By Timothy Gould, DPT
Let’s set aside for the moment the politicized hot-button talk about healthcare costs in the United States and look at the problem of controlling health care costs as perhaps your physician might look at managing an illness.
Diagnosis: Spending Acceleratitis
The latest official numbers from the National Health Expenditure Accounts (NHEA, which is responsible for the official tabulation of healthcare costs in the U.S.) show that health care spending increased to $3.2 trillion in 2015. That equates to $9,990 per woman, man and child in the country. Early projections from the Department of Health and Human Services estimate that in 2016 that number increased to $3.35 trillion and $10,345 per person. Between 2017 and 2025, an annual rate increase of 5.8 percent is expected and will bring spending to $5.5 trillion seven years from now. This far outpaces the rate of growth of the national economy, and thus healthcare spending becomes a significantly greater percentage of GDP on a yearly basis.
Causes: Price Hyper-Inflatia / Multi-Factorial
The single greatest element in these growing costs is price inflation for medical services. Charges for services go up and care gets more expensive each year. An aging population and general population growth contribute to a lesser extent. When considering all areas of healthcare expenditure, utilization of services has been shown to have only a small effect, if any at all.
Treatment: A Healthy Dose of Healthy You
The concern about such a rate of spending increase is, of course, how we pay for it. This is where the finger pointing starts and arguments flare. The government should pay for it because health care should be a right for all citizens. The insurance companies should pay for it because their investors are profiting from the ills of others. Those that use the most should pay the most. The politicians need to step in and figure it out. The politicians need to stay out of the way and let it play out on the open market. The pharmaceutical companies should be forced to lower prices. And on and on.
No matter your perspective on the subject or who you choose to point your finger at, the enormous and growing cost of health care cannot be handled effectively by any of these entities or means. People get sick, researchers investigate cures, companies develop new drugs, engineers invent new diagnostic and intervention technologies, physicians conceive innovative treatments, and the cost goes up and up. No matter who is holding the bill at the end of the day, it is unreasonable to expect that it can continue to be paid when considering the projected rate of increase.
Therefore we have to point our fingers elsewhere. Namely, at ourselves.
We have to go back to the beginning: People get sick. Without that most crucial of factors, costs don’t skyrocket. As individuals and as a society, a greater emphasis on wellness and prevention is essential and will undeniably decrease healthcare expense.
Consider this: According to the Department of Commerce, more health care dollars go toward treatment of cardiovascular disorders than any other diagnostic category. (Interestingly, the category “Neoplasms,” which includes cancers, is lowest on the expenditure list, below disorders of the musculoskeletal, pulmonary, endocrine and nervous systems). And, yes, we rank among the best in the world with regard to heart attack mortality (which is not the case for many other measures of quality in our health care system). We also know that many cardiovascular conditions can be prevented altogether or improved with proper risk factor management. Managing high blood pressure and high cholesterol, eating a balanced diet, exercising regularly and addressing stress can go a long way to reduce one’s risk for a cardiovascular event. In the diagnostic category of care that is associated with the greatest cost. i.e., cardiovascular disorder, imagine what even modest lifestyle changes could do when made en masse.
As a population, however, we seem to be moving in the other direction. We take our health and our bodies for granted, assuming that modern medicine will bail us out when we find ourselves in trouble. At the level of the individual, it’s difficult to make lifestyle changes that promote personal wellness and help prevent disease; it is far easier to abide by our current habits and ask for a pill or a surgery when things go awry. It is not simply a matter of negligence, however. Often, it is a matter of lack of information. At a societal level, we don’t do a comprehensive job in educating people on the nature of wellness, risk factor management, and prevention. Sure, we’ve made it clear that cigarettes and excessive sugar in your diet are bad for you. But do we value these lessons in our culture highly enough to invest resources to help people truly understand the associated risks, the practical application of management strategies and the necessary behavior modifications? I propose that we do not.
I’m not suggesting that if we all exercise, eat better and get regular check-ups that the natural state of human vulnerability and illness will cease to exist. Things out of our control—disease, accidents, aging, mutation, degeneration, genetics—will always play major roles in dictating our collective health. But when we take personal responsibility for the factors that we can control, we can effect change in our own lives as well as for the greater good.
A health teacher of mine in high school once mused, “Suppose you are given a car when you turn 16 and told that it’s the only car you’ll have for your entire life. If it breaks down, you are out of luck. You can bet people would take care of that car and treat it like gold. And yet, knowing that our bodies are the only ones we’ll ever have, we neglect and abuse them until they break down.”
We can’t simply rely on medicine to fix us up when we break down. The costs go beyond dollars when we do so. It is up to each of us to do a better job taking care of ourselves in the first place.
Timothy Gould holds a doctorate in physical therapy from SUNY Upstate Medical University in Syracuse, New York, and works at Dee Physical Therapy in Shelburne. He can be reached via email.