A Healthy Solution To Our Unhealthy Health Care Cost Problem - Understanding The Root Causes

A recurrent theme in this blog is the failure that is Obama Care and how, despite over 2,000 pages of new legislation, the new law is highly likely to be a miserable failure on many fronts:

• It will fail health wise because the process and people (the political class) that developed it did not have the creativity and problem solving skills necessary to identify the root causes of rising health care costs in this country and attack those root causes.
• It will fail health wise because Obama Care is little more than a rearranging of existing medical expenses and new taxes that do not aggressively address the root causes of rising health care costs.
• It will fail financially because it did not address the rampant fraud that currently exists in our government health care programs, fraud that is likely to increase exponentially as government interference and incompetence increases in this field.
• It will fail financially since those that put the legislation together never wanted a true picture of the final costs, with budget estimates excluding some of the provisions of the final bill and the legislation's timing was such that in the first ten years, revenues are collected for all ten years but the true costs and expenses of the program don't start until the fifth year.
• It will fail freedom-wise since the legislation and the government behind it forces every American to purchase health care insurance whether they want to or not, hardly liberty enhancing government in action.
• It will fail freedom-wise since it did not put the responsibility for efficient health care on the individual, it let the individual off the hook for their own health care by substituting government regulations, agencies, and compulsions.

What are the true causes of rising health care costs in this country? I do not know if anyone has the complete answer but it is not too much of a stretch to conclude that the following factors are significant:

• America does not exercise enough.
• America eats too much.
• America eats too much of the wrong types of food.
• America does not exercise enough.
• America smokes too much.

If these are indeed "root causes" of our poor health and resultant high health care costs, than they need to be addressed as a public health problem, not a tax, expense, and government bureaucracy problem. No matter how much you rearrange current health care expenditures, no matter how many more taxes you impose to pay for rising health care costs, no matter how many citizens you force to purchase health care insurance, the problem will not go away since these root causes have not been the  focus of your legislation. Until it is, Obama Care has no chance of solving the problem.

Consider an article in the current issue of AARP's magazine. The article focuses on the residents of Albert Lea, Minnesota which is a participant in the AARP/Blue Zones Vitality Project. This program started in May, 2009 and is focused on lessons learned in so-called "blue zones" - regions in the world where people have a long life span. The lessons learned in these zones focus on exercise, good eating habits, connecting with others, and finding purpose in life. Outputs and activities from this towns efforts included fifteen healthy initiatives, among which were the following:

• Cooking classes to help people learn to eat healthier.
• Formation of walking groups to get people more active and connected to others.
• Construction of pedestrian-friendly paths.
• Creation of community gardens.
• Two thirds of the city's restaurants began serving health food options.

Within just five  months, town residents participating in the program had lost three pounds on average and had gained about three years to their estimated life spans. One resident, used her participation in dance classes to lose thirty pounds.  Another resident has lost 55 pounds and has increased his life expectancy form 52 years to 78 years by eating smaller portions at meal time, walking daily, and doing community theater work.

A year later, according to the article, more and more people are walking, dancing, and bicycling. In 2010, residents had accumulated over 42,000 miles in distance traveled via exercise, up from about 37,000 miles in 2009. Twenty two town employers now offer work-site wellness programs to their employees, which has resulted in over 1,000 free health assessments. These people are living healthier, living longer, and not contributing to our rising health care problems since they took personal responsibility for their health, not nameless and numerous government agencies.

Similar results were pointed out in a spring, 2010 Fortune magazine article which was an interview with Dr. Delose Cosgrove, the CEO of the Cleveland Clinic. The Cleveland Clinic is one of the best and well known hospitals in the world. Despite being the best and serving some of the richest people in the world, they also have one of the lowest costs structures. How did they accomplish this double play of outstanding care at low costs? According to the article and Dr. Cosgrove's experiences:

• In our current health care industry there is no incentive for staying well.
• Obesity in America accounts for 10% of all health care costs.
• Smoking, diet, and lack of exercise, according to Dr. Cosgrove, contribute to  40% of premature deaths in this country, 70% of chronic diseases such as heart disease, and account for 75% of the nation's total health care.
• At the Cleveland Clinic, all deep fryers were removed from the cafeterias, the menus were made healthier, the candy and soda machines were removed, free exercise programs were initiated fro Clinic employers, free Weight Watcher memberships were made available, and in the first year of this transformation, Cleveland Clinic employees lost 120,000 pounds of weight, 60 tons.
• From a smoking perspective, smoking was banned on the entire grounds of the Clinic, free smoking cessation classes were offered to both employees and the entire county where the Clinic is located, a lobbying push was made to ban public smoking everywhere in Ohio, and the Clinic stopped hiring smokers. In four years the smoking rate in the county went from 28% to 18%, a little less than the national average of 20%.

See a trend? Health care's rising cost problems cannot be solved by more government bureaucracy, more fraud in government health programs, punitive laws that make criminals out of Americans who do not purchase a government mandated service, and more taxes. It can be solved by understanding the root causes, which are likely the same ones identified in Albert Lea and at the Cleveland Clinic, and treating rising health care costs not as an accounting problem but as a public health problem.

If you make people healthier, you will reduce their need for medical and health care services which reduces demand and basic economic theory then takes over: reduced demand results in reduced prices and costs. Unfortunately, as we see every day, our politicians do not understand basic economics.

What to do? First of all, the legislation known as Obama Care needs to be repealed since it is becoming more and more obvious every day that it does not address the root causes of our problem and the financials upon which it was based were not solid: the cost of implementation will be significantly higher than the cost estimate that was used to sell the legislation.

Second, Step 26 from "Love My Country, Loathe My Government" needs to be implemented. This step provides a process of root cause problem identification via a panel of experts from a diverse set of fields and disciplines, sans lobbyists and politicians, in order to develop a long term public health care approach to reining in medical costs. This approach would leverage knowledge of diet, smoking, obesity, and exercise that we know accounts for a huge portion of our problem.

In real life, if you understand what is causing the problem, it makes it a lot easier to to solve the problem. Unfortuantely, in our surreal political world, we never get to the root cause of any problem, probably accounting for the dismal track record of our political class in the areas of drug addiction, failing public schools, leaky borders, high unemployment levels, etc. over the decades




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http://www.cato.org/
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