Monday, January 2, 2017

Healthy Eating-Living Leads To Massive Medical Costs Later

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"Screw healthy eatin'! I gonna have my wings, pizza and beer to save the country trillions!"

The article in PARADE magazine Sunday (p. 6) presented a dietician's prescription for the foods to eat in 2017 under the header: 'What to Eat in 2017'.   The foods consist mainly of "rabbit food" (e.g. beets, chick peas, lentils, maca) that my primary care doc has been trying to get me to eat for the past five years. She, of course, is barely 100 pounds and is a vegan by nature. Ditto with my sister-in-law Krimhilde who conducted her healthy living crusade for many years, even criticizing me once for eating a foot long Subway Italian BMT.  Now, alas, "K" is battling medical bills and the early stages of Alzheimer's disease.  But physically she is still a picture of health.

Is healthy eating-living really all it's cracked up to be, or a lot of oversold hype pushed on us by assorted healthy living scolds?

According to a recent study published in the Journal of the American Medical Association, the country spent $3.2 trillion last year on health care. Within a decade it estimated - as things are going now - a full one fifth of the U.S. economy will consist of medical care. In an earlier post (July 26) I cited my own efforts to try to control soaring medical costs to do with my prostate cancer - now estimated at over $65,000. Fortunately, Medicare and Medicare supplemental insurance has covered most of the costs. If I had been reduced to being on a Paul Ryan Medicare voucher program I'd have long since had to declare bankruptcy.

Other costs since then have continued to mount, including for x-rays, bone scans, genetic marker tests, and a scheduled 3D staging -mapping biopsy, as well as focal cryotherapy to treat cancer recurrence.  Despite my best ambitions to control the spiraling health care costs,  my medical providers and wife have made it clear I can't just allow the cancer to progress  What caused this cancer? Who knows? Some might be tempted to blame my heavy meat diet, but I am more inclined to lay blame on the hundreds of toxic chemicals in the environment.

In any case, what if it was my  meat diet?  Are those like me really responsible for driving up health care costs, OR is it more the health zealots with their lentil and avocado "smoothies" each day who add 25 -30 years to their lives and end up adding monstrous medical costs over a longer time?

According to a paper ( Death and Taxes: Why Longer Lives Cost  Money)  produced by the UK Institute of Economic Affairs:

"Despite the costs associated with the ageing population, it is sometimes claimed that people who are at risk of premature mortality due to lifestyle factors are a ‘drain on the taxpayer’. Smokers, drinkers and the obese, in particular, are blamed for rising costs to the general taxpayer.

These claims do not stand up against evidence. If one looks at the lifetime costs to all public services, it is clear that the ‘longevity-related’ costs of healthier people are considerably higher than the ‘lifestyle-related’ costs of less healthy people. Acute healthcare costs are usually higher, long-term healthcare costs are invariably higher, and welfare costs (eg. pensions) are vastly higher

The IEA paper goes on to elaborate:

:"In recent decades, healthier lifestyles and longer lifespans have been associated with a rise in the number of years spent in poor health. There has been a rise in the number of people suffering from chronic and non-fatal conditions which are often expensive to treat and manage. Medical science and healthier living do not eradicate the costs of disability and disease, they merely postpone them and pave the way for more expensive non-fatal conditions amongst very old people."

Whether one wishes to admit it or not, therefore, practicing healthy living or eating habits could merely be postponing massive, exploding medical costs until later as the IEA paper suggests.

But let's not bandy words, I can cite examples from my own extended family,  apart from Krimhilde. Janice's cousin Desmond, for example, hardly ever touched animal fats over this life - no bacon, no burgers, no steaks  None of that. He also didn't smoke and drank only on rare (celebratory) occasions.. He was the full embodiment of the healthy low BMI 80 -year old male-  until he got Alzheimer's at the age of 83 and went downhill from there. Having to be kept in a special nursing facility with astounding expenses paid for by his family estate.  See e.g.:

As the IEA document puts it:

"Long-term healthcare and nursing home costs are strongly associated with age and cannot be driven down by healthier lifestyles. Pensions and social care costs dwarf the healthcare costs associated with ageing and are intractable in an ageing society. These costs cannot be mitigated by policies that encourage healthy lifestyles. On the contrary, healthy lifestyles directly lead to higher costs by increasing the size and age of the retired cohort.

There is strong and consistent evidence that smokers incur less public expenditure than non-smokers. People who do not smoke have lower annual healthcare costs but higher lifetime costs due their longer lifespans.

Would it not have been better in retrospect for Desmond to have gorged on animal fats, smokes etc. to spare him the indignity of his later decline as well as expenses that nearly bankrupted his family?   You tell me.  Denver Post columnist Teresa Keegan certainly cut through the crap in a recent piece ('A Message to the Healthy Living Scolds: We All Die Someday'). She acerbically noted that while the health scolds target the food choices of the less well off, such as "cheap booze, fries, quarter pounders and cigarettes" they say nary a word regarding the vices of the one percent, e.g. "fine wines. Chateaubriand, Brie, and fat cigars".  Adding "these are considered somehow less harmful to one's health than burgers and fries".  Implying that too many of us are conditioned to class preferences and the higher the class (or income level) the easier it is to forgive the vices.

Keegan's point (and mine) is that life has to be about more than having a stringbean body BMI,  and triglyceridies lower than room temperature!  What is better? Living to 90 with low triglycerides and a BMI of 22, but getting Alzheimer's, or living only to 63 or 65 and croaking from a heart attack - sparing one's loved ones years of care and impossible bills? Nasty question, I know, but therein is the key to rising medical costs - in fact exploding costs. And the fact is that those who croak earlier spend less overall on medical procedures than those who eat healthy and postpone their health issues until 88 or 90.

As Ms. Keegan puts it:

"Anyone who thinks it's an absolutely fabulous idea to live to an advanced old age needs to pay a visit to a nursing home and talk with residents about the joys of arthritis, incontinence, macular degeneration and Alzheimer's"

Most of these nursing home elderly were like Desmond and Krimhilde, firmly swearing off "bad" foods, habits for a virtuous lifestyle, only to finding themselves in worse predicaments later, and at much more cost.  Again, no one disputes there are diseases that drive a lot of health care spending - and many are tied (at least using correlations) to "bad lifestyle choice". On the other hand, as Teresa Keegan notes, "okay you extend your life into the eighties, then what?"  Well, from the IEA study, a lot more expense merely because of all those added years - plus, diseases (like Alzheimer's) which by their very nature extract vastly more care costs, attention.

The IEA paper concludes:

"Long term planning of public finances should not be based on the fantasy that people can live longer lives without incurring additional costs, nor can it be based on the delusion that healthcare costs will fall if unhealthy lifestyles are stamped out. The reality is that it is healthy, not unhealthy, lifestyles that have driven up costs and they will continue to do so. It makes no sense to blame escalating public sector budgets on people whose lifestyle choices tend to be cost-saving."

Of course, no one - certainly not me - is advocating deliberate, dedicated consumption of high fatty foods, like the constant diet of Kentucky Fried Chicken that ultimately did in former child star Tommy Rettig  at the age of 54.  What we are saying is that one ought to be able to enjoy his food, even if those choices lean to burgers, the occasional steak and hot dogs, without being made to feel like a health spending criminal.  The reason is that it is actually the healthy eating zealots whose longer lives add the bulk of medical costs over time.  Maybe, indeed, we should strive more for a balanced quality of life - which includes eating what we wish up to a point - than emulating an abstemious monk who reaches 90 years of age, but wears Depends every waking minute- if he can recall where he stores them.

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