The Medicare debate raging in Washington isn’t just a dispute over the role of government in health care. Nor is it simply a debate about how to rein in government spending in a time of budget deficit.
Rather, today’s Medicare debate is mostly a proxy battle over how we can pay for the astounding increase in the chronic diseases that are plaguing America’s health.
One thing is certain: The long-term viability of Medicare depends on a national commitment to preventing the onset of costly disease in the first place. And that must begin with an investment in primary prevention.
Today, almost one of every two American adults has at least one chronic illness. According to the Partnership to Fight Chronic Disease, virtually all Medicare spending — 96 cents of every dollar — is spent on chronic-disease care and treatment. More than half of Medicare beneficiaries are treated annually for five or more chronic conditions.
By definition, a chronic disease is “unending.” While it can be controlled, there is no cure. And in most instances, a chronic disease requires treatment for the remainder of the individual’s life.
Paradoxically, chronic diseases such as heart disease, stroke, cancer, diabetes and arthritis not only are among the most common and costly of all health problems in the United States but also are among the most preventable, according to the Centers for Disease Control and Prevention.
Chronic diseases, in fact, are largely attributable to just four modifiable behaviors: lack of physical activity, poor nutrition, tobacco use and excessive alcohol consumption.
Primary prevention — that is, deterring the onset of disease before it occurs by engaging in beneficial lifestyle behaviors such as regular exercise, healthy eating, avoidance of tobacco and other controlled substances, stress management and routine medical exams — is the most efficient, cost-effective way to stem the tide of chronic disease that wastefully consumes billions in Medicare spending each year.
According to the CDC, 80 percent of heart disease, stroke and Type 2 diabetes — as well as 40 percent of cancer — could be avoided if people simply exercised more, ate more healthfully and stopped smoking. Statistics from the Exercise Is Medicine initiative indicate that at the proper moderate intensity, regular exercise alone can lower the risk of colon cancer by more than 60 percent, can reduce the risk of developing Alzheimer’s disease by one-third and can decrease depression as effectively as medications or behavioral therapy.
Health Affairs recently released a sobering new study indicating more disease and earlier mortality ahead for today’s younger Americans. According to the study abstract, a new “three-dimensional” method of forecasting vital health statistics — which takes into account the delayed effects of the health risks being accumulated by today’s younger generations — suggests future death rates and health care expenditures could be far worse than currently anticipated.
The study’s authors go as far as suggesting that policymakers adopt this more robust forecasting tool and redouble efforts to develop and implement effective obesity-related prevention programs and interventions.
Rep. Eric Swalwell, D-Calif., walks on Broadway after a Future Forum with young entrepreneurs in the Flatiron District of New York City, April 16, 2015. Reps. Steve Israel, D-N.Y., Seth Moulton, D-Mass., and Grace Meng, D-N.Y., also attended.