Marc Joseph Nutrition - Blog

Several recent articles drive home two key trends that are unlikely to change direction any time soon:

1. Health care costs continue to spiral upward.
2. More of these costs are being borne by individuals (you).

Runaway Costs

The first article (Health Care as if Costs Didn’t Matter) in the NY Times, highlights the large differences in care depending on geographic location.

In Idaho Falls, Idaho, anyone suffering from the sort of lower back pain that may conceivably be helped by the fusing of two vertebrae is quite likely to have the surgery. It’s known as lumbar fusion, and the rate at which it is performed in Idaho Falls is almost five times the national average. The rate in Idaho Falls is 20 times that in Bangor, Me., where lumbar fusion is less common than anywhere else …

… But it’s not clear that their patients are any better off. The evidence for lumbar fusion is incredibly mixed. It seems to help people with certain kinds of pain, but many others recover just as well without the surgery. Of course, doctors are almost always better off if the surgery is done: The typical hospital bill for lumbar fusion is roughly $50,000.

This is about as good an example as you can find of the health care mess. The number of lumbar fusions performed in this country has more than tripled since the early 1990s, and Medicare now spends more than $600 million a year on the procedure. It’s one reason your health insurance bill has gone up.

The article’s author notes that the call for universal health care may be a good idea, but that without dealing with the key cost driver (increasing usage of the system, especially expensive procedures), such an approach will be infeasible.

If we are really at the start of a once-in-a-generation push to fix health care, we need to be clear about the true problem. The main reason so many people lack health insurance is because of its cost. And a big reason for that cost is the explosion of expensive, medically questionable care, be it knee replacement, preventive angioplasty or lumbar fusion. The route to an affordable health insurance solution runs straight through this thicket.

Several individuals, including politicians on both the left and right and even the head of the Congressional Budget Office, have suggested that a cost-effectiveness institute needs to be established to figure out which kind of health care services really work.

(more…)

Fidelity Investments just put out a report showing that a 65-year old couple retiring in 2007, with no employer sponsored coverage and a life expectancy of 85 years (women) and 82 years (men), will need $215,000 to cover health care expenses over the rest of their lives. That’s up 7 percent from last year.

The primary reasons cited for the cost increase are familiar ones:

• Demographics - more older people living longer
• Greater use of expensive medical technologies and drugs

The breakdown of the $215,000 estimate is:

• 32% for Medicare coverage premiums for expenses from doctors’ visits, outpatient hospital care and prescription drugs
• 35% for cost-sharing provisions of Medicare, including co-payments and deductibles
• 33% for out-of-pocket prescription drug costs

And, the estimate doesn’t even include:

• Over-the-counter (OTC) drugs
• Dental services
• And most importantly, long-term care

Fidelity forecasts that 50% of pre-tax Social Security benefits will be consumed by health care costs within the next 16 to 18 years.

Not Retiring Anytime Soon?

Remember, that $215,000 estimate for health care costs in retirement is for a couple retiring in 2007. At a 7% annual rate of increase, that estimate will double to over $425,000 ten years from now.

If you haven’t yet seen the 60 Minutes piece linked in this post discussing Medicare and the financial future of this country:

Why Everyone - Both Young and Old - Should Care Now About the Big Changes Coming to Medicare

it’s definitely worth checking out. There is no bigger domestic issue facing us (and most industrialized countries).

Good nutrition is the key to staying healthy and avoiding the expensive chronic conditions that account for the vast majority of health care costs. Fortunately, it’s a factor you can control. Those people who take preventive action now will definitely be in better shape, both physically and financially, as the changes in the health care system unfold.

(Image: Sheffield Estate Planning)

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Discover How Nutrition Can Make a Difference in Your Life …

Marc Joseph Nutrition

If this excellent 60 Minutes segment (Under the Influence) discussing the shenanigans surrounding the passage of the Medicare prescription drug bill doesn’t make your blood boil, check for a pulse:

If you have ever wondered why the cost of prescription drugs in the United States are the highest in the world or why it’s illegal to import cheaper drugs from Canada or Mexico, you need look no further than the pharmaceutical lobby and its influence in Washington, D.C.

According to a new report by the Center for Public Integrity, congressmen are outnumbered two to one by lobbyists for an industry that spends roughly a $100 million a year in campaign contributions and lobbying expenses to protect its profits.

One reason those profits have exceeded Wall Street expectations is the Medicare prescription drug bill. It was passed three-and-a-half years ago, but as 60 Minutes correspondent Steve Kroft reports, its effects are still reverberating through the halls of Congress, providing a window into how the lobby works.

Watch the entire video.

The only thing wrong with the segment is that it came out three-and-a-half years after the bill was passed.

Realize that this single piece of legislation added $8 trillion to America’s future financial obligations. That’s more than all the money borrowed by the United States since it was founded 230 years ago. It’s like a gigantic credit card charge put on the backs of future generations.

Financially irresponsible? Clearly. Immoral? One could certainly make that case.

If you’re not aware of the upcoming Medicare crisis and what it may mean for you, check out this earlier post:

Why Everyone - Both Young and Old - Should Care Now About the Big Changes Coming to Medicare

One thing’s for certain: The people who take preventive steps now (e.g., through nutrition and lifestyle changes) are going to be much better positioned both financially and health-wise as the health care system changes.

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Discover How Nutrition Can Make a Difference in Your Life …

Marc Joseph Nutrition

Couple of new studies out that highlight what many likely intuitively know: Many Americans want to eat better and be more healthy, but they want it to be easier and more convenient to do so.

ACNielsen - LifeChoices

NPD Group - Eating Patterns in America

The AC Nielsen study notes that most people (82%) acknowledge that the responsibility for weight gain lies with the individual. And yet, despite the fact that approximately 6 out of 10 people perceive as effective some of the important steps they can take to control weight, such as:

• Reducing frequency of eating junk food
• Taking up a sport, hobby, or exercise program
• Substituting water for sugary drinks
• Reducing meal sizes
• Increasing exercise intensity or amount of exercise

even smaller percentages of people actually take action.

(The fact that approximately 4 out of 10 people don’t perceive the steps above as potentially helpful is a separate, slightly scary issue. But let’s focus on the other 6 out of 10 first.)

For example, 65% of people perceive reducing junk food consumption as effective in losing weight. Yet, only 64% of those people have actually tried that. And what’s really interesting is that 86% of those who tried it found it to be effective.

Likewise, 62% of people thought taking up a sport or exercise program would be effective, but only 32% of them actually tried it. Of those who tried it, 88% found it to be effective!

Easier, But Better?

Clearly, something is holding people back. And that ‘thing’ seems to be convenience. When asked why consumers don’t follow through on healthy lifestyle changes, the top three responses were lack of exercise (29%), easy availability of junk food (19%), and the ease of modern life (18%).

According to the NPD study,

“The driving force in our eating habits has always been convenience. The only surprise is how that will manifest in our behavior.”

For example: The top 5 reasons people chose a dish for dinner

1. Required little effort or easy to make = 53%
2. Took little/no planning = 50%
3. Made with foods that are on-hand = 39%
4. Everyone would like = 35%
5. Easily cleaned up = 34%

It’s true a healthy lifestyle can require more effort. Exercise take time. Healthy food alternatives aren’t always easily available, especially when eating out. Nor are fresh foods as quick and easy to prepare as packaged foods.

Life is busy for many Americans. It’s often just easier to go for the convenient alternatives.

Yet, the health of many Americans continues to decline, in large part because of their own dietary and lifestyle choices. My guess is that behavior changes won’t really take hold until the health care costs resulting from these dietary and lifestyle choices are more directly borne by the individuals making the decisions. That’s certainly beginning to happen today and will only accelerate going forward as the health care system changes. It’s a topic that we’ll revisit often.

As discussed in this article, there has been some recent research that suggests drug-coated heart stents may increase the risk of blood clots. Sales of drug-coated stents have fallen over the last year, and there is now more scrutiny on the use of stents in general.

Currently more than 1.5 million stents are placed in procedures every year in the U.S. Manufacturers of the stents pull in more than $6 billion and many times that is spent on the medical care for the procedures. It’s big business.

Some of these procedures are definitely necessary and save lives. As the article notes, though, the improvement in long-term survival rates using stents relative to other forms of treatment is less clear.

Yet, the prevailing attitude among some patients (and even some doctors) seems to be, “Well, if a problem develops, we can just fix it. It’s covered by insurance.”

“I see it all the time,” said Dr. Sanjay Kaul, a co-author of the recent Cardiosource editorial. He said his cardiology practice at Cedars Sinai Medical Center in Los Angeles included many “high-powered executives” who did not want to be bothered with taking pills to manage attacks of angina, the chest pains associated with narrowing coronary arteries.

Dr. Kaul said the overuse of stenting reflected a quick-fix mentality among patients and the financial incentives of doctors and hospitals to implant stents instead of prescribing drugs.

But stent advocates like Dr. Holland said patients demanded the stents because they provided more complete relief from pain, and because they wanted to avoid the potential side effects of the cocktails of heart drugs, which can include fatigue, sexual dysfunction, depression and light-headedness.

Dr. Holland says a typical patient profile might be a 55-year-old engineer at one of Boulder’s high-technology companies who is an avid outdoorsman and cyclist but hobbled by chest pains. To offer such a person drug therapy instead of the quick and more reliable relief of a stent, Dr. Holland said, “just doesn’t fly.”

And people wonder why health care costs so much? We all end up paying for the focus on the quick-fix, whether a pill or a procedure, in the form of higher drug, medical, and insurance costs.

Obviously, people with well-developed heart disease may need drugs and/or surgery to stabilize their situations. But, how many of these drastic interventions could have been prevented in the first place?

It’s no mystery why most people develop heart disease — a combination of poor diet and little exercise. There are good nutritional alternatives, without the medical and financial side effects of drugs and surgery, for people looking to avoid the development of and slow the progression of heart disease. For the sake of both health care and the health of individuals, the focus has to shift from repair/recovery to health promotion and disease prevention.

A recent University of Michigan study projected the cost of strokes in the U.S. to be $2.2 trillion over the next 45 years. The study factored in everything from hospital care to medications to home health care.

And that’s a conservative estimate, as it’s based on the current rates of primary risk factors such as diabetes, heart disease , obesity, and high blood pressure. With rates of obesity and Type 2 diabetes rapidly increasing in younger populations, the eventual costs could be much greater.

Fortunately, these risk factor conditions are largely preventable, with nutrition playing a significant role.

A recent Commonwealth Fund study shows that the challenges and concerns of high health care costs are extending into the upper middle class, too:

Forty-eight percent of individuals in families earnings between $35,000 and $49,999 said they had either a somewhat serious or very serious problem paying their medical bills in the last two years, according to a study by The Commonwealth Fund. Meanwhile, 50 percent of adults in that income bracket said they had difficulties affording their health insurance.

Meanwhile, 33 percent of individual in families earning between $50,000 and $74,999 a year said they had trouble paying for medical bills while 21 percent of people in families earning $75,000 or more reported such a dilemma. Fifty percent of individuals in families earnings less than $35,000 annually reported such a problem.

Thirty-five percent of people in families with an annual income of between $50,000 to $74,999 reported they had trouble paying for health insurance while 23 percent of those in families earning $75,000 or more said the same. Forty-eight percent of those in families with incomes of less than $35,000 said they the premium cost represented a problem.

Unfortunately, the system likely won’t be changing for the better any time soon. The need for better preventive care and avoiding the need to use health care services in the first place is greater than ever. Nutrition plays a central role in helping to do that.

A recent survey of Fortune 500 companies found that many companies are reducing retiree health plan coverage and nearly 1 in 7 plan on eliminating retiree coverage entirely.

Even more telling is the study finding that, “About 40 percent of employers said they believed the best way to solve their retiree health cost problem is to exit it altogether…”

The article also mentions a recent Kaiser Family Foundation study that notes only one-third of employers in 2005 offered health retiree benefits versus two-thirds in 1988.

Clearly, the responsibility for health care is being shifted from employers to individuals. This trend means it is more important than ever for individuals to take steps to help prevent the onset of costly chronic diseases.

A sound nutrition program and avoiding environmental toxins are essential parts of such a plan. Action plan overviews for many of the most common conditions associated with aging are linked off the Marc Joseph Nutrition homepage.