On this point, though, he’s absolutely right. But that doesn’t mean we
need more government programs. What we need is a focus on chronic
Chronic diseases are among the most serious public health threats
facing the American people today. These conditions, which include
diabetes, chronic kidney disease, cardiovascular disease and cancer,
often last for years, requiring frequent treatment throughout a
person’s life. The toll they exact on American patients is appalling,
accounting for 70 percent of all deaths in the United States.
America’s exorbitant health care spending is also linked to these
destructive illnesses. In fact, 75 percent of the more than $2 trillion
spent on health care in the United States goes toward caring for those
with chronic conditions. Heart disease and strokes alone cost the
American people $448 billion in 2008.
It’s for these reasons that combating chronic conditions must be a
central goal of health care reform. Fortunately, unlike some public
health crises of the past, the challenges posed by chronic conditions
are hardly insurmountable. That’s because a large majority of them can
be prevented simply through healthier lifestyle choices.
As a practicing primary care physician specializing in treating the
elderly, I understand better than most how unhealthy habits can, over
time, lead to debilitating chronic conditions.
But before any effort to reduce the incidence of these diseases can be
effective, we need to rethink the way medicine is practiced in the
United States. In short, health care in this country needs to be more
For doctors, this means practicing a more personalized kind of care
that aims at keeping patients healthy, and not simply on treating
illnesses when they arise.
Toward this end, experimenting with new health care delivery models may
prove effective. In the “medical home” model, for instance, a single
personal physician coordinates all of an individual’s medical care over
the course of that person’s life. This allows for a more comprehensive
approach to medicine that stresses healthy living and disease
prevention over stopgap treatment solutions.
In other words, the government doesn’t have to step in and incentivize
us to take better care of ourselves. The truth is that the government
isn’t equipped to do such a thing. And that’s not a proper role for
Lawmakers can, though, create a system where both patients and
physicians are incentivized to prevent chronic illnesses before they
develop. Moving closer to a health care model where patients are
rewarded for living healthier lives and physicians are compensated
based on outcomes rather than volume of service would go a long way
toward reducing health care costs.
Just look at breast cancer, an illness that killed more than 40,000
women in 2004. According to Researchers at the Centers for Disease
Control and Prevention, regular mammograms could reduce that number by
up to one-third.
The same goes for hypertension, a leading cause of stroke and heart
attack. If caught early, high blood pressure can be effectively treated
with prescription medication before it evolves into something worse.
In fact, a recent study published in the journal Health Affairs found
that blood pressure medication reduced the number of heart attacks and
strokes in 2002, saving Americans more than $16 billion. That same
study found that properly using antihypertensive therapies could reduce
the number of premature deaths from heart disease in America by 89,000
and the number of hospital admissions for strokes by 287,000.
Recognizing the urgency of this issue, leaders of key health care
institutions – from AARP to pharmaceutical companies – have united
behind the goal of making chronic illnesses far less common.
Our health care system is ripe for reform. Not because it is
irreparably broken, but rather because the reforms we need are well
within our grasp. It’s crucial that we all work to reduce the
prevalence of chronic illness.
Gary Applebaum is a senior fellow at the Center for Medicine in the Public
Interest, which is known best for the usually pro-big pharma leanings of Peter Pitts. He is the former executive vice president and chief medical officer of Erickson Retirement Communities. This opinion piece first appeared in the San Diego Union Tribune.