The Need for a Preventive Medicine Infrastructure in the U.S.

One of the reasons that our healthcare system is so expensive is that the bulk of the costs are devoted to treating chronic, but often preventable diseases, such as obesity, diabetes mellitus, coronary heart disease, and lung cancer (see, for example: Seeking Solutions to the Chronic Disease Epidemic). A recent opinion piece in the Wall Street Journal by Deepak Chopra et al. discusses this same idea plus others (see: 'Alternative' Medicine Is Mainstream). I quote excerpts from it below with boldface emphasis mine. Read the whole article by these preventive medicine experts. It could save your life and provide ideas for reforming the system.

Heart disease, diabetes, prostate cancer, breast cancer and obesity account for 75% of health-care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle....Many people tend to think of breakthroughs in medicine as a new drug, laser or high-tech surgical procedure. They often have a hard time believing that the simple choices that we make in our lifestyle -- what we eat, how we respond to stress, whether or not we smoke cigarettes, how much exercise we get, and the quality of our relationships and social support -- can be as powerful as drugs and surgery....Our "health-care system" is primarily a disease-care system. Last year, $2.1 trillion was spent in the U.S. on medical care, or 16.5% of the gross national product. Of these trillions, 95 cents of every dollar was spent to treat disease after it had already occurred. At least 75% of these costs were spent on treating chronic diseases, such as heart disease and diabetes, that are preventable or even reversible. The choices are especially clear in cardiology. In 2006, for example, according to data provided by the American Heart Association, 1.3 million coronary angioplasty procedures were performed at an average cost of $48,399 each, or more than $60 billion; and 448,000 coronary bypass operations were performed at a cost of $99,743 each, or more than $44 billion. In other words, Americans spent more than $100 billion in 2006 for these two procedures alone.

This article got me thinking. Why do we spend so many billions of dollars on disease treatment and so little on disease prevention? The answer, I think, is that there are so few advocates for healthy living in our communities and little infrastructure to encourage and support preventive medicine. Moreover, our physicians are reimbursed for treating disease and provided noting for helping their patients change their bad habits. I am purposely avoiding a discussion of the fact that most physicians have little or no training in preventive medicine. Who do we expect will be lobbying our politicians at the state and federal levels for the funding of health programs such as exercise, smoking cessation, and weight reduction. Compare this with the number of lobbyists who will be advocating new hospital construction and greater benefits for organ transplant patients.

For me, the answer is relatively simple, I would like to make the modest proposal that some small percentage of government dollars previously allocated to the treatment of disease be earmarked for disease prevention program. Even if the infrastructure for such programs is not now widely available, the availability of funds will serve as a stimulus for their development in our communities. Local health and fitness centers will be part of this health infrastructure. In addition, we need more nurses and physicians who can function as health coaches and spend adequate time working with patients on an ongoing basis to modify their lifestyles when necessary.

Comments

[Ajit Alles]

It seems to me that one of the reasons that we do not have a good preventative healthcare prgram is because in the US technology is king and is perceived as glamorous and the quick fix to all medical problems. Additionally, it is very lucrative to Medicine Inc. The majority of media medical stories are all about the latest medical gadgets and pulling patients back from the brink. I am not a Luddite by any means, but I think our cultural emphasis and reimbursement system has to change before we see any real change in our healthcare model. I agree with Dr. Chopra entirely we have a disease-care system. Preventative medicine offers a huge bang for buck, but this is completely overshadowed by our emphasis on the latest technology and "miracle cures".