blog.bioethics.net

Talking about the consequences of chronic disease

The Milken Institute released a report this week totaling the cost of preventable chronic disease in the US. The report's tally for 2003 was $1.3 trillion.* And when you float a number like that, people tend to notice. "Healthy living could save U.S. $1 trillion, study finds" is how the LA Times headlined its story about the report (others used similar headlines).

There are good reasons to trumpet this number -- it's an easy way to give people a sense of the scale of the problem and it certainly grabs attention. But there is another way to talk about this issue. The US is spending billions, if not trillions, on conditions such as diabetes and heart disease because millions of people are afflicted with them. And if you look at it that way, maybe the headlines are different, something along the lines of, "Millions in the US suffering unnecessarily from disease."

So? What difference does it make?

Well, if cost is the main descriptor we use for the size of this problem, maybe we look at the guy jamming french fries into his face and say, "Quit that! You're gonna cost all of us a ton of money!" Or, you could tell him, "Hey! Don't do that! You're setting yourself up for all sorts of avoidable pain and misery in the future!" Is it a problem of cost or suffering? And who's bearing the consequences, that guy or us?

The answer to those questions is: both. But the way we enter the process of tackling the problem could have a big impact on the solutions we develop. If we see preventable chronic disease as an economic problem -- caused by that guy shotgunning french fries -- maybe we hold health care budgets tight or slap a tax on unhealthy behaviors. Hey, someone else's french fry problem isn't going to cost us money! If we flip the situation around, though, and look at it as a problem of suffering, maybe we invest more in prevention programs and follow up care. People shouldn't have to suffer if we can prevent it. We should do something about that.

Of course, this doesn't have to be an either/or situation. And the way out of this problem will probably involve taking something from both perspectives. We just need to keep in mind that we'll all fare better in this discussion if we focus not only on what we're talking about, but how.

*About that $1.3 trillion... the Milken Institute figures that the US spent $277 billion on treatment and lost $1.05 trillion in productivity. It's almost always worth taking lost productivity numbers with a grain of salt (or even a whole shaker full) because it's awfully hard to figure how productive someone would have been if something else had happened. (Think about all those stories about lost productivity from the NCAA tournament -- just because the guy in the next cubicle spent an hour poring over his picks doesn't mean he would have been otherwise writing a report.) That said, even if the Milken people are off by half, it's still an enormous number... something like 5% of GDP.

-Greg Dahlmann