Second Opinion: An Ounce of Prevention
Column
Written by Mike Sharkey   
Friday, 29 February 2008

Second Opinion - Mike Sharkey - Health Executive - RedCoat Publishing
Mike Sharkey, Managing Editor
I’ve resolved to do my part in the battle to lower the nation’s skyrocketing healthcare tab. So put some extra cheese on my Big Mac and supersize those french fries, would you please? And I can’t wait to light up that unfiltered after-dinner cigarette.

In case you missed it, a new study just turned one of the most basic premises of healthcare reform on its head. According to the Netherlands’ Institute for Public Health and the Environment, thin, healthy adults actually cost more to care for than adults who smoke or are obese.

“It was a small surprise,” lead researcher Pieter van Baal told the Associated Press, a statement that instantly became the frontrunner for the 2008 Understatement of the Year Award.

Van Baal and his colleagues took cost-of-illness data and disease prevalence in the Netherlands in 2003 and plugged it into a model simulating the lifetime health costs for three groups: thin non-smokers, obese people, and smokers. A report published in the Public Library of Science Medicine details their findings.

On average, healthy people lived 84 years, obese people 80 years, and smokers 77 years. The average cost of care for each group from 20 years old on was $417,000 for healthy people, $371,000 for the obese, and $326,000 for smokers.
The Dutch study, published on February 4th, contradicts the popular belief weight loss and smoking cessation programs will help America slash billions from its $2 trillion in annual healthcare spending. In fact, less than a week prior, on January 31st, Blue Cross and Blue Shield of Minnesota, along with the Minnesota Department of Health, claimed that it costs 15% to 20% more to care for obese patients today, and in 12 years it will be 60% higher than the cost of caring for a person with healthy weight. If something isn’t done to stem the rising obesity tide, they said, it would cost Minnesota an additional $3.7 billion a year in healthcare costs by 2020.

In report after report, agencies and experts sing the same song: obesity adds billions of dollars to the nation’s annual healthcare bill, and preventing it would produce dramatic cost savings. However, not a single one of those reports considers the long-term impact.

“Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained,” the Dutch researchers conclude. “Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.”

A lone study on the cost of smoking cessation published in the New England Journal of Medicine back in 1997 supports the Dutch researchers’ findings. That study concludes: If people stopped smoking, there would be a savings in healthcare costs, but only in the short term. Eventually, smoking cessation would lead to increased healthcare costs.

The source of that study? Drs. Bonneux and van der Maas from Erasmus University in—you guessed it—the Netherlands. Either the long lobbying arm of the tobacco industry reaches all the way to Rotterdam, or the Dutch are simply adept long-term thinkers.   

What to make of all of this? The Dutch study is certainly a sizable monkey wrench. It specifically addresses obesity and smoking, but in reality, it says much more about our efforts to reform our healthcare system. Leaders have, to this point, uniformly stated that improving the health of our citizens will dramatically reduce overall healthcare costs. If the opposite is true, and the long-term impact will be even greater costs, it’s time to go back to the drawing board—immediately. We must continue to enhance our efforts to improve the public health, but we must do so with the knowledge that an ounce of prevention is not worth a pound of cure. 
 
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