Healthier Lifestyle Drives Healthcare Costs UP

Popular wisdom has it that if we live a healthier lifestyle, we'll keep the cost of healthcare down. I suggest that perhaps the opposite is true.

Not too many years ago, we got old, we got sick and we died. Sometimes we didn't even get old, we just got sick and died. We really didn't think much about a healthy lifestyle. We smoked, we watched a lot of TV, there were very few joggers. We rode a bicycle of we liked it, not to get any cardio benefit out of it. We ate trans fats and loaded up on cholesterol laden foods. We got cancer, heart failure or complications from diabetes. There wasn't much to be done except go home to die.

We now live longer than in the past for two main reasons: we live a healthier lifestyle and medical science has advanced to the point that they can now cure or slow down previously terminal diseases. While that is all well and good, it doesn't come free, and we have not yet figured out how to pay for our new-found health.

Our obsession with health leads to several costly things. The most glaring one is that, since we live longer, we are more likely to need nursing home care due to Alzheimer's, dementia or some other debilitating illness. Like it or not, no matter how healthy we are, our bodies eventually wear out. While there have been significant strides made in the area of prolonging life by lifestyle, medication,surgery and machines, there has been very little progress in dealing effectively with end of life issues. Collectively, we have not come to a realization that there is some point beyond which it is not worth keeping someone alive. As such, we spend enormous amounts of money on people who would choose death if it were an option.

Another costly effect of our healthy lifestyle is that we are no longer content to sit in front of the TV with our knee elevated when it is stiff and sore. We want to run, cycle, play golf and kayak. Not a problem, get a knee replacement, hip replacement, shoulder replacement.... or even two of each. These are not inexpensive procedures. I'll be the first one in line to get one as soon as I can no longer swing a golf club, but it should be recognized that these expensive procedures are part of the COST of a healthier lifestyle.

While it's somewhat related to the first issue, another costly result of living "healthier" and longer is that, in the long run, we need more medical care and medication. Again, like it or now, no matter how healthy we are, our bodies will wear out. We'll go to the doctor, we'll have surgery, we'll get medicine. First one pill, then two, then three. Some are necessary, like insulin for a diabetic. Others solve problems we didn't even know we had until we saw it on TV (didn't you always wonder why you were carrying around that beaker of green liquid?). The more different medicines we take, the more unpredictable are the interactions. Some mixed side effects lead to the prescription of yet another medicine.

So, if I don't smoke and get lots of exercise, I'm much less likely to get lung cancer and die when I'm 50. But, since I live past 50, I'll have a hip replacement, a knee replacement, a coronary bypass, treatment for prostate cancer, and extended physical therapy for a torn rotator cuff. I'll eventually be taking medicine for gout, overactive bladder, blood pressure, type 2 diabetes and arthritis. I start to forget things and wander off in the grocery store. Finally, my wife can no longer take care of me, so it's off to assisted care, then a full blown nursing home where, in my lucid moments over a period of 8 years, I wish my life could end.

Again, I do NOT mean to imply that smoking from age 16 and getting cancer and dying at age 50 is a preferred life scenario. What I am saying is that the healthy lifestyle and longer life leads to expenses that neither we as individuals nor the country as a whole were able to anticipate or plan for. So as we continue to invent new cures, prolong life and fill up our nursing homes, we will continue to cripple ourselves with unsustainable cost increases.

What to do? The first order of business should be to figure out a way by which a healthy person can define, unambiguously, the point beyond which he/she no longer wants to live. When that point is reached, a humane, legal and socially acceptable means to end life should be available. We've got to quit avoiding this issue and figure out a way to deal with it. I want that option for myself and I know many people who think the same way.

Second, maybe it's time to slow down the pace of medical advancement. Or, if we're going to continue, we've got to consider the results of that advancement in the context of what is affordable. OOPS, is that starting to sound like rationing? As much as I hate to use that emotion-laden word, we already do it and to manage our health care costs in the future, we've got to get it out in the open and have an honest dialog about how to do it. We can either ration the development of new technology (by constraining the available research dollars), or ration the use of the technology (say, by constraining the number of a given procedure to be performed each year). Alternatively, we can come up with some kind of single payer system where we, as a nation, decide how much we want to spend on health care, we tax the citizens and businesses to collect that much money and we budget the expenditures to achieve that cost. Of course there won't be enough for EVERYONE to get ANY procedure at ANY time they want it. Of course, there will be abuse. Of course, the rich will be able to buy services outside the system. Those are issues to be addressed, not issues that invalidate a single payer system.

It's easy to bash "big pharma" or "greedy insurance companies", but they are only part of the problem. Our culture is another big part of the problem. We've got to think seriously about how our current expectations for health care are not affordable and part of solving that problem should be managing those expectations.