I have read with great interest recently regarding the article out of the Netherlands as reported in the WSJ Health Blog here
The crux of the argument is as follows.
Healthier people live longer and therefor cost more money. In this study they found those that smoked and were obese lived shorter, to the tune of 7 and 3 years respectively.
As the arguement goes, unhealthy people die off earlier, so their lifetime medical expenses are less, therefore saving money in the health care system.
Intuition says that would make sense.
I have heard this argument before. That smokers actually save money for Medicare because they die before fully maximizing their government benefits.
My only problem with this line of thinking is this.
Why are we treating any disease? If treatment of disease leads to prolonging of life, and therefore greater expense to the system, we should just give up and let nature take its course.
If we should suddenly view smokers and the couch potatoes as a benefit to our medical system in the long run financially, then we should not be picky.
We should view uncontrolled diabetes as a benefit.
Uncontrolled hypertension as a benefit
Uncontrolled hypercholesterol as a benefit
We should stop screening for colon cancer.
We should stop screening for breast cancer.
We should stop preventative medicine.
We should stop treating illness.
We should encourage poor hygeine.
We should stop washing our hands.
Maybe spit in the surgical site.
How about rubbing some manure in that diabetic ulcer.
We should relax clean water regulations.
Bring back leaded gasoline
What I wouldn't give to have CFC's back in our atmosphere.
A little extra lead in the paint may be a good thing to reconsider.
How about growing spinich near a cow pasture
We could relax airline safety controls.
Remove all speed limits
Make drunk driving legal.
I could go on and on and on.
Do you see the ridiculous train of thought that develops when one attempts to argue that unhealthy lifesyles actually benefits a national health system's bottom line.
Instead of incentivizing quality initiatives (that have a constantly changing evidence base), maybe our government should start incentivizing bad care.
That's the key. Save The Medicare National Bank.
Die Young.
Pretty soon you'll see our government paying subsidies to the public to NOT go to the doctor. To stop taking their meds.
Much like our government pays billions to farmers not to farm, we should be paying our citizens not to doctor.
I guess I really never thought about it like that before.
Save Medicare by not giving a crap about yourself.
Maybe the Medicare National Bank should start paying doctors extra with the highest complication rates. With the highest mortality rates.
The lawyers should start suing the best doctors for providing the best care as they are a danger to society.
Maybe insurance should pay extra for performing never events. A smaller population leads to less expenses. What's the matter with leaving a sponge in the belly. One less entitled system sucker to deal with.
I should quit my job.
Anyone who comes to the ER and is sick will have to fend for themselves at home. Shut down all inpatient hospitals.
Stop performing caths.
Stop EGDs
Stop CT scans.
No more surgery.
No more imaging.
The new stated goal of care is: There should be no care. That is the new Universal health plan.
You can do your country a patriotic favor and die.
Lets Do Like The Smokers Do.
photo credit
6 Outbursts:
Lets just do like in the movie, "Logan's Run" where eveyone is killed when they reach 35! Wow, that would save TONS of money!
I've been waiting for your thoughts on this and I'm disappointed.
I'm afraid the commenter on KevinMD who noted that alive folks continue to pay in was going in the right direction. If you expand the definition of "pay in" to include things like income from work and help you provide to your kids/grandkids your social balance sheet tips into the black.
I suspect if you factor in the loss of productivity that those younger unhealthy folks have you'd find they are a net drain. Compared to the healthy person who makes it to a late retirement age, the unhealthy person who dies early has lost opportunity income.
My Dad retired at 62 because his own father had died at 62 and he didn't want to die at work. Since he's now 76 and still going I figure I'll work until 68 or I become unemployed. While my actual contributions may be debatable (contributing to the blogo-sphere isn't on my performance goals) from a national accounting perspective my income will be considered an addition.
That aside, life is a whole lot more fun if your health is good.
ginger. I would strongly agree with you in terms of the other tangible and intangible benefits of not smoking and exercising.
I wanted to limit this blog entry to just the silliness of implying that that being unhealthy somehow is better for the system over all. The assertion that dying younger as a goal that should be something we should be encouraging. The silliness of that arguement was what I was trying to point out.
I whole heartedly agree with you in terms of all the other benefits that come with healthy lifestyles.
Awesome. I laughed out loud. Could I get paid more for not taking my boards? Even better.
While I agree with you that it is silly to say that being unhealthy is good for the "system", it is also silly to try to fund Medicare/insurance expansions with supposed cost savings from preventitive medicine. Good health provides intangible benefits to the system, but it costs $$. The Democrats are going to have to look somewhere else to find the money to pay for their health care plans.
I think that your post is mostly based on the assumption that all of this should be viewed through the lens of government policy implications. The only thing that study really showed me was that the whole concept of the government incentivizing any lifestyle choice, good or bad, is a ridiculous notion. We don't really know what the costs are or what they will be, or what they would be if a different choice had been made. There's a strong case for "live and let live" here. It's fair to say that on a personal level, being healthy longer is a great thing, but trying to extrapolate "might have beens" from studies and then basing public policy on that is pure folly.
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