Any prescription for treating looming budget deficits and making America fiscally solvent will include health care cost control. Unfortunately, strategies put forth by Democrats and Republicans are not likely to deal with the underlying causes of cost increases. Both propose short-term economic fixes to what are long-term secular changes in cost drivers.
The major driver of Medicare cost increase is expenditures on chronic disease, accounting for nearly two-thirds of the increase in recent years. More individuals are living into their 70s, 80s and 90s, and this population is burdened with costly chronic conditions. Health problems from diabetes to depression are increasing, but very little is being done to address the development of these largely preventable chronic diseases.
Individual and population health follow a trajectory. Research is clearly showing that lifelong health trajectories are initiated and programmed in utero, and formulated during the early years — right through adolescence. It is not only the poorest children who are at greatest risk for lifelong health problems. Many low-income and middle-class families are squeezed by lower wages, higher costs of living and a lack of adequate education and support services that their children need to arrive at school healthy and ready to learn. Children deprived of a healthy trajectory are more likely to experience school failure, teen pregnancy, criminality and substance abuse during the second decade; obesity, elevated blood pressure and depression by the third and fourth decade; coronary artery disease, diabetes and renal disease by the fifth and sixth decades; and premature aging and memory loss in old age.
If we are going to deal with the drivers of increasing health care costs, we need to decrease the number of people with expensive chronic health conditions. The U.S. has gotten away with its pay-for-failure strategy for many years because its economy was growing steadily and funds were available for rescue programs. But this kind of policy stance condemned many children to never reaching their biological, health and educational potential.
The long-term consequence is that the U.S. will have higher dependency rates and much higher health care costs than befits our stature as a wealthy Western democracy.
As we leave the industrial era and enter a much more competitive global information-based economy, the U.S. needs more of its children to complete college. We also must bring down the health care and dependency costs caused by a growing population of adults with chronic physical and mental health conditions. Achieving both of those goals requires the same solution: optimizing health and development pathways in the early years.
The most leveraged and cost effective way to do that is to focus on the time in life when health trajectories are being formed, developed and launched. The nations we compete with have already done this or are moving in this direction. It is time we look around, review the science and move into the 21st century.
Dr. Neal Halfon is the director of the UCLA Center for Healthier Children, Families and Communities.
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