Montana Viewpoint


Prevention is the best way to lower future health care costs.

August 18, 2003

If I knew I was gonna live this long, I woulda took better care of myself.”
~ Eubie Blake, 1893-1993

A couple of weeks ago I participated in the National Governor’s Association Policy Academy on Chronic Disease Prevention and Management. A chronic disease is on that either takes a while to manifest itself (smoking and cancer) or one that lasts a long time (arthritis). Typical chronic diseases are diabetes, arthritis, cancer, heart disease and obesity. Most chronic diseases can be prevented or lessened by changing our habits or early detection. That’s important not just for the individual, but for government as well.

Why is your government so concerned about your health? It’s not the same reason your mom had. Providing health care for Americans is the second largest expense of state governments after education, and one of the largest for the nation. America spends 14% of its Gross Domestic Product on health care, and 75% of that cost is attributable to chronic disease.

Over the past ten years the cost of health care per person in America has gone up 40%. That’s a lot when you consider that our number of people over 6—the group that accounts for the lion’s share of health care costs—has held steady at about 13% of the population. Individual health care costs are expected to continue their increase, and there’s an event that is going to make those costs soar in the near future. In 2011, the first of the post WW II baby boomers will reach 65, and the number of folks over 65 will rise to 20% by 2020.

If health care costs increased 40% with a static elderly population, what will they do when the number of elderly on Medicare almost doubles? You can see why government types are nervous. You should be, too, because you’re going to pay for it.

The purpose of the seminar was to help states come up with a plan to minimize the increase in health care costs. Attendance at the seminars was awarded to only nine states in a competitive process.

The fact that our personal actions contribute to our health problems is obvious; smoking and lung cancer, for instance. There are societal factors that figure as well; cigarette advertising encourages people to do something that is physically harmful. A vigorous public policy emphasizing early detection of breast cancers has met with great success, but at the same time, the less robust promotion of early detection of colorectal cancer has kept the fatality rate for this disease the same. That’s a matter of public policy.

Obesity is now being listed as a chronic disease and is associated with high rates of cancer, heart disease and diabetes. Calling overeating and under exercising a disease seems to be stretching the definition, but obesity plays a significant role in health problems, and it’s not entirely a matter of personal restraint. I don’t know anyone who wants to be overweight.

I nearly fell off my chair a few years back when I read that someone was suing a fast food company for making him overweight. “Ridiculous!” I thought to myself. But after reading “From Wallet to Waistline, the Hidden Costs of Supersizing” published by the National Alliance for Nutrition and Activity, it appears that the fast food folks are using methods similar to those used by the tobacco industry to increase their bottom line.

Supersizing” costs the customer little and earns the business a lot, because the cost of food is only 20% of their operating costs. Therefore they encourage customers to buy larger servings. People finish what’s put in front of themthe adult version of the “Clean Plate Club.” Restaurant servings in general have gotten larger, and even today’s dinner plates are bigger than they used to be.

I for one dread a warning label on a hamburger bun, but some states are already enacting legislation to require fast food restaurants to notify their customers that eating their food can cause weight gain. Go figure. But there is some really interesting data on the growth (so to speak) of obesity in America. In 1985, only eight states had populations where over 10% of the people were overweight. By 2001, 20% or more of the population of every state in the nation (except Colorado) were overweight. That’s a trend that is due to a shift in eating habits, and can be mitigated.

Why all the hype on obesity? Overweight people have a significantly higher incidence of diabetes, heat disease, and cancer, among other chronic diseases. The expectation is that by concentrating on reducing obesity we will see a corresponding decrease in other chronic diseases, and the associated costs.

Health care is usually thought of as taking care of sick people, but a more important aspect of health care is keeping people from getting sick. It will cost money to implement the changes suggested to lessen chronic disease, but no matter how much it costs, in the long run it will be lots less than not doing it.

Jim Elliott
Phone: 406-444-1556
Mail: State Senate Helena, MT 59620