AN OUNCE OF PREVENTION by David F. Torchiana, MD

A common criticism of the U.S. healthcare system is that we spend too much on treating sickness and not enough on staying healthy. The idea is that a greater emphasis on wellness and prevention will lead to a healthier population and cost less than our current system.

There are huge benefits to having a healthier population – improved quality of life, increased productivity, and longer life expectancy to name three. There also are immediate financial returns to better health, particularly for the private sector. The Milken Institute , an economic think tank, estimates that more than 109 million Americans have at least one chronic disease for which the cost – measured in terms of the total impact on the economy – is $1.3 trillion annually. Of that, $277 billion is spent on direct treatment. The remaining 80 percent is lost economic productivity. Even a modest improvement in health would make a major difference to the Medicaid program, employers’ healthcare costs, and workforce productivity.

What would it take to accomplish this? According to the Milken study, 40 million cases of chronic illness could be delayed through lower rates of obesity, continued reductions in smoking, a decline in alcohol consumption, increased physical activity, bringing cholesterol rates down to their 2000 levels, improved air quality, a gradual decline in illicit drug use, and a modest improvement in early intervention and treatment.

This would reduce the national economic impact of illness by 27 percent, increase productivity by $905 billion per year, and cut short-term treatment costs by more than $200 billion annually. It would be an impressive accomplishment, and is the reason why prevention should continue to be at the top of our cost management agenda.

Just don’t expect the Medicare bill to go down too. While healthier people live longer, the reality is that most will still die of a chronic illness at the end of life. A study of autopsies on octogenarians found that none of them died of old age. All had underlying chronic illnesses, the most common being cardiovascular and respiratory diseases.

No amount of prevention will eliminate human disease entirely. The need to pay for its treatment at the end of life will remain.

David F. Torchiana, MD
Massachusetts General Physicians Organization