Health Care Financing – Which Finger Goes in the Dike?

With the recent presentation to the Supreme Court regarding the constitutionality of the Affordable Care Act, the financing of health care has once again assumed center stage in the American political agenda. And well it should – strapped by an accelerating national debt and the resultant devaluation of American bonds (and with it financial and political credibility), rising health care costs, and a mandate for increased rather than decreased entitlement, the lawmakers and the nation are severely divided and perhaps confused regarding what can be done to successfully emerge from this morass. As with any issue of vital importance in which there are fundamental philosophical and practical differences, the politicians are likely to have a field day with the topic, especially in an election year – great fodder for the media, but low yield for meaningful solutions.

 

Falling somewhat remarkably if not regrettably under the radar during all the media hype at the Supreme Court was a recent report from the National Health and Nutrition Examination Survey (NHANES) – just 2% of Americans meet all seven of the American Heart Association criteria for cardiovascular health. 2%!! I suppose we should be pleased – previous studies found only 1%. Progress indeed!

 

Let’s think about this for a moment. Despite remarkable medical advances and a progressive and significant reduction in mortality rate over the past twenty-five years, cardiovascular disease remains the leading killer of men and women in the United States, the developed world, and increasingly throughout the entire world. Perhaps the cynic might note that once people die, they no longer create health care expenses. The reality is quite the opposite. Congestive heart failure alone accounts for nearly $39 billion annually – the price of rescuing people from otherwise fatal heart attacks, or managing the end-stage of inadequately treated hypertension. With a rapidly growing population of elderly, these expenses can only reasonably be expected to accelerate.

 

So what are the seven AHA criteria for heart health? Esoteric and unattainable goals? Hardly. Stop smoking. Body mass index (BMI) within the normal range. Healthy diet. Regular exercise. Control of blood pressure, glucose and cholesterol. All are both readily understandable, measurable, and attainable – with no new drugs or devices, no startling scientific discoveries, no vast legislative disruptions.

 

If these goals were only to reduce the burden of cardiovascular disease, that would be more than sufficient reason to embrace them. However, recent reports from the American Cancer Society emphasize that, aside from smoking’s well-known association with multiple malignancies, obesity seems to contribute to the growth of several cancers as well. Cancer – the number two killer of Americans. Prevent cardiovascular disease and cancer, and you drop your death rate by 50%. There is no strategy in the forums of health care policy with anything close in potential to drop expenses (not to mention health improvement) so dramatically.

 

So what’s the impediment? Why aren’t the politicians delivering fiery diatribes about health prevention? Yes, they pay it lip service. But the reality is, there is only so much they can do. This is not a problem of governance; this is a problem of individual will. Perhaps there is much room for improved leadership and inspiration in this area. However, in the final analysis, regardless of how vigilant the physician, how facilitating the government, nor how impressive the public service messages, the ultimate decision rests with individual choice. The choices each one of us make regarding the selection and quantities of the food we put into our bodies, the physical activities in which we engage (or don’t engage), the cigarettes we choose (or not) to smoke, and the resultant vigilance with which we manage our blood pressure, our glucose and our cholesterol, are all decisions which we make every day. Organizations such as the Florida Heart Research Institute, with its long commitment to public awareness through cardiovascular risk screening and education, can certainly help. However, it is the decisions that we as individuals make that will largely determine our health as a nation. Abdication of this personal responsibility leaves the politicians with little choice but to argue over which finger is best to place in the dike.