare established the “National
Prevention Council,” which “comprises 20 federal departments, agencies and
offices and is chaired by the Surgeon General.” (Its “national strategy” was
issued in June 2011.) Other treats
for public-health bureaucracies include Medicaid funds for smoking-cessation
programs targeted at pregnant women and “guidance and information to states”
for obesity awareness. For-profit insurers are required to get into prevention,
too. As the
Kaiser Family Foundation glowingly summarizes, under Obamacare, “private
health plans must provide coverage for a range of preventive services and may
not impose cost-sharing (such as copayments, deductibles, or co-insurance) on
patients receiving these services.”
becoming a big “business,” but it suffers from an unforgivable oversight. It
has no interest in the economics of unhealthiness.
1960, nearly 50 percent of U.S.
healthcare expenditures were covered by consumers’ wallets. By 2010,
out-of-pocket spending declined to under 15 percent, edged out by Medicare,
Medicaid, and employer-supplied insurance.
people from the direct monetary consequences of their poor health habits, and
livin’ clean is no longer a priority. After all, “someone else” is paying the
bills, so why not gobble another bag of Skittles,
stick with a two-pack-a-day habit, or feel no guilt devoting an entire weekend
to binge-watching Sons of Anarchy on Netflix? As health-policy
experts Kenneth Thorpe and Jonathan Lever explained: “Largely preventable and
highly manageable chronic diseases account for 75 cents of every dollar we
spend on health care in the U.S.”
America Foundation’s Phillip Longman is one of the few researchers who
understands that the reason we don’t “live any longer than Costa Ricans” is
“differences in behavior.” Americans, the demographer wrote, “exercise less,
eat more, drive more, smoke more and lead more socially isolated lives. Even at
its best, modern medicine can do little to promote productive aging, because by
the time most people come in contact with it their bodies are already
works. Don’t smoke, and you won’t get COPD. Stay
in shape, and cardiovascular diseases are unlikely to strike. Eat kale,
blueberries, and broccoli, and your immune system will be unconquerable.
Recognize the value of social capital, and mental illnesses are kept at bay.
Keep your waistline slim, and the chance of developing diabetes is low.
well-intentioned, taxpayer-funded finger-wagging won’t move the
needle on Americans’ dismal diet and exercise habits. What’s needed is a strong
link between unhealthy living and financial pain. What’s needed is a complete
reversal of 50 years of healthcare policy.
D. Dowd Muska (www.dowdmuska.com) writes about government, economics, and technology. Follow him on Twitter @dowdmuska.
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