Bob Nease is chief scientist for a company called Express Scripts, which manages health benefits for more than 50 million people. He believes the key to reducing health care costs is changing the way Americans think and act.
Nease cited an experiment that the National Institutes of Health conducted for an article that appeared in USA Today last weekend.
The agency conducted a study of 3,234 people described as pre-diabetic. They had a family history of diabetes, or lived a sedentary life or were overweight.
A third of the studied group went through a behavior modification program with exercise training and life coaches — at a cost of $2,780 each. About 58 percent of those patients avoided full-blown diabetes.
About one in four Americans older than 20 were considered pre-diabetic in 2007. Francis Collins, director of the NIH, said the cost of treating diabetics last year was about $299 billion and observed that it would be far cheaper to provide behavior modification training for millions of pre-diabetics than to continue to spend billions treating victims of the disease.
A second experiment show-ed that behavior modification can reduce complications of the disease by 90 percent if fortified with daily phone calls urging patients to continue the behavior changes taught — but also discovered that the patients went back to destructive behavior when the phone calls stopped.
Nease and others who have studied the importance of behavior modification conclude that it may be more important that employers provide wellness programs such as gym memberships or smoking-cessation classes than to provide more money for health insurance. They also believe that social support will be necessary for behaviors to change.
“We made smoking socially unacceptable,” Nease said. “We’ve done the exact opposite with being over-weight.”
AS IMPORTANT as lifestyle is to personal health, it is unrealistic to conclude that the nation should embark on a massive program of behavior modification with health care cost reduction as the goal.
The fact that tobacco use continues to kill about 400,000 Americans a year and remains the primary avoidable cause of death 50 years after the surgeon general’s report should be all the proof needed that society’s ability to change personal behavior without the use of force is sharply limited. An estimated 25 percent of the U.S. adult population still smokes or chews tobacco.
The way to control health care costs is to deliver health care through systems that set prices and allocate resources. Every other wealthy nation on earth follows that path and spends far less on health care than the U.S. does. Most of those nations provide good care for all of their citizens, while the U.S. continues to leave about 17 percent of its population uninsured. Many of those nations have better health care outcomes than we do.
The fact is that the current emphasis on individual life-styles in the health care cost debate is an ego-stroking way to avoid the nut of the problem; it’s a cop-out, to be blunt about it.
— Emerson Lynn, jr.
