Wednesday, March 11, 2009

Health Reform and the High Cost of Healthy Living...

We’d be a healthier nation if we slimmed down. But cutting the obesity rate could actually lead to higher overall health costs, ananalysis published in PLoS Medicine suggests. That may come as a surprise to top presidential candidates, who talk both about cutting health-care costs and fighting obesity.

Dutch researchers simulated lifetime costs, starting at age 20, for smokers, the obese, and a “healthy living” cohort that maintained a healthy weight and didn’t smoke. The average lifetime costs of certain diseases were higher for the unhealthy — smokers are more likely to get lung cancer, the obese more likely to become diabetic.

But the healthy living 20 year olds could expect to live to about age 84, compared with age 77 for the smokers and 80 for the obese. Those additional years can be expensive: For healthy 20 year olds, the remaining lifetime health care costs over $400,000, compared with $365,000 for the obese and $321,000 for the smokers.

These figures are based on costs in the Dutch health care system, so they can’t be applied directly to the U.S. (And besides, this is a rough estimate based on models.) Still, with everybody in the thrall of Superduper Tuesday fever, it’s worth noting that presidential candidates in both parties like to talk both about cutting costs and fighting obesity.

Clinton, for example, notes that “had the prevalence of obesity remained the same today as it was in 1987, we would spend 10 percent less per person — approximately $200 billion — on health care today.” McCain and Obama both call obesity an “epidemic,” and both place great emphasis on lowering health care costs.

They’re right to focus on obesity as a great threat to public health in this country. But, perversely, reducing obesity and the burden of disease it causes may wind up costing the nation more, not less.

As the researchers conclude: “A remaining and most important question is whether prevention should be cost-saving in order to be attractive. Obviously, the answer is that it need not be cost-saving: like other forms of care it ‘merely’ needs to be cost-effective.”

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