“Prevention can reduce the incidence of disease, but savings may be partially offset by health care costs associated with increased longevity.” https://pubmed.ncbi.nlm.nih.gov/22052182/
A few years back I was hospitalised because of a bite on my arm from one of our cats (long story) and was given heavy doses of multiple antibiotics.
If that hadn't been treated so promptly I might have required surgery or might even have lost my arm (a nurse told me about someone who lost a leg to a cat bite!).
Edit: When I went to the hospital I had no idea how serious it was and turned up to the "Minor Injury Unit" - they had me in A&E and X-rayed within about 10 minutes!
Edit: Of course, having been in the hospital for 3 days rather than the expected hour or so I was fretting about car parking charges - turns out they are free at the point of parking....
Suppose the odds work out to 1:100,000 lost arm vs 300$ hospital treatment. Now a lost arm is expensive but it’s not 30 million dollars expensive.
Those numbers aren’t based on anything but that’s the kinds of calculations involved. And as I mentioned the winners seem to be extremely cheap options like vacations.
On a brighter note, no one is anti-vacation.
This is why vaccines are generally free out of pocket, the ROI is very positive for the insurance company.
And of course there's an XKCD for that:
B. I have trouble believing this analysis is really looking at the whole picture.
One of the costs of illness that is frequently cited is lost productivity. You are going to tell me that when people live longer, all of them are merely running up more medical bills without also working additional years to help cover those costs?
For example, how many people get coronary heart disease, and how many years of their work would be needed to pay for a bypass or stent or even open heart surgery? I assume these surgeries cost hundreds of thousands of dollars. Plus the ongoing costs after that. Same with effects of diabetes and hypertension, which might as well effect everyone.
Of course, there is liability, patents, licensing costs, etc that can be changed.
On the other hand, if you drink and drive while young and healthy, you can helpfully donate your organs to someone with a terrible condition and they can run up potentially a few million dollars in health care.
https://data.oecd.org/conversion/purchasing-power-parities-p...
This has India at 23:1 for USA.
An extremely simplistic analysis would say assuming that conversion factor holds true for all costs, you are “spending” $100,000 dollars of US value when you spend $4300 USD in India.
These folks could be doing other, more productive things with their lives, rather than wasting away in the shadows while we debate the national merit of saving them.
(These are examples from TFA)
This is the thinking of an insane person.
Taking care of the elderly is what money is for, yes?
I mean, "increased longevity" and caring for our sick and elderly is kind of the point of civilization?
No. There is only one goal: defeat entropy. ("Evolution".)
> money is for feeding hungry children
Who then (ideally) grow up and become (eventually) old, eh?
It sounds like you're saying these are Universal truths, but I certainly don't think they are.
I don't think the goal of civilization is to fight entropy or Foster evolution, or prolong lifespan. I also don't think most people would agree with that.
I also don't think longevity is a singular goal on an individual or civilization level. As a simple thought experiment would you rather live to 50 and absolute happiness and pleasure, or live to 100 in complete misery?
In re: the (sole, underlying) purpose of civilization, well, do you believe in evolution? I don't mean that in a snarky or combative way. I do, and as a corollary to that it seems clear to me that, whatever else is going on, successfully getting into the future, aka "defeating entropy", is as close to a "Universal truth" as you're likely to get, outside of physics. Evolution may have changed form when the human brain, uh, evolved, but the fundamental structure of the situation didn't change: we're still evolving, still trying to find the best way to ensure the future contains humans for the foreseeable, uh, future. Remember, all the other hominid species have gone extinct! We are not guaranteed to succeed, eh?
There's a discussion we could have around around whether caring for the elderly is really the optimum strategy, but I don't think that's really very interesting? I'm spending a significant amount of my person time and resources caring for my elderly mother who has dementia. I could put her in a home, and use the extra time to work more hours, and I would make more money even after paying for her care. I may yet have to do that if she becomes more difficult to care for, so far we have been lucky. Our neighbor's father got dementia and would sometimes try to fight them. Like throw punches and such! Mom's a cheerful sweetheart. I'm very grateful for that.
Anyway, if someone wants to tell me that I'm wasting my time caring for my mom, well, I'd question their sanity.
- - - -
> I also don't think longevity is a singular goal on an individual or civilization level. As a simple thought experiment would you rather live to 50 and absolute happiness and pleasure, or live to 100 in complete misery?
Now I'm struggling to understand you. :) The thought experiment is so simple that it doesn't make sense. Do I really sound like someone who would choose the latter option? Can you imagine anyone who would choose the latter option?
Not that it should really matter, if the goal is to "get them healthy", right? But it's not, it's about having someone to hate and look down on. Black Mirror nailed this vibe perfectly in Ten Million Merits.
Anyway this is a specific problem with the US healthcare system though - we spend way too much on patients who are circling the drain and everyone else gets screwed. Broken bones and bad dentistry and missed immunizations are what produces the single largest improvement in health outcomes - Cuba really only has something like a 7-year reduced lifespan vs the US iirc, because they do well at delivering that basic care even if you're not going there for proton radiotherapy or other ultra-high-end treatments. And the US does the latter but sucks at the former.
I guess somewhat more recently we have people like Lizzo trying to push back on things like this, but the CDC has recently pushed a recommendation for bariatric surgery on children as young as 14 so. Shrug, I guess.
Your point seems to rather be that some diseases are cheaper to treat than others, or that the total area under the cost-life curve is driving the cost, not just the last few months.
Like only counting dollars is a bad way to run a society.
How would you show that on your balance sheet?
Absolutely. But one measure everyone understands is money, and you can convert a lot of situations into money. Poor health = missed work, missed rent payments, drugs needed etc. It’s not a nice measure, but it works.
Universal healthcare actually means a downgrade in the experience for these people, which is one of the reasons why they don't want it. Yea, they might want to make sure that people don't get sent to the poor house just because they came down with some random disease, but god forbid they have to wait their turn behind some plebe in the doctors office.
But it also means a much higher cost. I know these people are wealthy, but they are getting fleeced. Many (all?) socialised systems also have a private system along side, so the wealthy can avoid the great unwashed.
It's not really very interesting to discuss the bad position at any length, except maybe as a launching point into some more interesting adjacent discussion.
That wasn't the point I was trying to make. Everyone arguing against me is trying to claim that and then say it's a dumb position.
Try arguing with my actual point in the future.
I'll grant you I could have stated it more clearly. My bad. I also clarified, yet this assertion lives on.
Whatever.
We pay a lot more per capita than any of those other places, but the ratio of what we pay per capita to what a given other first world country pays per capita has been pretty steady long term.
> Does spending on prevention save the country money over all? A recent report from the Congressional Budget Office in the New England Journal of Medicine suggests the answer is no. The budget office modeled how a policy to reduce smoking through higher cigarette taxes might affect federal spending. It found that such a tax would cause many people to quit smoking — the desired result. In the short term, less smoking would lead to decreased spending because of reductions in health care spending for those who had smoked.
> In the long run, all of those people living longer would lead to increases in spending in many programs, including health care. The more people who quit smoking, the higher the deficit from health care — barely offset by the revenue from taxing cigarettes.
Well darn, we're damned if we do, damned if we don't.
> But money doesn’t have to be saved to make something worthwhile. Prevention improves outcomes. It makes people healthier. It improves quality of life. It often does so for a very reasonable price.
An important point to make.
> There are many good arguments for increasing our focus on prevention. Almost all have to do with improving quality, though, not reducing spending. We would do well to admit that and move forward.
> Sometimes good things cost money.
This is a value judgement, one I happen to agree with. Thank you for sharing this article.
I was under the impression that USA healthcare has out of control costs due chronic diseases[1] . None of which have any 'preventative care' that you get at an hospital( cancer maybe an exception) . What can a hospital do about 'physical inactivity' ?
We can blame this or that but mind boggling half the population in USA is obese. What can any healthcare system possibly do about that.
One hospital was having so many resources consumed by a relatively small number of very ill homeless people and concluded that housing them would be cheaper and more effective, so it did.
Health care really shouldn't be used to mean medical care per se. And that's one of the things that complicates such discussions.
Exactly.
Whole hospital floors are completely dedicated to patients with completely preventable diseases with proper lifestyle choices (uncontrolled type-II diabetes, most cardiac and vascular surgeries...). What these people needed a decade or two ago was someone to coach them/engage in a long term discussion about their labs and deteriorating health with them.
I can't help to think that defining healthcare exclusively as medical care is an attempt at further gatekeeping from a profession already known for these practices... I mean, what brings in more dollars for the provider, a series of hospitalizations and vascular surgeries or a few hours of consulting and coaching?
So a hospital can actually do a lot for fatties. Being able to talk to a nutritionist, set up a plan, gain access to any applicable medication, addressing out underlying inflammation/hormone/disordered eating...
This is such a stupid, self-defeating policy for an insurer. Until your problem costs us a lot, don't you dare try to mitigate it on our dime!
Bariatric procedures can be included as a sort of "rider". This is typically written into self funded plans. Bariatric is not an essential coverage therefore ACA qualified plans do not typically include them - unless medically necessary.
Not that I shed tears for insurance companies, but I think this would be a lot of money. Now… the problem should have been addressed twenty years ago before it went critical.
The last local obstetricians were pushed into hospitals and large groups by insurance companies paying them 20-40% of prevailing fees. They now make more per procedure and don't have to pay for facilities or do billing. Why would the insurance company pay so much less? Because once the cartel is created their profit (and pricing) will double.
That is for profit healthcare for you. Costs guaranteed to grow at DJI rates.
Not true. The Surgical Center of Oklahoma, a purely for profit clinic that does not take insurance, has not raised the rates for any of their services since 1995.
Yes, they have not raised rates...despite inflation
That's true profit healthcare.
What we have is a monster hybrid between government healthcare and subsidized, monopoly care
Ideally the party in opposition to government-funded healthcare would do this.
Source?
>Had the pathology fees that apply to the examination of breast masses not increased, our price would be the same now as it was in 1997, but alas it is now $2,365. Only three other fees have increased since we began quoting them over the phone in 1997.
That said, I'll admit that the claim is broadly true.
https://mises.org/wire/why-arent-there-more-free-market-surg...
Costs have continued to rise because provider organizations have been merging in order to gain more market negotiating power. Expensive patented drugs and medical devices also play a major role in driving up costs.
It’s unpopular to point fingers at provider orgs.
I assume gp meant bariatric surgeries by 'weight loss procedure'. These are not just cost considerations , they come with significant risks and long term side effects. They aren't get out jail free card to be handed out like candy and isn't a 'preventive care' for obesity related diseases.
I suspect the real issue is that there are no universally proven ways to reduce weight that have high success rates of adherence - for example, this is why CPAP and insurance is really tricky... too many people wear them for a bit then stop using them, wasting thousands of dollars (between the sleep study and the equipment itself).
Quick, rank speculation:
100% of obese people don't go on to suffer from 100% of the potential risks of obesity.
Given the actual percentages, it may be cheaper for the insurance company to pay for (and, at least in part, deny!) actual treatment for those potential risks than to cover the vast majority of preventative doctor visits and labs.
Additional rank speculation-- I wonder if that problem gets worse as obesity numbers rise. E.g., symptom A necessitates a test for condition X, but symptom A plus obesity necessitates tests for condition X, Y, and Z...
Just curious
At one point my family medicine guy suggested he could write down something arguable just to get me to a nutritionist (think making me do some wicked pose while measuring my blood pressure and then writing it down as "high blood pressure") and I told him just don't bother. We did however in future meetings ensure I always had something else to talk about besides my weight progress so I'd never get billed again.
The excess adipose tissue causes subtle, progressive damage which won't necessarily be obvious in the regular preventative screening exams that most younger patients receive. But as some point after age 50 or so the systems decompensate and the patient's overall health deteriorates rapidly.
Offering nutrition advice at food stores is probably a better approach then doctors visits.
Healthcare insists on the very best, most expensive in gauzes and then when they can’t afford them they let people die, instead of using cheaper gauzes which are just fine and have been used for years.
- I’m uninsured. Too risky.
You could do something about that.
People who do vigorous sport can turn into complete couch potatoes once they are too old to practice that sport. Difficult concept for you to get, perhaps? Hint: being “healthy” wasn’t the point; it was the excitement, the adrenaline… etc.
The first time we've had any sort of medical intervention that seems to actually address this is the invention of GLP1 agonists and similar medications. Most insurance providers REFUSE to provide coverage for these medications, even though they are a net positive for the patient and society. Taking a GLP1 agonist while obese can straight-out /prevent/ the development of Type 2 Diabetes, even while you are still obese, and can cure some people of Type 2 Diabetes while they are ungoing further treatment.
I am very lucky in that my insurance does cover this treatment. The insurance of several of my friends (who are on ostensibly "better" plans because their premiums are more heavily covered by their employers) does not cover this. If I could make one legal change to the healthcare system in the US, it would be to require insurance providers to cover preventative treatments for obesity. Obesity is the primary cause of chronic health problems in the US, and it's nearly entirely preventable with proper care, but it's almost impossible to get that care /even as a tech worker with employer-provided insurance/.
It should be affordable and accessible for nearly anyone in the US to get access to GLP1 agonists and a dietitian. It isn't currently. Lacking this, means that obesity will continue to be a social disease that drives up healthcare costs and drives down productivity, quality of life, and total life outcomes in the US.
My impression was that obese people first get less insulin sensitive over the years and then become obese as a result.
They usually measure insulin sensitivity as a proxy to 'metabolism'.
> It should be affordable and accessible for nearly anyone in the US to get access to GLP1 agonists and a dietitian.
I thought it was only approved for diabetes not obesity.
Ozempic and Wegovy are the same substance from the same company, Ozempic is approved for diabetes, Wegovy is approved for obesity. Similar situations apply to other competing GLP1 agonists.
What i don't understand is that you are saying these are "preventative treatments for obesity" . aren't preventative treatements given before the condition even comes into picture, these drugs are after you get obese so not sure how they are preventative.
Doesn't weight just come back instantly once you stop these drugs. Hard time accepting that solution is putting 200million americans on this drug for rest of their lives.
"Cardiometabolic improvements seen from week 0 to week 68 with semaglutide reverted towards baseline at week 120 for most variables."
https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.147...
Yes, if you stop taking the drugs, after a short time you return exactly how you were prior. You must take these drugs for life, unless something else comes out that improves the situation.
Ah I understand now what you meant. I remember looking into while ago( i have like half my extended family on these drugs now lol) but couldn't really find evidence to support this claim.
"There is only limited-quality evidence that at-risk patients taking GLP-1 receptor agonists are less likely to progress to diabetes (number needed to treat [NNT] = 23). Serious adverse events were more likely in patients taking GLP-1 receptor agonists than in patients taking placebo (number needed to harm [NNH] = 42). There is insufficient evidence to evaluate the effect of DPP-4 inhibitors on at-risk patients. There is no evidence that either medication class affects the development of diabetes-associated complications.1"
The GLP-1 drugs can be a net benefit for some patients but they come with serious side effects. In particular most patients lose significant amounts of lean muscle tissue, which is a risk factor for metabolic diseases and sarcopenia.
There are circumstances when those drugs are medically indicated. However, it seems they are being over prescribed without proper consideration of the harmful side effects.
Was that higher fraction compared to equally drastic calorie reduction in other methods in a RCT?
It's not something so mechanical as this. For obese people, our /bodies metabolic system/ overestimates our required calorie intake and causes us to feel the pangs of hunger far past when we've consumed a sufficient amount of calories. It's not a conscious choice to overeat, nor is it something that takes effort to do. I ate like a normal person while traveling around the world, walking 10 to 15 miles per day, and going to the gym 3 times a week for an hour, and I still gained back 40 pounds over the course of 18 months (nearly 20 of it in the first 6 months) after going off a monitored, strict calorie restrictive diet.
My actual daily caloric intake need was around 1200 kcals, exceeding this isn't hard to do, and keeping to it was a daily struggle that wasn't possible to maintain while traveling when I could no longer strictly control all the food I ate or even know how many calories it was or what its ingredients were. If I was to guestimate, I'd say I was consuming between 2500-3000 kcals daily while traveling, and this was sufficient to gain almost all of the weight I lost over 7 years back in a matter of months.
This is the reality of being obese. It's not like you choose to be fat, or you choose to over eat, or even that you're over eating to the point of gluttony, it's merely that your metabolism needs far less calories than it believes it needs, so if you simply eat a normal amount when you are hungry, you will be fat, guaranteed.
The reason GLP1 agonists work so well is that they actually change how your body's metabolism reacts, and make it so you no longer feel hungry constantly. In fact, you have to force yourself to eat sometimes or you'll end up having the effects on not eating often enough. While taking a GLP1 agonist, reducing or maintaining weight is not the same struggle as it is without medical intervention.
I counted calories and religiously recorded all of my physical activity and food and water intakes using very technological means tied into MyFitnessPal for almost a decade. It was not for lack of effort, dedication, or knowledge that I gained back weight or realized that I was not going to succeed for a lifetime without medical intervention. It's simply not possible to rationally fight your base biological impulses when they are fall into your body's basic survival mechanisms. I effectively "tortured" myself psychologically for almost a decade, and the net result was the moment I stopped I gained all the weight back. GLP1 agonists are basically miraculous.
My hypothesis: Obese people are unknowingly malnourished and keep eating because they still need nutrients they aren't getting.
Maybe not just crazy talk given how nutritional value of produce has gone down in recent decades.
/pet theories
The thermodynamic model of calories-in-calories-out doesn't work because we are not a thermodynamic system; it doesn't take into account the hormonal and metabolic changes that occur when calories are chronically restricted.
It's an incorrect impression. All health care systems have to deal with chronic diseases. Americans are fat, through they aren't twice as fat as other people, and the UK and Greece are nearly as fat in Europe. US health care costs are out of control because the system is kleptocratic.
> What can any healthcare system possibly do about that.
Its damned job. The healthcare system doesn't get to complain about the existence of sick people, even if people eugenically think that some illness are less deserving than others.
Did a quick google search.
"The Health Survey for England 2021 estimates that 25.9% of adults in England are obese and a further 37.9% are overweight but not obese." 1
"Approximately 70% of American adults have obesity or overweight. " 2
1. https://commonslibrary.parliament.uk/research-briefings/sn03...
2. https://www.fda.gov/news-events/press-announcements/fda-appr...
They are, almost:
"US obesity prevalence was 41.9% in 2017 – March 2020"[0]
"25.9% of adults in England are obese"[1]
[0] https://www.cdc.gov/obesity/data/adult.html [1] https://commonslibrary.parliament.uk/research-briefings/sn03...
That certainly doesn't explain a great deal of it.
Many people can't stick to a diet or exercise plan because they haven't been treated for a related problem. For example, many people can't effectively exercise due to joint pain which could be alleviated by physical therapy which is frequently denied by health insurance.
Additionally, the "healthcare system" includes stuff like nutritional and exercise education, public gyms, etc., all of which are woefully underfunded in the US. Worse, the programs which do exist have been heavily influenced by lobbyists (lobbyist influence on the Food Pyramid, for example, is well-documented). The corporate right to lie in advertising also means that much education is undermined by straight up lies in ads.
https://www.findahealthcenter.hrsa.gov/
Whether would-be patients are sufficiently informed of this opportunity is another question, but resources for preventive care are not completely unavailable to these folks.
Exactly. More people are making more money which is way more important than providing healthcare to those with not-enough-money. Not saying that it should be like this, but it is.
Ye olde "the horse was lost because the horseshoe was lost because a nail was lost" principle. It's not just that someone has an advanced illness, if they die and now their kid needs additional resources from the welfare system, the rest of us are paying for it.
According to this piece, under EMTALA -- he Emergency Medical Treatment & Labor Act passed in the 1980s -- it's not illegal to treat undocumented immigrants.