Do Healthy People Cost Us Lots of Money?

I was scanning the headlines of my news subscriptions and one popped out and really caught my attention: "Truth is, healthy people cost us all a lot of money".

Prevention and wellness tends to be a lot like mother and apple pie - few people are willing to speak up against it. So intrigued, I decided to understand what kind of argument one would make against it. The article in Houston Chronicle is a review of a new book ("Health Care Half Truths: Too Many Myths, Not Enough Reality") by Arthur Garson Jr., the provost at the University of Virginia Medical School.

The gist of the argument is summarized thusly:

Medical economists agree that cancer screenings and gym classes can lead to physical well-being and longer lives. But in the interests of honest accounting, they add that prevention does not reduce overall health-care spending. On the contrary.

Let's put it bluntly: Longer lives cost more money. Those who make it to 90 thanks to exercise and six daily servings of vegetables are more likely to suffer the expensive ravages of old age. Everyone dies of something.

So he who avoids a fatal heart attack at 70 is more at risk of cancer at 80. Those extra 10 years can mean extra CT scans, hip replacements and physical therapy, even for those in relative good health.

So the thinking is that prevention creates "pay me now or pay me later" situation. Those healthcare dollars are going to be spent anyways and we are just postponing the inevitable health problems that come with age. If 30 is the new 40, then 90 is the new 80.

Garson makes the point that prevention alone would not be able to generate enough savings to pay for the rest of the healthcare reform, no matter what the politicians are promising. Prevention of disease in the workplace is going to reduce the costs for employers but ultimately shift them to Medicare and ultimately the taxpayers.

He may be right on that count. However this line of thinking raises further questions that span the areas of demographics, morals and ethics. If we do the right thing and prolong life, are we as a society prepared to bear the cost of caring for our elderly? As the population ages, are we prepared to tackle such touchy subjects as raising retirement age and accomodate aging population in the workforce?

I cannot help but consider the alternatives to facing these issues as the society. Think about this, perhaps the cost of healthcare was the lowest in the "Dark Ages", with life expectancy "between about 20 years and 40 years". That also meant no need for dealing with retirement issues and of course things like insurance. Back in those days intensive care usually meant frequent prayer. Another "solution" to healthcare reform is described in the dystopian novel Logan's Run, set in an apocalytpic society that terminates everyone reaching the age of 30 to "manage population and the consumption of resources".

This demonstrates what lies on the other end of life expectancy continuum, but also exposes another painful truth. To be successful, the healthcare reform must address the issue of aging demographics, inevitably extending the debate beyond healthcare proper. We have to figure out how to reduce costs, knowing that much of the savings will be scooped up the extending lifespans.

Did the task just get even harder?