Unconsidered costs

health care

Why is it that when Americans face-off in debates about transportation infrastructure they invariably end up arguing about the wrong thing?

Motorists rant about holier-than-thou, scofflaw cyclists and inattentive pedestrians that can dart into their road at any second as if this carried some significance. Cyclists and pedestrians whine about pollution and congestion caused by motor vehicles, and the sloth of drivers as if suggesting your adversaries are fat, lazy and trying to poison the world is somehow going to sell them on your cause.

Wouldn’t it be better to point out to them the money they stand to save by encouraging more like you to walk and ride?

Consider this: U.S health care costs now represent a more 17 percent of the nation’s gross domestic product (GDP) a greater than threefold increase since 1960, and investigators from the Centers for Disease Control and Prevention (CDC) are reporting almost a quarter of the country’s young adults suffer from prediabetes along with 18 percent of those ages 12 to 18.

“These new findings are evidence of a growing epidemic and a tremendously worrisome threat to the future of our nation’s health,” Ann Albright, the director of the CDC’s Division of Diabetes Translation, said in a prepared statement. “Additional research is needed to support the development of interventions for youth and increasing access to programs that we know work for young adults, like the CDC-led National Diabetes Prevention Program.”

In actuality, the need isn’t so much for new research as it is for getting Americans moving before the national economy chokes on health care costs or the country’s ruling elite decide that no matter how much the Sarah Palins of the world might scream American really does need “death panels.”

Doctors have known for years now that “physical inactivity is a primary cause of most chronic diseases,” as one study put it.

Researchers in 2015 found lack of exercise twice as deadly as obesity. A 2012 study concluded a lack of physical activity was as deadly as smoking. 

A 2018 CDC study concluded that 8.3 percent of the deaths of Americans age 25 and older are premature and attributable “to inadequate levels of physical activity. Increasing adults’ physical activity levels to meet current guidelines is likely one way to reduce the risk of premature death in the United States.”

The costs

If all these people were dying promptly, it would be one thing – tragic for friends and family but of little cost to society except in the case of those dead while still in their working years. But costs rise significantly the more and longer people are kept alive by modern medicine.

A quarter to a third of the people on federally funded Medicare are being treated for diabetes, according to the CDC.

There are nearly 60 million Americans on Medicare today, and some presidential candidates are proposing Medicare for All. Spending on Medicare in 2018 represented 15 percent of total federal spending and is projected to rise to 18 percent by 2029, according to KFF (formerly the Kaiser Family Foundation) – an independent, national organization which studies health care.

Medicare is funded by a trust that looks to run out of money by 2026, KFF notes. The trust spent $731 billion on Medicare payments in 2018, up from $462 billion a decade earlier.

Medicare spending today matches spending on national defense, which makes that CDC warning of a cohort of prediabetics aging toward the program especially alarming. Now, of course, their health costs are being picked up by employer health insurance or Affordable Care Act (ACA) plans which are subsidized by the government.

They all help fuel health-care spending that eats up a disproportionate portion of GDP.

“On average, other wealthy countries spend about half as much per person on health than the U.S. spends,” according to the Health System Tracker, a KFF-affiliated organization.

There are a lot of reasons health-care spending in the U.S. is so high, starting with the significantly higher wages paid nurses and doctors. But if Americans were healthier, they wouldn’t be needing health care professionals as much, and they wouldn’t be spending as much of the estimated $404 billion on drugs alone that Pew, another foundation looking at health-care issues, calculates will be spent next year.

And the country wouldn’t be losing an estimated $27.8 billion per year in worker productivity as researchers reported in The Lancet in 2016.  The biggest cause of productivity was Type 2 diabetes, the disease the CDC describes as a “growing epidemic.”

Tomorrow’s problem

“Type 2 diabetes used to be known as adult-onset diabetes, but today more children are being diagnosed with the disorder, probably due to the rise in childhood obesity,” the Mayo Clinic notes.

Obesity, inactivity and age are known risk factors.

“The risk of type 2 diabetes increases as you get older, especially after age 45,” Mayo says. “That’s probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.”

When one looks at the data, it’s pretty clear Americans can get moving, or everyone can look forward to paying – in one way or another – to support an ever more expensive health care system to care for people with diabetes and other chronic diseases.

Either that or someone can order up government-mandated fitness programs or death panels or maybe Uncle Sam could buy everyone a Peloton exercise bike given how wonderful they appear to make the world, at least if you’re a male, or so the Twitteratis and Ad Age are chattering. 

On the other hand, the country could start fixing cities so that people can get around on foot or by bike as they did in the past. This isn’t just about foot and bike paths. It’s about design.

“Although we tend to think of walking to work, shopping, cafés and parks as big city amenities, traveling by foot was the foundation of community life in small towns, suburbs and villages before the dominance of cars, parking lots and malls,” writes Jay Walljasper at AARP, a website for the elderly.

A Portland-based development firm – Gerding Edlen – has popularized the idea of “The 20-Minute Village” which it describes as making possible “all of the necessary and enjoyable things that make life great within 20 minutes of your home.”

Communities designed in this manner have been shown to get people up and moving. The CDC has been getting increasingly active in this area but doesn’t seem to have fully connected with officials at local and regional levels.

It advertises a whole “package of resources (that) can help state and local health departments, public health professionals, and community organizations as they aim to build more activity-friendly communities. To increase physical activity, the Community Preventive Services Task Force (CPSTF) recommends built environment approaches that combine one or more interventions to improve pedestrian or bicycle transportation systems (activity-friendly routes) with one or more land use and community design interventions (everyday destinations).”

But ideas aren’t much good unless people connect to them, and not many motorists are going to connect to making cities more walkable or ridable until the message gets across that you can spend a comparative little now to get people moving or you can spend a whole lot later to pay to keep them alive.

It’s the message pedestrians and cyclists should be selling. Screaming about how the streets should be safer doesn’t resonate well. It is, after all, a little selfish and easy for motorists to dismiss in the sense of: “If you’re that afraid, get a car and drive like everyone else.”

And the argument that you’re using muscle-powered transportation to get around to conserver energy and save the planet from global warming sounds both elitist and holier-than-thou in the sense of: “If you cared about the future of the world, not to mention your children, you’d be riding a bike, too.”

No motorists want to hear that. But explaining that limited spending today going to save huge, ongoing expenses tomorrow might get a few thinking that maybe there is something to making your city more walkable/rideable, and if you can likewise get the message into people’s heads that every body on a bike is one less car on the road….

Well then, it’s not impossible that heated debates in which people talk over each other turn into a sensible discussions that might just get somewhere.













9 replies »

  1. “…or everyone can look forward to paying – in one way or another – to support an ever more expensive health care system to care for people with diabetes and other chronic diseases.”

    Raises the question, why is the government subsidizing medical care for people with avoidable conditions?

    • Matthew,
      The entire health care system in the U.S. has zero incentive to keep people “healthy”.
      Big Pharma lobbyists and Federal policy experts switch seats quite frequently and pass self supporting legislation.
      As long as Capitalism rewards the medical community for pushing drugs (including chemotherapy) and performing expensive procedures then there will be no incentive for change.
      Instead of just looking for a specific cure (aka drug) for each disease, the medical community needs to start eliminating the causes from their patients lives…and at this point we all very well now the causes of many of these diseases.

  2. It’s not the inactivity. It’s the diet. Specifically, it’s the carbs. Type 2 Diabetes is entirely dietary caused. Some docs refer to Alzheimer’s as Type 3 Diabetes for the same reason. Switch to a lo carb – hi fat diet and you can control it. We as a nation screwed up in the mid-’60s when we adopted a high carb low fat diet (the old food pyramid). Proof of all this can be found here in Alaska, with the spike of the “western diseases” – hypertension, Type 2 diabetes, heart disease, overweight, etc – when the western diet high in fat and sugars was introduced to the native population. Science writer Gary Taubes has done a lot of good work on this over the years. Well worth your time to research. Cheers –

      • Agimarc,
        It is not just “carbs” which is the problem but processed foods with added rancid oils and sugars (especially high fructose) that is causing the problem.
        A “whole foods diet” made up of plant based nutrients is the answer.
        Fruits and veggies contain glucose and fructose which is easily digested and transferred to our cells while starches in breads and pastas are not.
        Breads and pastas also contain high levels of gluten that add plaque to out digestive system and further prevent the absorption of key nutrients…where fruits are opposite and clean the plaque out of the intestines.
        A high fiber diet that includes oatmeal, flaxseeds, apples and veggies will keep your arteries open and digestive tract working well.
        A healthy gut is the secret to a healthy life!

  3. There is a difference between health and healthcare. I think Michelle Obama’s gardening and athletic shoes did more for the former than her husband’s latter.

    Speaking of unintendeds, how about the increased carbon footprint from high-end recreational gear and equipment made from petochemicals and the fossil fuels burned on auto, boat, helicopter and plane transport to enjoy those righteous activities.

    • I agree that too many Americans are confused b/w “health” and “healthcare”…
      The problem lies in the fact that our society rewards doctors for just treating people…not healing them.
      In other countries like China doctors are rewarded when their patients are “well” and healthy.
      If America switched our paradigm and only rewarded physicians who patients were well and felt good you would see doctors care more about their patients diets and exercise instead of just prescribing them a couple hundred dollars of pharmaceuticals a month and sending them out the door.

  4. Craig, speaking of costs, you left out the fact that taxpayers are shouldering the burden of illegals and their healthcare ($30 billion) amd education costs ($60 billion) annually. How does that figure into Medicare/Medicaid costs compared to other countries?

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