It Just Doesn’t Add Up: Rocket Science and Healthcare

by pribut on July 12, 2009

It just doesn’t add up when you mix and match numbers that aren’t meant to be simply added together. When you have numbers that represent things that can’t be merely added together and derive from different measuring systems, you can’t simply join them together. If you thoughtlessly and carelessly put the numbers together, you could crash a space landing craft, as happened when meters and feet were jumbled together by NASA and NASA’s private industry contractors some years back. In 1999, this resulted in the Mars Climate Orbiter plunging and crashing onto the surface of Mars. And that was “rocket science”.

The numbers I’m talking now  are health care cost numbers that have been bandied about both left and right. The latest bit of what I call the 3 D’s (dumb, deceptive, and dangerous) of thinking and posturing was seen in David Broder’s column today in which he quoted Democratic Senator Ron Wyden (D Oregon) as saying:

“As you look at what is being proposed [in two Senate committees] you don’t see savings in the 10-year budget. That’s why the discussion has shifted to finding new money to finance expanded coverage. But at home, when you tell people we’re already spending $2.5 trillion a year on health care and now we’re going to spend $1 trillion more, it just doesn’t add up.”

No, unfortunately that doesn’t add up at all. Nor should it. You can’t take a yearly figure, the $2.5 trillion dollars and then seemingly add $1 trillion more to it and now you don’t make any sense at all. And this comes from a democratic senator who 3 years ago proposed his very own healthcare and health insurance reform bill. His bill declared savings of over $1 trillion over 10 years. The savings was declared by having the cost not climb by the amount it would have been anticipated to climb over that period. This form of logic and calculation has been used by nearly everyone speaking about healthcare costs. We’ll let it be. But both Weyden and Broder should know better than to jumble these numbers up in such a deceptive manner.

You can’t take a yearly figure and then add to it a 10 year cost to it, pretending that the 10 year cost is an annual, yearly expenditure. That is deceptive and dangerous, and likely calculating rather than merely dumb. It is intended to mislead rather than enlighten. We shouldn’t expect that from elected officials, representatives to government, appointed officials, pundits, talk show hosts and participants. Nor should it be acceptable from columnists both noted and those of little renown, nor should it come from bloggers. Yet this sort of unexamined rhetoric and misleading numbers appears often. I have no explanation for this phenomena.

Certainly there are good features in Weyden’s program. Many of these I wrote about back under Bush 41. A more global amortization of costs and risks, elimination of prior existing condition clauses and more. And Wedyen specifically promised a plan as good as what those in the federal government have. And that is a very fair, and well administered system. But that was great 20 years ago. We do need something outside the current system to serve as a model, example, and fail safe system. And we do need it to be cost effective.

We need to cut health care costs. We need to lessen the risk of chronic disease. We need any addition to the system to be paid for in some manner by itself. We also need to look at the costs to the economy of chronic illness, absenteeism, lack of productivity caused by illness. We need to look at the costs to the economy of health related bankruptcy. We need to examine the health fairs, such as those in Tennessee where people come from several states away to sit and stand in lines of people, hundreds long, to receive treatment in groups inside tents giving the appearance of an American refugee camp. There is more, but you’ve seen it elsewhere and either related to what you’ve read or ignored it.

There are a few proposals that may help control costs. The first was a bill proposed in the senate that the premiums charged (yes, there will be and should be premiums charged) for a government system should be at acturarial prices. The other proposals include what may ultimately be cost savers such as shared electronic medical records, and incentives for healthy lifestyle. Of course in some camps the term “lifestyle” has other connotations. But here and where it is applied to heathy living choices it means:

  1. No smoking.
  2. Healthy body weight.
  3. A healthy diet including a variety of vegetables eaten every day.
  4. Meet the recommended exercise requirements:
  5. 30 minutes of moderate exercise x 5 days per week or 20 minutes of vigorous exercise x 3 days per week (Not enough in my book. I think you should add 10 minute warm up and 5 minute cool down to high intensity training. But then you are actually exercising for 35 minutes.)

Exercise is one of the most important components of a cost reduction plan for health care. In combination these items would all help reduce the incredibly high 65% over weight and obese figures for the U.S. adult population. Childhood obesity also bodes poorly for the future. As we compare these numbers and our health care dollars spent with other nations, one could observe that we far “out weigh” the other nations. Along with obesity, an awful diet, and a loss of regular physical education in schools we are becoming sicker at earlier ages and less productive as individuals and a nation. The costs of chronic disease occurring earlier in life than they should if one adheres to the 4 healthy life habits are an incredible economic burden. A delay in onset of chronic disease, meaning it will occur later in life, and compression of illness, meaning it appears so late in life, that you don’t suffer for years and years with the chronic disorder, will dramatically reduce the cost of the chronic diseases to society.

According to the peer reviewed journal article by Reeves and Rafferty (2005), only 3% follow the healthy life habits mentioned above. So get a move on, shape up, and help reduce health care costs. And don’t forget that we do need a lean, efficient, and effective health care system. This means changes and reform. And perhaps a blog entry entitled the “7 Habits of Highly Effective and Healthy People”. We’ve got 4 above, and I have no problem suggesting another 3.

References on Fitness, Life Choices, Health, and Chronic Diseases

  1. Reduced Disability and Mortality Among Aging Runners: A 21-Year Longitudinal Study. Chakravarty, Eliza F. MD, MS; Hubert, Helen B. PhD; Lingala, Vijaya B. PhD; Fries, James F. MD. Archives of Internal Medicine. Volume 168(15), 11/25 August 2008, p 1638–1646
  2. Effects of Exercise Modality on Insulin Resistance and Functional Limitation in Older Adults: A Randomized Controlled Trial. Davidson, Lance E. PhD; Hudson, Robert MD, PhD; Kilpatrick, Katherine MD; Kuk, Jennifer L. PhD; McMillan, Kathleen MSc; Janiszewski, Peter M. MSc; Lee, SoJung PhD; Lam, Miu PhD; Ross, Robert PhD. Archives of Internal Medicine: Volume 169(2), 26 January 2009, p 122–131
  3. Effect of a lifestyle intervention on change in cardiorespiratory fitness in adults with type 2 diabetes: results from the Look AHEAD Study . Jakicic, J.M., Jaramillo, S.A., Balasubramanyam, A., Bancroft, B., Curtis, J.M., Mathews, A., Pereira, M., (…), Ribisl, P.M.    2009    International Journal of Obesity
    Article in Press. 20 January 2009; doi:10.1038/ijo.2008.280.
  4. Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial. Luft, A.R., Macko, R.F., Forrester, L.W., Villagra, F., Ivey, F., Sorkin, J.D., Whitall, J., (…), Hanley, D.F.    2008    Stroke; a journal of cerebral circulation 39 (12), pp. 3341-3350
  5. Laukkanen JA, Kurl S, Salonen R, et al. The predictive value of
    cardiorespiratory fitness for cardiovascular events in men with
    various risk profiles: a prospective population-based cohort study.
    Eur Heart J. 2004;25:1428–37.
  6. Katzmarzyk PT, Church TS, Blair SN. Cardiorespiratory fitness
    attenuates the effects of the metabolic syndrome on all-cause and
    cardiovascular disease mortality in men. Arch Intern Med. 2004;
    164:1092–7.
  7. Physical Activity and Coronary Heart Disease in Men: The Harvard Alumni Health Study . Sesso, Howard D. ScD; Paffenbarger, Ralph S. Jr MD, DrPH; Lee, I-Min MBBS, ScD
    Circulation Volume 102(9), 29 August 2000, pp 975-980
  8. Healthy Lifestyle Characteristics Among Adults in the United States, 2000. Mathew J. Reeves, PhD; Ann P. Rafferty, PhD.  Arch Intern Med. 2005;165:854-857.

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