Knowing the difference between symptom and disease is critical to successfully treating a patient. We need to apply that principle when looking at the healthcare system. With so much discussion around Medicare for All, there is a key truth that is being overlooked; out of control medical costs are a symptom, not a disease. While our healthcare system is in dire need of an overhaul, that alone will not save us. The diseases that stand to make our kids the first generation to live shorter lives than their parents, while crippling our economy, are created by systems outside of healthcare. Without addressing these issues, any healthcare system we put into place won’t be able to keep up.
Discussion around our healthcare system seems to treat medical conditions as things that just happen, which we have no control over. This is simply not true. It’s estimated that 90% of diabetes is preventable. Heart disease is 80% preventable. Cancer is at least 40% preventable. These are lifestyle-based diseases, created by choices which are reinforced by policies outside of the healthcare system.
To properly assess the actual costs to the healthcare system, you need to look at the cost of treating a sick individual, but you also need to look at disease prevalence. The former is where the entirety of the healthcare debate seems to focus. From there, it moves to how to design a cost-effective system that provides quality care. The fact that reducing lifestyle-based diseases would be an extremely good way to make any system cost-effective has been ignored in every healthcare debate I’ve seen.
The costs of these diseases are staggering and are rising quickly. Left unchecked, they’re likely to ruin our economy, while ruining millions of lives. Heart disease cost the US $200 billion in 2015. Cancer cost 80.2 billion. Diabetes cost the US $327 billion in 2017, a 26% increase from 2012. Continuing at that rate, this would cost $510 billion by 2027. Even that number is conservative, as it ignores the fact that the diabetes rate is increasing in young people, and treating people for longer costs more money. These costs are preventable. The best way to lower them is to adjust policies that encourage sickness.
Type II diabetes is closely tied to diet and exercise, with high-carb, low-fiber processed foods being the main culprit. Research is showing that sugar acts like an addictive drug in our system. Yet, not only are there no meaningful policies to make it easier to reduce sugar, our policies actively encourage it.
We subsidize corn, which is largely used to make high-fructose corn syrup, the most common form of sugar in our diet. We subsidize sugar itself. We subsidize all the main components of processed foods, as this is one of the few goods that the US exports. This leads to a situation where these foods are the cheapest, most available foods in our country.
We can look to our own recent history in finding ways to effectively combat diabetes. Processed food companies are in a similar situation now as cigarette companies were 50 years ago; it’s becoming clear the harm that they’re causing, which they’re fighting with sponsored studies designed to show the safety of their product. They’re also counting on their loyal customers who love their products.
We’ve made enormous progress lowering smoking, and with it, lung cancer. We didn’t do this by making cigarettes illegal, we did it by making them expensive and inconvenient. Education played a small part, but the biggest changes came from direct policies.
There’s no good reason not to handle processed foods in a similar way. Doing so lowers our healthcare costs and improves lives. Doing it in a smart way also allows us to redirect any money raised via taxes into the healthcare system itself. Better yet, that money can be used to implement other policies which lower the rates of lifestyle-based diseases.
A second factor outside the healthcare system which is wreaking havoc is wealth inequality. In our current system, this may be the thing that breaks it entirely.
The wealth gap has put us into a feedback loop, with no clear way to come out of it. Uninsured people who can’t pay for healthcare use the emergency room when things progress to life or death situations. They can’t pay their bills. Hospitals are forced to raise their rates to cover the lost income. Rates go up, as do insurance premiums. Less people can afford healthcare or insurance.
Additionally, studies show that low-income populations consistently have worse health than other groups. People living near the poverty line are more likely to have stress around housing, food, and childcare. They’re less likely to live near grocery stores and less likely to have a car to buy groceries elsewhere. They’re more likely to miss meals. They’re more likely to feel unsafe walking in their neighborhoods. Universal coverage would break the feedback loop I mentioned earlier, but it would do little to help with these other issues.
The simplest, most effective way to help low-income communities improve their heath is to lower wealth inequality. I’ll leave the specifics to economists, but a living wage would certainly help. We have forty years of data to show that policies favoring corporations and the wealthy lead to a widening income gap. Addressing that issue stands to save us money spent on health care.
The wildcard in this whole discussion is how the environment stands to affect our health in the future. The WHO estimates that environmental toxicity creates at least 10% of our health care costs here in the U.S. This alone would be a good reason to examine ways to improve our environment.
As bad as the effects of our environment are now, they’re likely to get far worse if we continue to ignore the reality of global climate change. We’re seeing drought in African believed to be caused by climate change. We’re seeing once-in-lifetime storms at rates that we’ve never seen before. These storms have enormous human costs, of course. They have huge costs associated with rebuilding. They also create healthcare costs, both long-term and short-term. Hurricane Harvey flooded 800 wastewater treatment facilities and 13 Superfund sites. It’s impossible to know how much illness that will create, but it will create it.
Higher temperatures create obvious problems in severe storms, but secondary effects stand to have catastrophic consequences. When the climate changes, species are forced to adapt. This may mean finding new homes or new food sources. In the 14th century, the black plague swept through Europe, Asia and Africa, killing 50 million. There is solid evidence that the root cause of this was a climate shift in Central Asia. You could certainly make the point that this event happened without global climate change, and you’d be right. The point is that global climate change stands to create these types of events at a level that we’ve never seen before.
Meaningful change in our healthcare system is a necessity, but that alone isn’t enough. No healthcare system can withstand the poor health that we’re creating. The baby boomer generation will be retiring en masse over the next ten years, creating a spike in Medicare spending. We will need a functioning system and a strong, well-paid workforce to support them.
A successful healthcare system will require changes in policy which favor healthy lifestyles, living wages and environmental protection. As it stands now, our healthcare system is a mirror image of how the medical system itself operates; treating symptoms, with little attention to root cause. That’s true for our current for-profit system and the proposed Medicare For All plan. This isn’t the fault of those in the healthcare system or those designing healthcare policy, treating symptoms is all they can do. The root cause of our illness lies outside the healthcare system and it will need to be treated there.