big, big health bills down the road

The other shoe dropped today. The first one dropped a couple of weeks ago when the Journal of the National Cancer Institute (JNCI) published: “Cancer Care Costs in the United States: 2010–2020.”
The estimated total cost of cancer care in the United States in 2020 is expected to be $158 billion assuming the most recent observed patterns of incidence, survival, and cost remain the same. This represents a 27% increase from 2010 due only to the projected aging and growth of the US population, according to a study published online January 12th in The Journal of the National Cancer Institute. However, the authors also note the cost of cancer care could rise even more quickly under some reasonable assumptions such as a 2% annual increase in costs of the initial and final phases of cancer care. […] Under a different scenario of continuing trends in cancer incidence, survival, and costs of care, the total cost of cancer care in 2020 is expected to be $173 billion, an even larger increase (39% from 2010).
That was shoe #1. Shoe #2 slammed to the floor when I read on physorg.com today: “Cost to treat heart disease in United States will triple by 2030.”
“Despite the successes in reducing and treating heart disease over the last half century, even if we just maintain our current rates, we will have an enormous financial burden on top of the disease itself,” said Paul Heidenreich, M.D., chair of the American Heart Association expert panel issuing the statement. […] Between 2010-30, the cost of medical care for heart disease (in 2008 dollar values) will rise from $273 billion to $818 billion, the authors predicted. “We were all surprised at the remarkable increase in costs that are expected in the next two decades,” Heidenreich said. “We need to continue to invest resources in the prevention of disease, the treatment of risk factors and early treatment of existing disease to reduce that burden.”
And, heck, there are more shoes to come. Some projections show Alzheimer’s disease increasing by 40% just between 2000 and 2025. The cost in dollars and in stress of that disease is huge. Just to round things out, an article in USA Today a couple of weeks ago put a big price-tag on obesity:

The total economic cost of overweight and obesity in the United States is $270 billion per year while the cost in Canada is about $30 billion a year, a new study shows. […] The $300 billion total cost in the United States and Canada is the result of: increased need for medical care ($127 billion); loss of worker productivity due to higher rates of death ($49 billion); loss of productivity due to disability of active workers ($43 billion); and loss of productivity due to total disability ($72 billion), said the Society of Actuaries (SOA).

That’s not even counting the long-term cost of obesity on the upcoming generation. A Stanford Medical Center publication lists among the effects of obesity: high blood pressure, diabetes, heart disease, joint problems, cancer, sleep apnea, metabolic syndrome, psychological problems…among other things. Some project that the current generation my be the first in US history to actually live shorter lives, on average, than their parents.
I worked 40 years in public health, 35 of them in a cancer organization. Never in my career did I hear a serious discussion of the economics of cancer, the aggregate cost of research and treatment, nor what, if any, unintended consequences might result in the bigger picture of healthcare in society. No one raised the question of whether surviving one disease just make people candidates for other problems just as dire. In the cancer community the goal these days is not to get rid of the disease entirely — a goal that it took a long time to realize isn’t feasible in the foreseeable future — but to make cancer a disease that no one dies from. So the result will be that cancer “survivors” will be shifted over to die eventually of something else: heart disease, maybe, or Alzheimer’s. Just as long as death isn’t from cancer, it’s a victory…of sorts.
My point is not that relieving the burdens of disease is an unworthy goal. But during the 20th century medicine fragmented into dozens of specialized professions, advocacy groups, and agencies, all pushing the envelope of what they want to achieve. It’s time for all concerned to step back and determine what expectations are realistic and what the consequences are. We’re now in a huge political hassle over the cost of future health care and who’s going to pay it. The data above indicate the price will be great. It’s time for well-intended advocates to include in their mission wrestling with the real-world issue of making their ambitions feasible with finite resources.

1 Response to “big, big health bills down the road”

  1. August 3, 2019 at 2:09 am

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