If the rhetoric in the 2016 political season has meaning, we can expect to hear a lot more about health care and in particular the Affordable Care Act. A new study published in the Journal of the American Medical Association sheds light on what that discussion will be about. And, while it hardly offers any easy fixes, it does suggest where we should be looking.
The first and clearest finding is that Americans spend a phenomenal amount of money on health care. In 2015 that added up to $3.2 trillion – yes, with a “T.” That is more than five times the budget for the entire Defense Department.
On its own, says a JAMA editorial, the U.S. health care system is the fifth largest economy in the world. Only the national economies of the United States, China, Japan and Germany are larger. By 2020 U.S. health care is expected to be in fourth place.
The study points out the self-evident fact that older people tend to be sicker and use more health care resources. But it also looks at what it calls a “reverse gender gap,” meaning women consume more health care throughout life, but particularly in that women typically live longer than men.
Its more interesting findings are the ones that suggest changes to the health care system. One is that the largest proportion of health care spending is for chronic conditions such as diabetes, cardiovascular disease, chronic respiratory disease and cancer – many of which can to some extent be preventable.
Another, quoting the JAMA editorial, is this: “The U.S. medical community often underemphasizes the importance, toll, and cost of behavioral health and substance abuse.”
Overall, the study seems to suggest data-driven policy changes. Few public health dollars go to preventing back and neck pain, but together those account for the third-highest health care cost. (Diabetes is No. 1.) The fifth-highest cause of health care spending is falls, followed by depression. And, of course, tobacco use leads to health care spending via several paths.
So, perhaps one way to control health care costs is to do more to prevent disease.
