A new Harvard study estimates that lack of health insurance kills about 45,000 Americans annually, which is 2.5 times as many as the previous best estimate commonly cited in the health care debate. This is a big difference (27,000 additional lives). But it still pales in comparison with the more than one million Americans who die annually by their own hands--which they use to light cigarettes, lift forks and convey too many alcoholic beverages to their lips.
That so many die as the result of behavioral causes is no argument against universal health coverage, and the new Harvard study bolsters the case for covering everyone, which I suspect we could do just by harvesting some of the incredible waste in the system today. But the vast loss of life associated with bad habits does suggest that we could do vastly more good by changing people's behavior, whether by exhortation, better education or sumptuary taxes.
Tobacco offers a promising precedent; smoking is down by something like half since mid-century, as I recall, and while this has contributed (perhaps significantly) to our national weight gain, on net this reduction in smoking has saved many lives and much suffering and expense. Further reductions in tobacco, as well as an assault on over-eating and unhealthy foods, might produce similarly large gains.
A pdf of the study is here (it's quite brief) and an even briefer essay on the whole subject, from the Wall Street Journal, can be found via my earlier Atlantic posting about the devastation we inflict on ourselves by our unhealthy lifestyles. There is vast room for improvement in this area, and progress in it could be a major force for reducing our runaway health-care costs--not to mention saving the lives of so many of our fellow citizens. President Obama has rightly called on students to work harder in school. Why not rally the rest of us to save ourselves from early death?
(Photo: Flickr User Siege N. Gin)
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Daniel Akst
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Well, a lot of people talk about the savings to be found in eliminating fraud, waste & abuse (FWA) from Medicare, Medicaid or the wole existing medical system, but I don't remember anyone talking about the specifics of this FWA. Where is it, how can it be eliminated, and at what cost (what's the cost to police it). I would think if it's as big as some claim, it should be easy to find enough of it so that everyone can see it exists and can them maybe be quantified.
Now, I understand that some savings may be found in mandating some common medical records system, etc. but that surely can't account for all of the reported costs savings. So where is the rest of this FWA?
Then the questions remains, why hang policing the system and eliminating the existing FWA on any of these bills? Why wait to reap the cost savings?
Your "research" is so cursory it beggars belief. Obviously social stigma and increased taxes have decreased tobacco consumption an incredible amount, and this redounds all to the good.
But the idea that you decrease health care expenditures by reducing tobacco consumption is ludicrous. There is plenty of data out there suggesting that tobacco use actually DECREASES net government expenditures on a given person -- and that health care costs alone are something close to a wash. At the very least, it's quite clear it won't do much for saving money. Given that, it's not clear to me that curbing obesity would necessarily decrease net healthcare costs. Those people get older, get more checkups, ultimately contract some kind of cancer (as even the healthiest of us would if we live long enough) and will rack up the typical mammoth expenditures in their last 6 months of life. Regardless, next time you make a point, perhaps you should take the time to see if it's actually true. You know -- research. That thing that journalists supposedly do. The idea that health care is fixed by less people smoking, less people going to McDonalds, and "reducing waste" is probably one of the silliest things I've ever read.
Certainly promoting healthy behavior is something we should do. But not because it saves us money. Because it doesn't.
"Might produce similarly large gains." What a joke. This kind of lazy, hacky, preconception reinforcing tripe is what I expect from the clowns of most editorial pages, not from The Atlantic. When I click on stories on this site, I expect to read things that someone has actually researched.
I don't want to be as harsh as the previous commenter, but he has a point. All those people ultimately will still have to die, and their long drawn out deaths may actually cost more. Besides, I bet someone who dies before retirement often will cost far less to society than someone who lives to the ripe age of 85 with perhaps years of prescription medication, several heart bypass surgeries and a few years of nursery home care.
The debate about healthcare and its costs avoids speaking about any of this. End of life care is what is the most expensive right after care for the chronically ill. Everything I know about current trends in medical science and pharmacology indicates that these will continue to be areas in which costs explode. Socalled biologicals are a great example. There are quite a few cancer treatment methods on the horizon that may require patients to pop a pill for the rest of their lives in order to 'cure' (or should one say: keep in check) a variety of cancers. Great for the pharma industry. Bad for the cost curve.
What this debate should focus on instead is how to increase the productive years individuals have in our society, by extending careers, finding alternative forms of work for the elderly, and keeping individuals healthy longer. It is some of the larger discussion we will be having in a few years (hopefully in Obama's second term) about how to restructure both Social Security/Medicare and retirement benefits to make them work in the 21st century.