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The Acute Nature of Chronic Problems
Why the AARP drumbeat on costs won't help cure a single patient

Peter J. Pitts
Medical Progress Today
November 10, 2005

Policymakers in the U.S. and abroad are obsessed with the cost of healthcare. A recent World Health Organization study reports that India, China and Russia will suffer losses of billions of dollars in national income over the next decade unless investments are made to prevent rising levels of chronic diseases. And a March 2005 research synthesis from the Department of Health and Human Services' Agency for Healthcare Research and Quality estimates that the United States could save nearly $2.5 billion a year by preventing hospitalizations due to severe diabetes complications alone.

But this global debate shouldn't be primarily about the money - it should be about saving lives. And the U.S. should lead this debate. Unfortunately, our domestic debate is being driven by the numbing AARP drumbeat (what are wholesale pharmaceutical prices this week?) of cost-cost-cost-cost-cost. Our elected representatives look at the Veteran's Administration's lower-than-average cost of pharmaceuticals as if it was the Holy Grail of accounting. But nobody asks why American vets aren't any healthier - and perhaps even less healthy in some respects - than the rest of us. While the drums are beating, Americans grow larger, their cholesterol counts continue their deadly ascent, and diabetes becomes the real American pandemic.

In 1979, 31,691 Americans had a foot amputated because of undiagnosed and untreated diabetes. Last year that number grew to over 80,000. Hundreds of thousands of heart attacks and strokes, caused by high blood pressure and high cholesterol, cost the American health care system billions of dollars while the cost in terms of human suffering cannot even begin to be measured.

The American health care system is broken in important respects. American health care is designed to provide acute care, but too often neglects the urgent imperative of chronic conditions. This disconnect will become even more problematic as Baby Boomers continue to age and the fastest growing demographic segment in America is the over-75 population. The argument that health care is "too expensive" is too broad. A better argument is that waiting until Americans become seriously ill to intervene is too expensive. Earlier diagnosis and earlier, continuing care is crucial to the future health of both Americans and the American health care system.

Prevention must be our first line of defense. Our health care system often works miracles when people become very ill, but it needs to do a better job at keeping people healthy before disease attacks. Although proper diet and nutrition are misunderstood and undervalued, better health care habits will not prevent the diseases that all Americans (and Baby Boomers in particular) will develop as we age. There are effective treatments, including medicines, which stop diseases such as hypertension and diabetes from progressing, allowing millions of Americans to lead active and productive lives rather than undergoing surgery, emergency care, hospitalizations, disabilities, and nursing home care.

We cannot afford, in terms of either dollars or lives, to continue playing the health care "blame game," tending to focus on health care prices - for hospitals, insurance, drugs, and doctors. Disease is the enemy and the cost of disease is staggering. Rather than looking for a villain, it's time to start asking the hard questions and finding the right answers - focusing on how to reduce the price of a diabetic amputation is the wrong approach. We need to focus on prevention because that's the best way to save money and improve lives. Now is the time to do this, so that we can invest in and afford better treatments for other conditions such as cancer and Parkinson's disease, which are so desperately needed and that hold so much promise.

All Americans deserve access to quality health care, but how can Americans get broader access to health care without diluting the quality of health care and compromising the future of health care? If miracles have become expectations - "What's a miracle worth?"

The first step in this process is an honest, broad-based dialogue. In order to revitalize our health care system we must refocus the debate about health care on the prevention of disease before it becomes expensive and deadly. In order to save lives, reduce costs, enhance quality, and deliver on the promise of robust health to all groups of Americans, all of the players in the health care debate - including government - must work together as a team, as a unit, as a public health defense force armed and ready to advance the public health.

Peter J. Pitts is a former Associate Commissioner at the Food & Drug Administration and Senior Vice President for Global Health Affairs at Manning, Selvage & Lee.

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