Live After Quit

The Government Throws Money at Heart Disease, but Prevention Is Better than Cure

You’re more likely to die of heart disease than anything else, partly because, well, if nothing else gets you, your heart will give out. And a heart attack could cost you upwards of $760,000 these days, when you consider hospital charges, prescription drugs, additional care for the rest of your life, and then indirect costs like loss of time at work.

Up to 80 percent of premature heart disease can be prevented simply by the adoption of a healthy diet, regular exercise, and avoiding tobacco. In 1999, The Lyon Heart Study demonstrated that a change of diet could lead to 70 percent less heart disease—about three times the reduction in risk achieved with statins—and a 45 percent reduction in death rate.

But the state keeps throwing vast quantities of public funds at statins, despite years of mounting evidence that they do not reduce all-cause mortality in patients who have not had a heart attack already. As for stents and coronary bypass surgery, prevention is better than cure.

A major problem with the government colonization of healthcare is that, while people certainly don’t like the government telling them to put down the corn chips or get off the sofa for a run around the block, they sure like free treatment. Once the “right to be treated” becomes the accepted norm, paying for preventable diseases makes sense, and then becomes an approach backed by a coalition of medical lobbyists and willing patients.

There is a prevailing cultural view that people are not capable or willing to make lifestyle changes or take better care of their health, and it certainly suits the medical industry for people to believe this as it allows them to sell endless numbers of statins, stents, and perform costly operations like bypass surgery. But we have some case studies proving that, with the right support, people can take better care of themselves.

In Ribera, New Mexico, a private company was licensed to deliver the government-provided healthcare. To keep costs down (and turn a profit), it provided lots of active, preventative care to keep people away from hospitals.

For example, the hospital took note of who would come in with chronic bronchitis in the winter, and then contacted them the following October offering them a visit. If they were suffering from poor health, they were given preventative treatment making them less likely to end up in the hospital later, saving money and a traumatic trip to the emergency department on a cold winter night. They also monitored people with known heart conditions to offer early treatment and consequently managed to admit a staggering half as many heart attacks as in the past.

In 1995, Duke University Medical Center instituted a program to prevent congestive heart failure, which was the most common diagnosis leading to hospitalization among the elderly. Nurses would call heart failure patients at home to check on their breathing and make sure they were taking the right medication properly. Nutritionists helped patients improve their diets. Doctors shared information about them and came up with new ways to improve care. The number of hospital admissions for congestive heart failure at Duke declined, and patients who were admitted spent less time at the hospital, bringing the costs down for insurers by 37 percent.

One would think with such astonishing results to boast, programs like these would have become commonplace in the two and a half decades since. But they haven’t. And under the current system they likely won’t because Duke lost money as a consequence of the program.

In a free market there would be a huge incentive for companies to find innovative ways to prevent the $760,000 waste on a preventable heart attack and to help people realize the benefits of greater health. People love being fit. They love being able to run around with their kids on their back without getting out of breath and being able to roll around with their partners without getting exhausted.

But so long as government funds continue to prop up the “firefighting” model of healthcare, where we wait until people get really sick and then treat them with expensive drugs and surgery, we are unlikely to see the emergence of many “fire prevention” programs.