With little notice, UnitedHealth released a major paper last week considering diabetes in America.
First the bad news: a large portion of our population either has the disease or is pre-diabetic.
Now, the really bad news: diabetes and pre-diabetes rates are going to soar in the coming decade, according to the analysis, in part driven by the obesity crisis.
I’ll return back to the study in a moment, but it underscores a paradox: medicine has never been better; our overall health, however, is worsening.
Indeed, after seventy years of staggering medical progress – whereby medicine has evolved from passive care to miraculous cure – we seem to have entered into a new age, one in which personal decision will increasingly influence our health and the cost of our health care.
The problem is that almost no one in Washington seems to have noticed.
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On this, we can all agree. Medicine has been transformed in the past decades.
Pre-1941: Prior to 1941, the state of medicine is well represented by Luke Fildes’ famous etching.
The doctor looks august, thoughtful and pensive. But notice what he isn’t doing – much of anything. Frankly, there isn’t much difference between the passive approach of physician here and the distraught mother in the background. Outside of thyroid supplement and insulin, medicine offered little but empathy to its patients.
The Modern Era: On February 12, 1941, the era of modern medicine was ushered in when the first clinical use of penicillin. Medicine went from passive care to miraculous cure. The doctor in that famous etching got off his chair and started to do things.
The latter part of the twentieth century saw one discover after another. Steroids, antipsychotics, open heart surgery, kidney transplants – all within a dozen years of penicillin’s first clinical use. The pace of change has been extraordinary.
Today, medicine has never been so advanced. Surgeries are done on fetuses months before birth; death by cardiovascular disease has fallen by two thirds in fifty years; diseases that were once death sentences, like childhood leukemia, are curable.
The Age of Preventable Illness: But if medicine has never been so advanced, the actual health of Americans is far less robust. The Era of Modern Medicine has given way to the Age of Preventable Illness. Americans have embraced a culture of extremes: too much alcohol, tobacco, drugs, and food, and not enough exercise and restraint. American leads the way in medical innovation, winning more Nobel Prizes in Medicine than all other countries combined. We also lead the world in obesity, and have the poor life expectancy statistics to show for it.
The consequences of the culture of extremes are unfortunate.
Indeed, as others have argued, including Dr. Steven Schroeder in the New England Journal of Medicine, we have reached a point where traditional causes of premature death – environmental exposure or lack of access to health care – are modest. What isn’t modest? Dr. Schroeder argues “behavioral patterns.”
The statistics are discouraging: 1 in 5 smoke; 3 in 10 are obese; 1 in 3 don’t even take their prescribed medications for illnesses like hypertension.
Which brings us to that study on diabetes.
In “The United States of Diabetes,” researchers at UnitedHealth estimate the rising cost of diabetic care in America. Diabetes has no single cause but, with profound weight gain, it’s clear that our obesity problems are causing diabetes to become ever more common.
This new study estimates that health spending associated with diabetes and pre-diabetes is currently $194 billion a year (7% of total U.S. health spending). That cost is projected to rise to $500 billion by 2020, as the percentage of people with diabetes and pre-diabetes rises to 52% of the population.
Interestingly, taxpayers are the ones who would be most on the hook for diabetic care and the treatment of diabetic complications, since the majority of diabetics will be on Medicare and Medicaid.
A few thoughts on the UnitedHealth study:
1) Washington Doesn’t Get It
For much of the last two years, Washington politicians of both parties have debated how to reign in healthcare costs. But as obesity rates rise and the resulting illnesses like diabetes become ever more common, we stand little chance no matter what happens to ObamaCare.
The larger debate is not about the IPAB or health-insurance exchanges or Medicaid expansion, it’s about health.
2) The ObamaCare Model is Dated
For Democrats, the view of healthcare is dated – they see illness as an act of God, leaving patients stricken with disease that could not have been avoided. Not surprisingly, then, ObamaCare seeks to divorce people from the financial consequences of their health decisions – regulating insurance to treat people equally regardless of age or illness (community rating), offering many no-deductible services, mandating the coverage of other services, and sweetening the deal with heavy subsidies.
Let’s be clear: a patient with Schizophrenia shouldn’t be punished because his father and grandfather had the disease. But many illnesses are preventable. Rather than encourage health, ObamaCare seeks to socialize the costs of bad health.
3) Public Health Efforts Have Been Weak
In the past, governments looked to “knee-jerk regulation.” Anti-obesity efforts – well meaning as they are – represent “feel-good regulation.”
Calorie listings, salt reductions, trans-fat bans. These efforts offer little potential of success.
Consider a NYU-Yale study that surveyed 1,100 fast food customers in poor New York neighborhoods. While people claimed making healthier choices when given the calorie-count information, researchers found that customers actually ordered more calories, not less.
The issue isn’t ignorance (does anyone really order a Big Mac and assume it to be a healthful meal?) or the plague of one bad ingredient (like salt), it’s a culture of excess. Policy prescriptions need to address the larger problem.
4) Conservatives Need More to Say
The conservative response to date has been anemic. With rising rates of obesity and diabetes, many have been happy to attack meddlesome liberal efforts, without offering anything in its place.
Take as an example Sarah Palin. Speaking in Plumsteadville, PA, the former VP candidate criticized the Pennsylvania’s State Board of Education’s plan to limit sweets in classroom parties. Earlier in the day, she had brought cookies to a classroom. She explained:
I heard there’s a debate going on in Pennsylvania over whether public schools were going to ban sweets. I wanted these kids to bring home the idea to their parents for discussion: Who should be deciding what I eat? Should it be government or should it be parents? It should be the parents.
The issue is more complicated than portrayed by the media, and Ms. Palin isn’t entirely wrong. The State Board of Education is considering pushing all children’s celebrations to one month and requiring that there be non-sugary food options at classroom parties.
It’s difficult to find this compelling (January kids would then celebrate their birthdays in, say, June?) or particularly practical (will children in large numbers opt for a medley of vegetables over the birthday cake?). And involving parents is reasonable enough.
But Ms. Palin’s attack is also paper-thin. Yes, the Board of Education seems to have identified a real issue and matched it with a bureaucratic answer, but what to do about the larger issue? Conservatives seem happy to attack the “nanny state” (to quote Palin’s Tweet) but offer little in its place.
And there is a conservative response on this issue. At a time of rising rates of obesity, we should emphasize physical education in our schools and better food in their cafeterias. Washington spends billions subsidizing big business and bad health choices through agricultural subsidies – it’s difficult to ever see the justification for this, but, at a time of record deficits, there is none. Health insurance needs to move from a model of sick care to one that promotes wellness. And, finally, we need to practice more restraint in our eating habits.
Conservatives have long argued for the need for personal responsibility, bemoaning fatherlessness and divorce. It would be a pity, then, to see the movement fall into obesity nihilism.