Author Topic: Avoidable Health Care Costs  (Read 18516 times)

beltim

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Avoidable Health Care Costs
« on: April 30, 2015, 02:21:58 PM »
Hi all,

I was reading MMM's April Fools Day post and stumbled on this:
Quote
…despite the fact that most of the nation’s health spending is done to treat self-imposed diseases related to the biggest four factors: exercise, diet, stress and sleep.

This was an unsourced assertion, I looked in the comments to see if anyone called him out on this and didn't find anyone.  This seems like an extraordinary claim deserving of extraordinary evidence, yet none was provided.  Does anyone here have any good data that more than half of US health care spending is is done to treat self-imposed diseases? 

beltim

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Re: Avoidable Health Care Costs
« Reply #1 on: April 30, 2015, 02:31:27 PM »
The best I've been able to find are a couple of sources 1,2 that say "potentially changeable behaviors" could represent 25% of medical costs, and cite a 2003 study at http://aspe.hhs.gov/health/prevention/.  The problem is, I don't know how they get the 25% number from that study.



1. http://www.scu.edu/ethics/publications/iie/v6n1/voluntary.html
2. https://www.jpmorgan.com/cm/BlobServer/JPM-ManagingFutureHealthcare.pdf?blobkey=id&blobwhere=1320628717006&blobheader=application/pdf&blobheadername1=Cache-Control&blobheadervalue1=private&blobcol=urldata&blobtable=MungoBlobs

Philociraptor

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Re: Avoidable Health Care Costs
« Reply #2 on: April 30, 2015, 02:40:28 PM »
From this 2009 Publication from the CDC:

"As a nation, more than 75% of our health care spending is on people with chronic conditions"

That statement referenced this report.

That report makes the following claim on page 16: "People With chronic conditions Account for 84 Percent of
All Health care Spending" (Source: Medical Expenditure Panel Survey, 2006)

Further down in the CDC publication, we have this statements: "Four modifiable health risk behaviors—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption—are responsible for much of the illness, suffering, and early
death related to chronic diseases."

beltim

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Re: Avoidable Health Care Costs
« Reply #3 on: April 30, 2015, 02:46:29 PM »
From this 2009 Publication from the CDC:

"As a nation, more than 75% of our health care spending is on people with chronic conditions"

Right, but this doesn't really say anything relevant, because "chronic conditions" has nothing to do with "self-imposed diseases."

Quote
Further down in the CDC publication, we have this statements: "Four modifiable health risk behaviors—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption—are responsible for much of the illness, suffering, and early
death related to chronic diseases."

Thanks for this.  I'll take a look, but "much" isn't quantified either in that statement on on that page of the CDC report.  I'll keep looking.

Philociraptor

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Re: Avoidable Health Care Costs
« Reply #4 on: April 30, 2015, 02:47:20 PM »
From this 2009 Publication from the CDC:

"As a nation, more than 75% of our health care spending is on people with chronic conditions"

Right, but this doesn't really say anything relevant, because "chronic conditions" has nothing to do with "self-imposed diseases."

Quote
Further down in the CDC publication, we have this statements: "Four modifiable health risk behaviors—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption—are responsible for much of the illness, suffering, and early
death related to chronic diseases."

Thanks for this.  I'll take a look, but "much" isn't quantified either in that statement on on that page of the CDC report.  I'll keep looking.
I was going to say the same thing. No distinction is made between preventable chronic conditions and nonpreventable ones.

forummm

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Re: Avoidable Health Care Costs
« Reply #5 on: April 30, 2015, 05:08:43 PM »
From this 2009 Publication from the CDC:

"As a nation, more than 75% of our health care spending is on people with chronic conditions"

Right, but this doesn't really say anything relevant, because "chronic conditions" has nothing to do with "self-imposed diseases."

Quote
Further down in the CDC publication, we have this statements: "Four modifiable health risk behaviors—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption—are responsible for much of the illness, suffering, and early
death related to chronic diseases."

Thanks for this.  I'll take a look, but "much" isn't quantified either in that statement on on that page of the CDC report.  I'll keep looking.

It's really hard to quantify, which is why you are having trouble finding it. But 9 out of the 10 leading causes of death are at least partially preventable (the other one is Alzheimers). Diet and exercise alone are significant causes of nearly all the diabetes (very expensive for a long time) and obesity, much of the heart disease, and quite a bit of the cancers. And then there are all the side effects of being in the healthcare system, like side effects of medications (which lead to additional medications), and getting infections in the hospital, etc. Tobacco is a huge killer of course. But it's really hard to say what percent of someone's heart disease is due to their diet and what percent is due to other factors.

One way to think about it is that people didn't use to have multiple chronic conditions like this until we started eating differently (sugar in everything, refined carbohydrates everywhere). Now most adults have multiple chronic conditions, and nearly all are lifestyle related. Everywhere our diet spreads, people start getting the same diseases. Look at Vietnam. They've been there eating rice, vegetables, and some pork for centuries. We introduce them to Coke and McDonalds and now the diabetes rate is insane.

beltim

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Re: Avoidable Health Care Costs
« Reply #6 on: May 03, 2015, 02:51:03 PM »
It's really hard to quantify, which is why you are having trouble finding it. But 9 out of the 10 leading causes of death are at least partially preventable (the other one is Alzheimers). Diet and exercise alone are significant causes of nearly all the diabetes (very expensive for a long time) and obesity, much of the heart disease, and quite a bit of the cancers. And then there are all the side effects of being in the healthcare system, like side effects of medications (which lead to additional medications), and getting infections in the hospital, etc. Tobacco is a huge killer of course. But it's really hard to say what percent of someone's heart disease is due to their diet and what percent is due to other factors.

I don't disagree that it's hard to quantify this.  Which is why I think MMM does a huge disservice when he apparently makes up numbers out of thin air.

Quote
One way to think about it is that people didn't use to have multiple chronic conditions like this until we started eating differently (sugar in everything, refined carbohydrates everywhere). Now most adults have multiple chronic conditions, and nearly all are lifestyle related. Everywhere our diet spreads, people start getting the same diseases. Look at Vietnam. They've been there eating rice, vegetables, and some pork for centuries. We introduce them to Coke and McDonalds and now the diabetes rate is insane.

This is a gigantic overstatement, and I think like MMM it does a huge disservice to the truth.

Cassie

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Re: Avoidable Health Care Costs
« Reply #7 on: May 03, 2015, 04:22:19 PM »
I have known people with great health habits, etc that still get chronic diseases like HBP because it runs rampant in their families.

forummm

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Re: Avoidable Health Care Costs
« Reply #8 on: May 03, 2015, 04:42:25 PM »
Quote
One way to think about it is that people didn't use to have multiple chronic conditions like this until we started eating differently (sugar in everything, refined carbohydrates everywhere). Now most adults have multiple chronic conditions, and nearly all are lifestyle related. Everywhere our diet spreads, people start getting the same diseases. Look at Vietnam. They've been there eating rice, vegetables, and some pork for centuries. We introduce them to Coke and McDonalds and now the diabetes rate is insane.

This is a gigantic overstatement, and I think like MMM it does a huge disservice to the truth.

I have to strongly disagree with you here. It's my job to know this. Did you know the term "western diseases" refers to the dramatically increased rates lifestyle related diseases that have swept from developed to developing nations as our diet and other lifestyle components has migrated? It includes everything from obesity, diabetes, and hypertension to many cancers and autoimmune diseases. Most of the spending on chronic diseases in the US is lifestyle related. It's just not well known.

I have known people with great health habits, etc that still get chronic diseases like HBP because it runs rampant in their families.

Did anyone say that the only cause of hypertension was lifestyle? As with all health conditions there is some heredity involved as well in certain cases. Type I diabetes also exists and is not generally lifestyle related. But Type II diabetes went from almost nonexistence to being the vast majority of diabetes cases in the country due primarily to diet. Arthritis is another example of a health condition that existed before our diets changed so much. But it is now exacerbated by people being so overweight and not maintaining a healthy level of physical activity throughout their life (activity is somewhat protective against the effects of arthritis in many cases).

beltim

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Re: Avoidable Health Care Costs
« Reply #9 on: May 03, 2015, 04:52:16 PM »
Quote
One way to think about it is that people didn't use to have multiple chronic conditions like this until we started eating differently (sugar in everything, refined carbohydrates everywhere). Now most adults have multiple chronic conditions, and nearly all are lifestyle related. Everywhere our diet spreads, people start getting the same diseases. Look at Vietnam. They've been there eating rice, vegetables, and some pork for centuries. We introduce them to Coke and McDonalds and now the diabetes rate is insane.

This is a gigantic overstatement, and I think like MMM it does a huge disservice to the truth.

I have to strongly disagree with you here. It's my job to know this. Did you know the term "western diseases" refers to the dramatically increased rates lifestyle related diseases that have swept from developed to developing nations as our diet and other lifestyle components has migrated? It includes everything from obesity, diabetes, and hypertension to many cancers and autoimmune diseases. Most of the spending on chronic diseases in the US is lifestyle related. It's just not well known.

I sure did.  I don't deny that diet and exercise play important roles in disease prevention, and that we're worse at diet and exercise than we used to be.

But you're making a statement - "most of the spending on chronic disease in the US is lifestyle related" – that's a little more defensible that MMM's.  Since the frequency of many diseases can be reduced by diet and/or exercise, you're right that almost all chronic disease is affected by lifestyle.  It's a pointless statement, though, unless you can say how much.

And it still provides no evidence for the original statement, that "most [i.e. more than HALF] of the nation's health care spending is done to treat self-imposed diseases." 

Basically, MMM's statement is propaganda.  Well-intentioned propaganda, to be sure, but definitely propaganda.  As far as I can tell there's no factual basis for the statement.

forummm

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Re: Avoidable Health Care Costs
« Reply #10 on: May 03, 2015, 05:49:03 PM »
Quote
One way to think about it is that people didn't use to have multiple chronic conditions like this until we started eating differently (sugar in everything, refined carbohydrates everywhere). Now most adults have multiple chronic conditions, and nearly all are lifestyle related. Everywhere our diet spreads, people start getting the same diseases. Look at Vietnam. They've been there eating rice, vegetables, and some pork for centuries. We introduce them to Coke and McDonalds and now the diabetes rate is insane.

This is a gigantic overstatement, and I think like MMM it does a huge disservice to the truth.

I have to strongly disagree with you here. It's my job to know this. Did you know the term "western diseases" refers to the dramatically increased rates lifestyle related diseases that have swept from developed to developing nations as our diet and other lifestyle components has migrated? It includes everything from obesity, diabetes, and hypertension to many cancers and autoimmune diseases. Most of the spending on chronic diseases in the US is lifestyle related. It's just not well known.

I sure did.  I don't deny that diet and exercise play important roles in disease prevention, and that we're worse at diet and exercise than we used to be.

But you're making a statement - "most of the spending on chronic disease in the US is lifestyle related" – that's a little more defensible that MMM's.  Since the frequency of many diseases can be reduced by diet and/or exercise, you're right that almost all chronic disease is affected by lifestyle.  It's a pointless statement, though, unless you can say how much.

And it still provides no evidence for the original statement, that "most [i.e. more than HALF] of the nation's health care spending is done to treat self-imposed diseases." 

Basically, MMM's statement is propaganda.  Well-intentioned propaganda, to be sure, but definitely propaganda.  As far as I can tell there's no factual basis for the statement.

I think your language is a little strong. As I said it's incredibly difficult to accurately account for the proportion of spending that is due to self-imposed diseases. There are so many factors involved and medical science is pretty poor as to attributing the proper causality of a condition, let alone the fractional proportionality due to a specific cause. The reason tobacco companies could escape blame in lawsuits for so long is that it was impossible to prove that person X's cancer was caused by tobacco use. So MMM may not have had a reference for his claim. But my guess is that it's pretty close to being true if not exactly true. I think calling it propaganda is a little much. Maybe a claim that is not 100% supported but has a good chance of being true, and is definitely close to being true if not totally true.

I just did some quick looking and here are some sources that suggest his claim is right or close to right.

http://kaiserhealthnews.org/news/052411thorpelever/
Quote
...the World Health Organization and the Centers for Disease Control and Prevention have estimated that 80 percent of heart disease and type-2 diabetes, and 40 percent of cancers, could be prevented by doing three things: exercising more, eating better and avoiding tobacco.

http://blogs.wsj.com/health/2012/05/01/california-study-shines-light-on-cost-of-preventable-diseases/
This says that about 25% of CALPERS costs were for preventable chronic conditions. But keep in mind that the most expensive people are having their costs paid for mostly by Medicare, and most people on the CALPERS health program are not yet retired (https://www.calpers.ca.gov/eip-docs/about/facts/facts-at-a-glance.pdf). So the 25% number is definitely well below the true number for the population.

http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
I think I made this point upthread, but 9 out of 10 of these diseases can be prevented through lifestyle and clinical services.

beltim

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Re: Avoidable Health Care Costs
« Reply #11 on: May 03, 2015, 06:02:05 PM »
I just did some quick looking and here are some sources that suggest his claim is right or close to right.

http://kaiserhealthnews.org/news/052411thorpelever/
Quote
...the World Health Organization and the Centers for Disease Control and Prevention have estimated that 80 percent of heart disease and type-2 diabetes, and 40 percent of cancers, could be prevented by doing three things: exercising more, eating better and avoiding tobacco.
Okay... now what percentage of health care spending are each of those?

Quote
http://blogs.wsj.com/health/2012/05/01/california-study-shines-light-on-cost-of-preventable-diseases/
This says that about 25% of CALPERS costs were for preventable chronic conditions. But keep in mind that the most expensive people are having their costs paid for mostly by Medicare, and most people on the CALPERS health program are not yet retired (https://www.calpers.ca.gov/eip-docs/about/facts/facts-at-a-glance.pdf). So the 25% number is definitely well below the true number for the population.

25% is about the percentage that I was able to find support for.   

Quote
http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
I think I made this point upthread, but 9 out of 10 of these diseases can be prevented through lifestyle and clinical services.
The issue isn't how many diseases can be prevented, it's what percentage.  Actually, it's what percentage of spending could be avoided. 

forummm

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Re: Avoidable Health Care Costs
« Reply #12 on: May 03, 2015, 06:18:50 PM »
I just did some quick looking and here are some sources that suggest his claim is right or close to right.

http://kaiserhealthnews.org/news/052411thorpelever/
Quote
...the World Health Organization and the Centers for Disease Control and Prevention have estimated that 80 percent of heart disease and type-2 diabetes, and 40 percent of cancers, could be prevented by doing three things: exercising more, eating better and avoiding tobacco.
Okay... now what percentage of health care spending are each of those?

Quote
http://blogs.wsj.com/health/2012/05/01/california-study-shines-light-on-cost-of-preventable-diseases/
This says that about 25% of CALPERS costs were for preventable chronic conditions. But keep in mind that the most expensive people are having their costs paid for mostly by Medicare, and most people on the CALPERS health program are not yet retired (https://www.calpers.ca.gov/eip-docs/about/facts/facts-at-a-glance.pdf). So the 25% number is definitely well below the true number for the population.

25% is about the percentage that I was able to find support for.   

Quote
http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
I think I made this point upthread, but 9 out of 10 of these diseases can be prevented through lifestyle and clinical services.
The issue isn't how many diseases can be prevented, it's what percentage.  Actually, it's what percentage of spending could be avoided.

Actually, reading closer, the CALPERS costs were just for current workers (i.e. those much younger and healthier than retirees). So the 25% number is much, much lower than the total would be for the nation, including seniors.

I don't have time (or the interest) to do a big research project and break down exactly what the best estimate is. If you enjoy that sort of thing, feel free. But in about 5 minutes of googling, I was able to find pretty decent evidence that MMM was in the ballpark.

About half of medical expenses are in the last year of life. So if you could prevent those causes of death you could prevent those last year of life expenses for those conditions.

beltim

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Re: Avoidable Health Care Costs
« Reply #13 on: May 03, 2015, 06:30:22 PM »
If by in the ballpark you mean within a factor of two, then yes.  Personally I don't think 25% is close enough to "more than half" to be credible support.

beltim

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Re: Avoidable Health Care Costs
« Reply #14 on: May 03, 2015, 06:31:21 PM »
About half of medical expenses are in the last year of life. So if you could prevent those causes of death you could prevent those last year of life expenses for those conditions.

Why?  Why wouldn't it just be deferred until the new last year of life?

bigalsmith101

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Re: Avoidable Health Care Costs
« Reply #15 on: May 03, 2015, 06:35:57 PM »
Hi all,

I was reading MMM's April Fools Day post and stumbled on this:
Quote
…despite the fact that most of the nation’s health spending is done to treat self-imposed diseases related to the biggest four factors: exercise, diet, stress and sleep.

This was an unsourced assertion, I looked in the comments to see if anyone called him out on this and didn't find anyone.  This seems like an extraordinary claim deserving of extraordinary evidence, yet none was provided.  Does anyone here have any good data that more than half of US health care spending is is done to treat self-imposed diseases?

Firstly, to constitute the assertion of "most", it simply needs to be the majority category of expense, not "more than half" as you suggest.

He didn't say "more than half", you did. He said, "most".

Why does this seem to you to be an extraordinary claim? To me, it is quite obvious.

The Agency for Healthcare Research and Quality found that:

Chronic Conditions Contribute to Higher Health Care Costs
Twenty-five percent of the U.S. community population were reported to have one or more of five major chronic conditions:

Mood disorders.
Diabetes.
Heart disease.
Asthma.
Hypertension.

Spending to treat these five conditions alone amounted to $62.3 billion in 1996.13 Moreover, people with chronic conditions tend to have other conditions and illnesses.

When the other illnesses are added in, total expenses for people with these five major chronic conditions rise to $270 billion, or 49 percent of total health care costs, according to 1996 MEPS data. On an individual level, treatment for the average patient with asthma was $663 per year in 1996, but when the full cost of care for asthma and other coexistent illnesses is taken into account, the average cost was $2,779.

Expenses for people with one chronic condition were twice as great as for those without any chronic conditions. Spending for those with five or more chronic conditions was about 14 times greater than spending for those without any chronic conditions.14 Persons with five or more conditions also have high hospital expenditures. In New York State during 2002, of the 1.3 million different persons admitted to the hospital, the 27 percent with five or more chronic conditions accounted for 47 percent of all inpatient costs.


The conclusion?

Research also continues to raise awareness of the importance of chronic conditions in overall spending and as a major driver of cost increases, leading to disease management programs and other efforts to both improve quality and reduce the costs of conditions such as diabetes, asthma, hypertension, heart disease, and obesity.

Each of the chronic conditions listed in the conclusion, diabetes, asthma, hypertension, heart disease, and especially obesity could be reasonably referred to as a self-imposed condition with the obvious exceptions for each category (excluding obesity).

My own conclusion?

America as a whole is FAT AS FUCK, doesn't exercise for SHIT, and can't get off it's lazy ass to know the difference. It's a major problem that shouldn't be down played. Without the back up info, MMM's statement can technically be considered propaganda, sure, but only by a pandering few.

The majority of these chronic diseases are indeed self imposed. Lifestyles and choices handed down to us by our parents, relatives and friends, and ignorant acquaintances.

Read this if you haven't yet:
http://www.cdc.gov/chronicdisease/overview/

And this:
http://www.forahealthieramerica.com/ds/impact-of-chronic-disease.html

And these:
http://archive.ahrq.gov/research/findings/factsheets/costs/expriach/index.html
http://www.nihcm.org/pdf/DataBrief3%20Final.pdf
« Last Edit: May 03, 2015, 06:37:48 PM by bigalsmith101 »

beltim

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Re: Avoidable Health Care Costs
« Reply #16 on: May 03, 2015, 06:51:27 PM »
Hi all,

I was reading MMM's April Fools Day post and stumbled on this:
Quote
…despite the fact that most of the nation’s health spending is done to treat self-imposed diseases related to the biggest four factors: exercise, diet, stress and sleep.

This was an unsourced assertion, I looked in the comments to see if anyone called him out on this and didn't find anyone.  This seems like an extraordinary claim deserving of extraordinary evidence, yet none was provided.  Does anyone here have any good data that more than half of US health care spending is is done to treat self-imposed diseases?

Firstly, to constitute the assertion of "most", it simply needs to be the majority category of expense, not "more than half" as you suggest.

He didn't say "more than half", you did. He said, "most".

Why does this seem to you to be an extraordinary claim? To me, it is quite obvious.

The Agency for Healthcare Research and Quality found that:

Chronic Conditions Contribute to Higher Health Care Costs
Twenty-five percent of the U.S. community population were reported to have one or more of five major chronic conditions:

Mood disorders.
Diabetes.
Heart disease.
Asthma.
Hypertension.

Spending to treat these five conditions alone amounted to $62.3 billion in 1996.13 Moreover, people with chronic conditions tend to have other conditions and illnesses.

When the other illnesses are added in, total expenses for people with these five major chronic conditions rise to $270 billion, or 49 percent of total health care costs, according to 1996 MEPS data. On an individual level, treatment for the average patient with asthma was $663 per year in 1996, but when the full cost of care for asthma and other coexistent illnesses is taken into account, the average cost was $2,779.

Expenses for people with one chronic condition were twice as great as for those without any chronic conditions. Spending for those with five or more chronic conditions was about 14 times greater than spending for those without any chronic conditions.14 Persons with five or more conditions also have high hospital expenditures. In New York State during 2002, of the 1.3 million different persons admitted to the hospital, the 27 percent with five or more chronic conditions accounted for 47 percent of all inpatient costs.


The conclusion?

Research also continues to raise awareness of the importance of chronic conditions in overall spending and as a major driver of cost increases, leading to disease management programs and other efforts to both improve quality and reduce the costs of conditions such as diabetes, asthma, hypertension, heart disease, and obesity.

Each of the chronic conditions listed in the conclusion, diabetes, asthma, hypertension, heart disease, and especially obesity could be reasonably referred to as a self-imposed condition with the obvious exceptions for each category (excluding obesity).

My own conclusion?

America as a whole is FAT AS FUCK, doesn't exercise for SHIT, and can't get off it's lazy ass to know the difference. It's a major problem that shouldn't be down played. Without the back up info, MMM's statement can technically be considered propaganda, sure, but only by a pandering few.

The majority of these chronic diseases are indeed self imposed. Lifestyles and choices handed down to us by our parents, relatives and friends, and ignorant acquaintances.

Read this if you haven't yet:
http://www.cdc.gov/chronicdisease/overview/

And this:
http://www.forahealthieramerica.com/ds/impact-of-chronic-disease.html

And these:
http://archive.ahrq.gov/research/findings/factsheets/costs/expriach/index.html
http://www.nihcm.org/pdf/DataBrief3%20Final.pdf

While most has several definitions, in the context MMM used it it can only mean a majority.

Regarding those five chronic conditions, you admit that there are unpreventable cases for each, but you assume that those are small. Without knowing the actual percentages, it's pointless - or disingenuous - to talk about the spending that could be avoided by preventing the cases that can be prevented.

We now have several sources that suggest the spending due to preventable causes is about 25% of health care spending.  Do you have a better source?

Also, it's hard to say that asthma is preventable except in some obvious cases (due to smoking, for example).

Gin1984

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Re: Avoidable Health Care Costs
« Reply #17 on: May 03, 2015, 07:10:17 PM »
Quote
One way to think about it is that people didn't use to have multiple chronic conditions like this until we started eating differently (sugar in everything, refined carbohydrates everywhere). Now most adults have multiple chronic conditions, and nearly all are lifestyle related. Everywhere our diet spreads, people start getting the same diseases. Look at Vietnam. They've been there eating rice, vegetables, and some pork for centuries. We introduce them to Coke and McDonalds and now the diabetes rate is insane.

This is a gigantic overstatement, and I think like MMM it does a huge disservice to the truth.

I have to strongly disagree with you here. It's my job to know this. Did you know the term "western diseases" refers to the dramatically increased rates lifestyle related diseases that have swept from developed to developing nations as our diet and other lifestyle components has migrated? It includes everything from obesity, diabetes, and hypertension to many cancers and autoimmune diseases. Most of the spending on chronic diseases in the US is lifestyle related. It's just not well known.

I have known people with great health habits, etc that still get chronic diseases like HBP because it runs rampant in their families.

Did anyone say that the only cause of hypertension was lifestyle? As with all health conditions there is some heredity involved as well in certain cases. Type I diabetes also exists and is not generally lifestyle related. But Type II diabetes went from almost nonexistence to being the vast majority of diabetes cases in the country due primarily to diet. Arthritis is another example of a health condition that existed before our diets changed so much. But it is now exacerbated by people being so overweight and not maintaining a healthy level of physical activity throughout their life (activity is somewhat protective against the effects of arthritis in many cases).
Do you have a citation for this?

bigalsmith101

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Re: Avoidable Health Care Costs
« Reply #18 on: May 03, 2015, 07:31:56 PM »
I want to know why any of this matters. Obesity is rampant, people need to exercise. Chronic diseases are rampant, people need to eat better.

I'd be happy if we could suffice to say that the facts maintain that a considerable amount of our health problems are well within our physical control.

However, this doesn't change that 20% of the US's health expenditure comes from 1% of the populace, and that nearly 50% is accrued by only 5%. The majority of which are over 64 years old and have more than one chronic disease. Likely caused by a lifetime of shitty lifestyle choices.

bogart

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Re: Avoidable Health Care Costs
« Reply #19 on: May 03, 2015, 08:40:19 PM »

It's really hard to quantify, which is why you are having trouble finding it. But 9 out of the 10 leading causes of death are at least partially preventable (the other one is Alzheimers). Diet and exercise alone are significant causes of nearly all the diabetes (very expensive for a long time) and obesity, much of the heart disease, and quite a bit of the cancers. And then there are all the side effects of being in the healthcare system, like side effects of medications (which lead to additional medications), and getting infections in the hospital, etc. Tobacco is a huge killer of course. But it's really hard to say what percent of someone's heart disease is due to their diet and what percent is due to other factors.

(emphasis added)

I think it's complicated.  It's well and good to say that various causes of death are (somewhat) preventable, but OTOH, death itself isn't.  I can't now find the article (it probably appeared in the last year or maybe 2), but there was an interesting NYT article basically saying that more people are dying from cancer nowadays because fewer are dying from heart disease (or maybe I have that backwards).  Something's going to get you.  So, sure, we can delay that, but even doing so increases health-care costs, over one's lifetime if not per annum -- but likely even per annum (over time) since the fact is that aging is, well, bad for us. 

I worked for awhile with researchers who researched health-care costs, and interestingly one thing they said was that smoking doesn't increase health-care costs overall -- the increased costs per year it creates (which are real) are counter-balanced (possibly positively, I forget -- that is, it may be a net savings) by the shortened life spans of smokers.  I'm not (quickly) finding a direct cite here, but here are two pop-press pieces (well, one blog piece) that may have useful info. --
http://www.forbes.com/sites/timworstall/2012/03/22/alcohol-obesity-and-smoking-do-not-cost-health-care-systems-money/
http://reason.com/blog/2012/11/21/want-to-save-health-care-costs-then-subs

If you, personally, want to live a long life with low per annum health care costs (whether those you pay OOP or in general) then you're probably well advised to watch your diet and your weight, get exercise, not smoke, and drink some but not lots of alcohol.  But if you want to keep overall system costs down, run -- no, wait, drive -- to the local convenience store straightaway and have a carton of cigarettes and a box of moonpies on me.

Gin1984

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Re: Avoidable Health Care Costs
« Reply #20 on: May 03, 2015, 09:01:30 PM »
I want to know why any of this matters. Obesity is rampant, people need to exercise. Chronic diseases are rampant, people need to eat better.

I'd be happy if we could suffice to say that the facts maintain that a considerable amount of our health problems are well within our physical control.

However, this doesn't change that 20% of the US's health expenditure comes from 1% of the populace, and that nearly 50% is accrued by only 5%. The majority of which are over 64 years old and have more than one chronic disease. Likely caused by a lifetime of shitty lifestyle choices.
You can have chronic diseases that have nothing to do with food.  I have a chronic disease, my mother has a chronic disease, my grandmother had a chronic disease, they were not the same disease and none of them were preventable via food.

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Re: Avoidable Health Care Costs
« Reply #21 on: May 03, 2015, 09:09:09 PM »
I want to know why any of this matters. Obesity is rampant, people need to exercise. Chronic diseases are rampant, people need to eat better.

I'd be happy if we could suffice to say that the facts maintain that a considerable amount of our health problems are well within our physical control.

However, this doesn't change that 20% of the US's health expenditure comes from 1% of the populace, and that nearly 50% is accrued by only 5%. The majority of which are over 64 years old and have more than one chronic disease. Likely caused by a lifetime of shitty lifestyle choices.
You can have chronic diseases that have nothing to do with food.  I have a chronic disease, my mother has a chronic disease, my grandmother had a chronic disease, they were not the same disease and none of them were preventable via food.

The fact that many individuals are susceptible to chronic diseases, totally unrelated to diet and exercise,  has already been established. It stills stands that a majority of the problems ARE related and therefore mitigable of our own free will. I'm sorry to hear that your family has been affected by such diseases. Likely, however, it is the exception to the rule.

Gin1984

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Re: Avoidable Health Care Costs
« Reply #22 on: May 03, 2015, 09:57:52 PM »
I want to know why any of this matters. Obesity is rampant, people need to exercise. Chronic diseases are rampant, people need to eat better.

I'd be happy if we could suffice to say that the facts maintain that a considerable amount of our health problems are well within our physical control.

However, this doesn't change that 20% of the US's health expenditure comes from 1% of the populace, and that nearly 50% is accrued by only 5%. The majority of which are over 64 years old and have more than one chronic disease. Likely caused by a lifetime of shitty lifestyle choices.
You can have chronic diseases that have nothing to do with food.  I have a chronic disease, my mother has a chronic disease, my grandmother had a chronic disease, they were not the same disease and none of them were preventable via food.

The fact that many individuals are susceptible to chronic diseases, totally unrelated to diet and exercise,  has already been established. It stills stands that a majority of the problems ARE related and therefore mitigable of our own free will. I'm sorry to hear that your family has been affected by such diseases. Likely, however, it is the exception to the rule.
Actually I have not seen, though I may have missed, any citation of the majority are related to obesity/diet (and I would point out that thyroid conditions are related to obesity, but are not caused by obesity rather thyroid conditions can cause overweightness).   

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Re: Avoidable Health Care Costs
« Reply #23 on: May 03, 2015, 10:03:59 PM »

Actually I have not seen, though I may have missed, any citation of the majority are related to obesity/diet (and I would point out that thyroid conditions are related to obesity, but are not caused by obesity rather thyroid conditions can cause overweightness).

That is because no one said that the majority are related to "obesity/diet" but rather that the majority of issues are caused by "self-imposed diseases related to the biggest four factors: exercise, diet, stress and sleep."

Also, I'll re-quote

The Agency for Healthcare Research and Quality found that:

"Chronic Conditions Contribute to Higher Health Care Costs
Twenty-five percent of the U.S. community population were reported to have one or more of five major chronic conditions:

Mood disorders.
Diabetes.
Heart disease.
Asthma.
Hypertension.

Spending to treat these five conditions alone amounted to $62.3 billion in 1996.13 Moreover, people with chronic conditions tend to have other conditions and illnesses.

When the other illnesses are added in, total expenses for people with these five major chronic conditions rise to $270 billion, or 49 percent of total health care costs, according to 1996 MEPS data. On an individual level, treatment for the average patient with asthma was $663 per year in 1996, but when the full cost of care for asthma and other coexistent illnesses is taken into account, the average cost was $2,779.

Expenses for people with one chronic condition were twice as great as for those without any chronic conditions. Spending for those with five or more chronic conditions was about 14 times greater than spending for those without any chronic conditions.14 Persons with five or more conditions also have high hospital expenditures. In New York State during 2002, of the 1.3 million different persons admitted to the hospital, the 27 percent with five or more chronic conditions accounted for 47 percent of all inpatient costs."

The conclusion?

"Research also continues to raise awareness of the importance of chronic conditions in overall spending and as a major driver of cost increases, leading to disease management programs and other efforts to both improve quality and reduce the costs of conditions such as diabetes, asthma, hypertension, heart disease, and obesity."

beltim

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Re: Avoidable Health Care Costs
« Reply #24 on: May 03, 2015, 10:20:09 PM »
Your quote doesn't support the conclusion. I feel okay repeating this since you repeated your quote.  Unsurprisingly, it still doesn't support the "majority of spending."

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Re: Avoidable Health Care Costs
« Reply #25 on: May 03, 2015, 10:21:14 PM »

Actually I have not seen, though I may have missed, any citation of the majority are related to obesity/diet (and I would point out that thyroid conditions are related to obesity, but are not caused by obesity rather thyroid conditions can cause overweightness).

That is because no one said that the majority are related to "obesity/diet" but rather that the majority of issues are caused by "self-imposed diseases related to the biggest four factors: exercise, diet, stress and sleep."

Also, I'll re-quote

The Agency for Healthcare Research and Quality found that:

"Chronic Conditions Contribute to Higher Health Care Costs
Twenty-five percent of the U.S. community population were reported to have one or more of five major chronic conditions:

Mood disorders.
Diabetes.
Heart disease.
Asthma.
Hypertension.

Spending to treat these five conditions alone amounted to $62.3 billion in 1996.13 Moreover, people with chronic conditions tend to have other conditions and illnesses.

When the other illnesses are added in, total expenses for people with these five major chronic conditions rise to $270 billion, or 49 percent of total health care costs, according to 1996 MEPS data. On an individual level, treatment for the average patient with asthma was $663 per year in 1996, but when the full cost of care for asthma and other coexistent illnesses is taken into account, the average cost was $2,779.

Expenses for people with one chronic condition were twice as great as for those without any chronic conditions. Spending for those with five or more chronic conditions was about 14 times greater than spending for those without any chronic conditions.14 Persons with five or more conditions also have high hospital expenditures. In New York State during 2002, of the 1.3 million different persons admitted to the hospital, the 27 percent with five or more chronic conditions accounted for 47 percent of all inpatient costs."

The conclusion?

"Research also continues to raise awareness of the importance of chronic conditions in overall spending and as a major driver of cost increases, leading to disease management programs and other efforts to both improve quality and reduce the costs of conditions such as diabetes, asthma, hypertension, heart disease, and obesity."
You said: " Chronic diseases are rampant, people need to eat better. ", which does imply that eating better aka diet would affect chronic diseases.  However, when you look at your list:
Mood disorders.
Diabetes.
Heart disease.
Asthma.
Hypertension
First one, born with it; second one, could be born or develop it, my grandmother was born with it; heart disease, can be born or could contract it from multiple sources say German measles-not much that could be done here; Asthma-born/genetic; hypertension that one I will give you is mostly created though not always.  So when I look at this, I see many genetic causes, not things people can treat. 

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Re: Avoidable Health Care Costs
« Reply #26 on: May 03, 2015, 10:40:30 PM »
You said: " Chronic diseases are rampant, people need to eat better. ", which does imply that eating better aka diet would affect chronic diseases.  However, when you look at your list:
Mood disorders.
Diabetes.
Heart disease.
Asthma.
Hypertension
First one, born with it; second one, could be born or develop it, my grandmother was born with it; heart disease, can be born or could contract it from multiple sources say German measles-not much that could be done here; Asthma-born/genetic; hypertension that one I will give you is mostly created though not always.  So when I look at this, I see many genetic causes, not things people can treat.

Please let me rephrase my statement, and review the things you see.

"Chronic diseases are rampant, most people need to get their priorities in line."

Also, it's not my list, it's the The Agency for Healthcare Research and Quality's list.

Mood disorders are often quite related to exercise and have been shown to respond to proper diet as well. Many other factors come in to play of course, and as such can't be dismissed.

Diabetes is most often diagnosed as Type II diabetes, commonly related to obesity and diet related problems, along with inactivity. Type I is much less common than Type II. According to the American Diabetes Association, "In 2012, 29.1 million Americans, or 9.3% of the population, had diabetes. Approximately 1.25 million American children and adults have type 1 diabetes." Essentially 1.25/29.1 (or ONLY 4.29% have a Type I), thought to stem from genetic disarray and/or viral infections.

Heart Disease occasionally stems from non-modifiable risk factors, like genetics, but this is more often not the case.  "The good news is that your choices can influence your heart health. Through lifestyle changes like smoking cessation, healthy eating, exercise, and managing diabetes, blood pressure and stress, you can greatly reduce your chance of heart disease." I.E, Lots to be done here.

Asthma, though genetic by nature, also has many variable concerns to be dealt with. Better overall health conditions can greatly reduce the onset of asthma attacks, as well as reduce, and occasionally eliminate the symptoms. Keeping one's body in a higher level of fitness and health can often, though generally not entirely, counteract the need for treatment.

Hypertension. We seem to agree.

beltim

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Re: Avoidable Health Care Costs
« Reply #27 on: May 03, 2015, 10:41:38 PM »
I want to know why any of this matters. Obesity is rampant, people need to exercise. Chronic diseases are rampant, people need to eat better.

I'd be happy if we could suffice to say that the facts maintain that a considerable amount of our health problems are well within our physical control.

However, this doesn't change that 20% of the US's health expenditure comes from 1% of the populace, and that nearly 50% is accrued by only 5%. The majority of which are over 64 years old and have more than one chronic disease. Likely caused by a lifetime of shitty lifestyle choices.

It matters.  It matters because a school of thought has often popped up on this thread that you can avoid health care costs by eating right and exercising.  And certainly we should eat better and exercise more.  But it seems like health care costs can be reduced by perhaps 25% by doing so - not 50%, not more! and it's not a replacement for medical care.

There are many other reasons too, of course.  It matters for health policy, for health insurance reform, for knowing how much of our health care spending excess is due to personal behaviors and not addressable by institutional reform.

As for the distribution of costs, that's always going to happen.  People will get heart attacks, cancer, and infections that are essentially unavoidable.  They will always represent the people on whom the most money is spent.  And people like you continue to demonize people who use health care resources because you think they had a lifetime of shitty choices.  Maybe that's true.  For some people it's certainly true.  But there's no  proof that's it's true in general.

Gin1984

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Re: Avoidable Health Care Costs
« Reply #28 on: May 03, 2015, 10:48:07 PM »
You said: " Chronic diseases are rampant, people need to eat better. ", which does imply that eating better aka diet would affect chronic diseases.  However, when you look at your list:
Mood disorders.
Diabetes.
Heart disease.
Asthma.
Hypertension
First one, born with it; second one, could be born or develop it, my grandmother was born with it; heart disease, can be born or could contract it from multiple sources say German measles-not much that could be done here; Asthma-born/genetic; hypertension that one I will give you is mostly created though not always.  So when I look at this, I see many genetic causes, not things people can treat.

Please let me rephrase my statement, and review the things you see.

"Chronic diseases are rampant, most people need to get their priorities in line."

Also, it's not my list, it's the The Agency for Healthcare Research and Quality's list.

Mood disorders are often quite related to exercise and have been shown to respond to proper diet as well. Many other factors come in to play of course, and as such can't be dismissed.

Diabetes is most often diagnosed as Type II diabetes, commonly related to obesity and diet related problems, along with inactivity. Type I is much less common than Type II. According to the American Diabetes Association, "In 2012, 29.1 million Americans, or 9.3% of the population, had diabetes. Approximately 1.25 million American children and adults have type 1 diabetes." Essentially 1.25/29.1 (or ONLY 4.29% have a Type I), thought to stem from genetic disarray and/or viral infections.

Heart Disease occasionally stems from non-modifiable risk factors, like genetics, but this is more often not the case.  "The good news is that your choices can influence your heart health. Through lifestyle changes like smoking cessation, healthy eating, exercise, and managing diabetes, blood pressure and stress, you can greatly reduce your chance of heart disease." I.E, Lots to be done here.

Asthma, though genetic by nature, also has many variable concerns to be dealt with. Better overall health conditions can greatly reduce the onset of asthma attacks, as well as reduce, and occasionally eliminate the symptoms. Keeping one's body in a higher level of fitness and health can often, though generally not entirely, counteract the need for treatment.

Hypertension. We seem to agree.
You cannot avoid nor treat mood disorders by exercise.  I seriously would like you to show one citation.  Not that in addition to treatment, exercise is good, but that mood disorders can be avoided or treated that way.  My professors would love to know that, you know those who are studying diseases in the brain and sure don't seem to think this.

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Re: Avoidable Health Care Costs
« Reply #29 on: May 03, 2015, 11:14:14 PM »
It matters.  It matters because a school of thought has often popped up on this thread that you can avoid health care costs by eating right and exercising.  And certainly we should eat better and exercise more.  But it seems like health care costs can be reduced by perhaps 25% by doing so - not 50%, not more! and it's not a replacement for medical care.

There are many other reasons too, of course.  It matters for health policy, for health insurance reform, for knowing how much of our health care spending excess is due to personal behaviors and not addressable by institutional reform.

As for the distribution of costs, that's always going to happen.  People will get heart attacks, cancer, and infections that are essentially unavoidable.  They will always represent the people on whom the most money is spent.  And people like you continue to demonize people who use health care resources because you think they had a lifetime of shitty choices.  Maybe that's true.  For some people it's certainly true.  But there's no  proof that's it's true in general.

I enthusiastically agree and approve of your line of reasoning. I do however take exception to your statement suggesting that I am among the people that continue to demonize people who use healthcare resources. I do not frown upon those who utilize the healthcare system for their needs. Indeed I feel pity for them, especially if they could solve their related problems though self action. In the cases of cancer, genetic disorders, and other non-modifiable chronic disorders, I take solace that I myself have yet to be affected by such a situation.

I am simply non-sympathetic to those individuals that have brought about the chronic illnesses stated above, through inaction and poor lifestyle choices. Mostly I see these issues cropping up in the mid 30's to 50's and then culminating with 2+ chronic diseases until they die. This is regrettable. And although diet and exercise are not a replacement for medical care, we both agree that it is a direct mitigating factor and can drastically reduce our dependence on such.


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Re: Avoidable Health Care Costs
« Reply #30 on: May 04, 2015, 08:04:46 AM »
Writing styles vary. Not everyone feels the need to post a dozen formal studies with every statement they make.

Perhaps it would be easier if you assume:
Your
Mileage
May
Vary

I agree with the people who state that lifestyle choicSe do affect many physical ailments. And I think that many Americans could do better at eating properly, exercising, reducing stress, etc.

But the tone of this thread sucks, and I'm going to go have some tea and ignore some of you. Because the thought that springs to mind with thread is that some of you need MORE DAMN FIBER.

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Re: Avoidable Health Care Costs
« Reply #31 on: May 04, 2015, 08:58:43 AM »
About half of medical expenses are in the last year of life. So if you could prevent those causes of death you could prevent those last year of life expenses for those conditions.

Why?  Why wouldn't it just be deferred until the new last year of life?

That's not how people think about these things. If a heroic effort by the pilot causes a plane to be landed in the Hudson, we say he "saved" 300 lives. In reality, every person on the plane will die someday--the death was just delayed, and will be from a different cause.

beltim

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Re: Avoidable Health Care Costs
« Reply #32 on: May 04, 2015, 08:59:09 AM »
It matters.  It matters because a school of thought has often popped up on this thread that you can avoid health care costs by eating right and exercising.  And certainly we should eat better and exercise more.  But it seems like health care costs can be reduced by perhaps 25% by doing so - not 50%, not more! and it's not a replacement for medical care.

There are many other reasons too, of course.  It matters for health policy, for health insurance reform, for knowing how much of our health care spending excess is due to personal behaviors and not addressable by institutional reform.

As for the distribution of costs, that's always going to happen.  People will get heart attacks, cancer, and infections that are essentially unavoidable.  They will always represent the people on whom the most money is spent.  And people like you continue to demonize people who use health care resources because you think they had a lifetime of shitty choices.  Maybe that's true.  For some people it's certainly true.  But there's no  proof that's it's true in general.

I enthusiastically agree and approve of your line of reasoning. I do however take exception to your statement suggesting that I am among the people that continue to demonize people who use healthcare resources. I do not frown upon those who utilize the healthcare system for their needs. Indeed I feel pity for them, especially if they could solve their related problems though self action. In the cases of cancer, genetic disorders, and other non-modifiable chronic disorders, I take solace that I myself have yet to be affected by such a situation.

I am simply non-sympathetic to those individuals that have brought about the chronic illnesses stated above, through inaction and poor lifestyle choices. Mostly I see these issues cropping up in the mid 30's to 50's and then culminating with 2+ chronic diseases until they die. This is regrettable. And although diet and exercise are not a replacement for medical care, we both agree that it is a direct mitigating factor and can drastically reduce our dependence on such.

Perhaps I misjudged you, and if I did I am genuinely sorry.  I was simply responding to your statement:
Quote
However, this doesn't change that 20% of the US's health expenditure comes from 1% of the populace, and that nearly 50% is accrued by only 5%. The majority of which are over 64 years old and have more than one chronic disease. Likely caused by a lifetime of shitty lifestyle choices.
I don't know which group you were referring to their health care as caused by "a lifetime of shitty lifestyle choices."  I interpreted it as the sentence before, or the 50% of health care spending.  This gets us right back to my original question, which is: do you have any support for your statement that 50% of health care spending is due to lifestyle choices?

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Re: Avoidable Health Care Costs
« Reply #33 on: May 04, 2015, 09:00:31 AM »
If by in the ballpark you mean within a factor of two, then yes.  Personally I don't think 25% is close enough to "more than half" to be credible support.

I don't know why you are choosing to ignore the explanation for why the 25% number is a dramatic underestimate. The 25% figure is from much younger, much healthier, and much less medically expensive people than the average source of medical costs.

beltim

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Re: Avoidable Health Care Costs
« Reply #34 on: May 04, 2015, 09:01:16 AM »
About half of medical expenses are in the last year of life. So if you could prevent those causes of death you could prevent those last year of life expenses for those conditions.

Why?  Why wouldn't it just be deferred until the new last year of life?

That's not how people think about these things. If a heroic effort by the pilot causes a plane to be landed in the Hudson, we say he "saved" 300 lives. In reality, every person on the plane will die someday--the death was just delayed, and will be from a different cause.

I don't really understand the analogy.  I mean, I get what you're saving that the deaths were delayed.  I just don't see how it pertains to cost.

beltim

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Re: Avoidable Health Care Costs
« Reply #35 on: May 04, 2015, 09:10:22 AM »
If by in the ballpark you mean within a factor of two, then yes.  Personally I don't think 25% is close enough to "more than half" to be credible support.

I don't know why you are choosing to ignore the explanation for why the 25% number is a dramatic underestimate. The 25% figure is from much younger, much healthier, and much less medically expensive people than the average source of medical costs.

Because when you go to that study, even when you include retirees the number is still only about 25% (Table 2).  25% is looking like a better and better estimate.

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Re: Avoidable Health Care Costs
« Reply #36 on: May 04, 2015, 10:18:23 AM »
I think this thread has not been very productive, at least with respects to some of the reply comments. I've already stated that these calculations are very complicated and hard to do, and therefore are not commonly used in this way in medical liturature. There are many assumptions that go into them and it's difficult to delineate causality. I'm not immediately aware of the report that shows exactly what you want to see. And I don't have time to look for it. Showing some evidence and then extrapolating from that has also fallen on deaf ears. But in one last attempt, here's an example I found from 2 minutes of googling.

"The five most costly and preventable chronic conditions cost the U.S. nearly $347 billion—30% of total health spending—in 2010."

https://www.apha.org/~/media/files/pdf/fact%20sheets/chronicdiseasefact_final.ashx

There are at least several dozen chronic diseases that I'm aware of. But if you look at just 5 that are preventable, their expenditure burden alone is 30% of total health spending. So if you add in the dozens of other chronic diseases, that will be substantially more than 30%. Is it 50.01%? Maybe. But,if not, it's still close.

You could look at other pieces of evidence and extrapolate from there. But I won't take the time to do that. Bottom line is that (as I've said all along) MMM was pretty close to right if not exactly right (I think it's more likely he was right). And for some dude without a medical background posting on an Internet frugality blog laden with obviously humorous and exaggurated statements about face punches, clown cars, and badassity, I think he was close enough. I wouldn't make the statement in a medical journal article without sourcing it. But I wouldn't take serious action based on medical research analysis from the aforementioned humorous blogger either.

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Re: Avoidable Health Care Costs
« Reply #37 on: May 04, 2015, 10:24:49 AM »
About half of medical expenses are in the last year of life. So if you could prevent those causes of death you could prevent those last year of life expenses for those conditions.

Why?  Why wouldn't it just be deferred until the new last year of life?

That's not how people think about these things. If a heroic effort by the pilot causes a plane to be landed in the Hudson, we say he "saved" 300 lives. In reality, every person on the plane will die someday--the death was just delayed, and will be from a different cause.

I don't really understand the analogy.  I mean, I get what you're saving that the deaths were delayed.  I just don't see how it pertains to cost.

The cost would be attributed to something else. And generally the more traditional ways of dying are more inexpensive. If you die of old age, that's generally free. If your otherwise healthy heart just stops for good one day, that will not be too expensive (relatively speaking). But if you are obese and diabetic and you can't breathe and you are in the hospital for dialysis because your kidneys failed from your obesity-induced high blood pressure and then you get open heart surgery and have hospital acquired infections and venous thromboembolism and pressure ulcers from your hospital stay, etc, etc, it adds up. Some end-of-life treatments for preventable cancers are literally hundreds of thousands of dollars during the last year of life.

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Re: Avoidable Health Care Costs
« Reply #38 on: May 04, 2015, 10:29:30 AM »
I think this thread has not been very productive, at least with respects to some of the reply comments. I've already stated that these calculations are very complicated and hard to do, and therefore are not commonly used in this way in medical liturature. There are many assumptions that go into them and it's difficult to delineate causality. I'm not immediately aware of the report that shows exactly what you want to see. And I don't have time to look for it. Showing some evidence and then extrapolating from that has also fallen on deaf ears. But in one last attempt, here's an example I found from 2 minutes of googling.

"The five most costly and preventable chronic conditions cost the U.S. nearly $347 billion—30% of total health spending—in 2010."

https://www.apha.org/~/media/files/pdf/fact%20sheets/chronicdiseasefact_final.ashx

There are at least several dozen chronic diseases that I'm aware of. But if you look at just 5 that are preventable, their expenditure burden alone is 30% of total health spending. So if you add in the dozens of other chronic diseases, that will be substantially more than 30%. Is it 50.01%? Maybe. But,if not, it's still close.

You could look at other pieces of evidence and extrapolate from there. But I won't take the time to do that. Bottom line is that (as I've said all along) MMM was pretty close to right if not exactly right (I think it's more likely he was right). And for some dude without a medical background posting on an Internet frugality blog laden with obviously humorous and exaggurated statements about face punches, clown cars, and badassity, I think he was close enough. I wouldn't make the statement in a medical journal article without sourcing it. But I wouldn't take serious action based on medical research analysis from the aforementioned humorous blogger either.

That's a pretty good study that you linked to, and I thank you for it.  But it, like many of the studies we've found, includes the non-preventable cases of chronic diseases in that 30%.  If you look at how much of that $347 billion is preventable, the study suggests $218 billion.  That's about 19% of total spending, if I've done my math right.  Add in the other preventable costs due to chronic diseases, and I bet you get to 25% or so.

forummm

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Re: Avoidable Health Care Costs
« Reply #39 on: May 04, 2015, 10:40:17 AM »
Just thought I'd add that the aforementioned humorous blogger was also posting in an April Fools thread.
« Last Edit: May 04, 2015, 10:46:06 AM by forummm »

forummm

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Re: Avoidable Health Care Costs
« Reply #40 on: May 04, 2015, 10:45:42 AM »
I think this thread has not been very productive, at least with respects to some of the reply comments. I've already stated that these calculations are very complicated and hard to do, and therefore are not commonly used in this way in medical liturature. There are many assumptions that go into them and it's difficult to delineate causality. I'm not immediately aware of the report that shows exactly what you want to see. And I don't have time to look for it. Showing some evidence and then extrapolating from that has also fallen on deaf ears. But in one last attempt, here's an example I found from 2 minutes of googling.

"The five most costly and preventable chronic conditions cost the U.S. nearly $347 billion—30% of total health spending—in 2010."

https://www.apha.org/~/media/files/pdf/fact%20sheets/chronicdiseasefact_final.ashx

There are at least several dozen chronic diseases that I'm aware of. But if you look at just 5 that are preventable, their expenditure burden alone is 30% of total health spending. So if you add in the dozens of other chronic diseases, that will be substantially more than 30%. Is it 50.01%? Maybe. But,if not, it's still close.

You could look at other pieces of evidence and extrapolate from there. But I won't take the time to do that. Bottom line is that (as I've said all along) MMM was pretty close to right if not exactly right (I think it's more likely he was right). And for some dude without a medical background posting on an Internet frugality blog laden with obviously humorous and exaggurated statements about face punches, clown cars, and badassity, I think he was close enough. I wouldn't make the statement in a medical journal article without sourcing it. But I wouldn't take serious action based on medical research analysis from the aforementioned humorous blogger either.

That's a pretty good study that you linked to, and I thank you for it.  But it, like many of the studies we've found, includes the non-preventable cases of chronic diseases in that 30%.  If you look at how much of that $347 billion is preventable, the study suggests $218 billion.  That's about 19% of total spending, if I've done my math right.  Add in the other preventable costs due to chronic diseases, and I bet you get to 25% or so.

You could be right. I didn't look at all into this before posting it--just the quote and the source. As I said a few times, the assumptions and how you calculate it are complicated. Government estimates from credible scientific agencies (as opposed to estimates from political officials) are almost always conservative in their methodology because they have to be beyond scrutiny.
« Last Edit: May 04, 2015, 10:47:59 AM by forummm »

beltim

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Re: Avoidable Health Care Costs
« Reply #41 on: May 04, 2015, 10:48:39 AM »
Just thought I'd add that the aforementioned humorous blogger was also posting in an April Fools thread.

Yeah, I wondered if that played a role.  But this part was after the break, in the serious part.

I think MMM just overstated the case a little to try to make a better case.  He's done this before in health-related posts, like when he tried to estimate the health benefits of biking.  It doesn't detract from the overall point - it just requires an adjustment in the maximum possible benefit.

forummm

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Re: Avoidable Health Care Costs
« Reply #42 on: May 04, 2015, 11:07:27 AM »
I also wanted to say that I appreciate people's interest in being 100% rigorously accurate. So good for you all that are interested in the truth. I approached this from the start as "ballpark is OK for this venue". Others can apply a different lense. Fair enough. No hard feelings on my end.

And that I don't think it's fair to put full blame on people who have preventable conditions. It's pretty easy to say that adults should know better than to use tobacco. But the official advice around diet has been pretty hideously awful for decades. It's hard for most people to know that eating poorly when people don't tell them that. The lie for decades has been to remove fat from your diet. What happened is that refined carbs and sugar replaced that fat--in products now called "healthy". Guess what, there was never evidence that normal amounts of unsaturated fat was bad for you. And plenty of evidence (for over 100 years) that sugar and refined carbohydrates actually made you fat, while eating fat itself was appetite sating. So the food pyramid that told people to eat lots of refined carbohydrates and to limit fat intake was official advice urging people to adopt a bad diet. It's hard to blame people too much for following the diet that everyone told them to take. It used to be that everyone knew that bread would make you fat. Somehow we forgot that as a society. And sugar started being injected into almost every processed food. And sales of soda, sugarry coffee, and juice (which is sugar water) and other sugarry drinks went through the roof. And strangely we all got fat.

Mr Fixit

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Re: Avoidable Health Care Costs
« Reply #43 on: May 04, 2015, 11:38:31 AM »
Quote
You cannot avoid nor treat mood disorders by exercise.  I seriously would like you to show one citation.  Not that in addition to treatment, exercise is good, but that mood disorders can be avoided or treated that way.  My professors would love to know that, you know those who are studying diseases in the brain and sure don't seem to think this.

I can say from personal experience that exercise absolutely has a effect on my depression symptoms.  Every doctor that I've seen have told me to exercise more as part of my treatment.  In fact, I have been able to get off my medication completely when my physical activity is at a high enough level.  Unfortunately for me, that level isn't sustainable, but I have been able to lower my medication dosage with a sustainable level of exercise. 

Exercise isn't going to have an effect on all mood disorders, or even for all people with the same disorder.  Harvard Medical School seems to think that exercise has a place in a depression treatment program: http://www.health.harvard.edu/mind-and-mood/exercise-and-depression-report-excerpt







beltim

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Re: Avoidable Health Care Costs
« Reply #44 on: May 04, 2015, 11:41:39 AM »
I also wanted to say that I appreciate people's interest in being 100% rigorously accurate. So good for you all that are interested in the truth. I approached this from the start as "ballpark is OK for this venue". Others can apply a different lense. Fair enough. No hard feelings on my end.

And that I don't think it's fair to put full blame on people who have preventable conditions. It's pretty easy to say that adults should know better than to use tobacco. But the official advice around diet has been pretty hideously awful for decades. It's hard for most people to know that eating poorly when people don't tell them that. The lie for decades has been to remove fat from your diet. What happened is that refined carbs and sugar replaced that fat--in products now called "healthy". Guess what, there was never evidence that normal amounts of unsaturated fat was bad for you. And plenty of evidence (for over 100 years) that sugar and refined carbohydrates actually made you fat, while eating fat itself was appetite sating. So the food pyramid that told people to eat lots of refined carbohydrates and to limit fat intake was official advice urging people to adopt a bad diet. It's hard to blame people too much for following the diet that everyone told them to take. It used to be that everyone knew that bread would make you fat. Somehow we forgot that as a society. And sugar started being injected into almost every processed food. And sales of soda, sugarry coffee, and juice (which is sugar water) and other sugarry drinks went through the roof. And strangely we all got fat.

Thank you.  I really appreciate this post.

Cassie

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Re: Avoidable Health Care Costs
« Reply #45 on: May 04, 2015, 04:27:00 PM »
All the people I happen to know with asthma are thin, eat healthy & exercise, never smoked etc. HOw is this there fault?  My son was diagnosed with asthma at the age of 1. I guess it was his fault.

NoraLenderbee

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Re: Avoidable Health Care Costs
« Reply #46 on: May 04, 2015, 05:08:41 PM »
I get the feeling there are a lot of young people posting on this thread who have not yet had much experience of aging. There are genetic predispositions that don't show themselves until later in life. There is the wear and tear of normal living--which includes the wear on your joints from healthy exercise. There is the unavoidable fact that most of us live in places with some air and water pollution, which we cannot control as easily as we can control what we eat. There is plain old bad luck--you can eat right and exercise and everything and be struck down in your 30s by breast cancer or in your 50s by a sudden, unanticipated stroke.

One reason the last year of medical care is so expensive is simply that medicine has a lot more treatments and interventions for the diseases of age. Naturally, we use them. When there was nothing you could do for cancer, it didn't cost a lot for Grandma to die. Now that there are more treatments, they get used, and of course they cost money. That is the price we pay (literally) for having medical interventions that can extend our useful lives. I consider it progress that I have the chance to live into my 80s instead of dying in childbirth or of tuberculosis in my 30s.


kendallf

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Re: Avoidable Health Care Costs
« Reply #47 on: May 04, 2015, 07:37:37 PM »
Beltim in particular, several others in part...

I generally appreciate your analytical posts and thoroughness.  This thread is an exception. 

What action are you going to take if you decide that, indeed, the % of healthcare costs which are avoidable are indeed lower than 50%?  Sit on the couch, watch TV, smoke a cigarette and eat a Twinkie while washing it down with a Coors Light?

Because if you are, I'd pay money to see that video. 

beltim

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Re: Avoidable Health Care Costs
« Reply #48 on: May 04, 2015, 07:44:01 PM »
Beltim in particular, several others in part...

I generally appreciate your analytical posts and thoroughness.  This thread is an exception. 

What action are you going to take if you decide that, indeed, the % of healthcare costs which are avoidable are indeed lower than 50%?  Sit on the couch, watch TV, smoke a cigarette and eat a Twinkie while washing it down with a Coors Light?

Because if you are, I'd pay money to see that video.

How much money?


Seriously, I started this thread mostly to see if there was a good source for MMM's claim.  My own research didn't come up with anything good - the best data I saw were claims of 25%, without a clear delineation of how they figured it.  forummm, for all the grief I gave him/her, came up with a much better study than I did - but it basically agreed with a 25%-ish figure.

So what will I do if the number is 25%?  The same things as if it were 50%, or 0%, honestly: not much.  This data matters for health policy, for discussions, and for analysis.  It doesn't play into my exercise plans, or diet plans, or career plans.  I started this thread mostly because I'm curious, and I indulge my curiosity.

P.S. Thank you for your appreciation on my other posts.

Gin1984

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Re: Avoidable Health Care Costs
« Reply #49 on: May 04, 2015, 07:44:32 PM »
Quote
You cannot avoid nor treat mood disorders by exercise.  I seriously would like you to show one citation.  Not that in addition to treatment, exercise is good, but that mood disorders can be avoided or treated that way.  My professors would love to know that, you know those who are studying diseases in the brain and sure don't seem to think this.

I can say from personal experience that exercise absolutely has a effect on my depression symptoms.  Every doctor that I've seen have told me to exercise more as part of my treatment.  In fact, I have been able to get off my medication completely when my physical activity is at a high enough level.  Unfortunately for me, that level isn't sustainable, but I have been able to lower my medication dosage with a sustainable level of exercise. 

Exercise isn't going to have an effect on all mood disorders, or even for all people with the same disorder.  Harvard Medical School seems to think that exercise has a place in a depression treatment program: http://www.health.harvard.edu/mind-and-mood/exercise-and-depression-report-excerpt
The first line there says that exercise is not cure-all.  My statement was that you could not prevent or treat completely mood disorders with exercise.  In conjunction makes sense, yes but not as the only treatment.  And I really would not the actual citations, not something that says a study without the author name or citation.  That is my issue.  Acting like exercise is cure all.