Is There Another Financial Crisis Looming?

October 21, 2008
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Will Medicare Break the Bank?

The economic crisis fills the news, and rightly so. But there is another crisis on the horizon that may dwarf the dizzying “rescue fund” figures—the funding of Medicare, as Treasury Secretary Paulson indicated over a year ago.

While the current economic downturn has eclipsed the attention on Medicare’s insolvency, the fact remains that nearly 50 cents out of every health dollar comes from government sources, according to a recent front page USA Today article. Thirty-one percent of that healthcare dollar goes to hospitals, 21% to physicians, and 10% to prescription drug spending. There is a clear possibility that government may expand that spending with a socialized system of healthcare, depending on Congressional action.

The fastest growing component of that healthcare dollar is prescription drug spending. In 1990, $40.3 billion was spent on prescription drugs. In 2006, that number had ballooned to an overwhelming $216.7 billion. But while Americans spend more for healthcare than any other industrialized nation, our actual health is far worse than that of many countries who spend much less on healthcare, according to a recent report card on healthcare performance.

Our healthcare dollars are primarily disease-care dollars. The vast majority of Medicare funding is spent  treating Medicare patients during the last twelve months of their lives. Additionally, there is great disparity when it comes to healthcare spending. Seniors over 65 comprised about 13% of the US population yet consumed 36% of our healthcare expenditures. Government figures show that in 2002, the average healthcare expense was $11,089 per year for those over 65, but only $3,352 per year for those aged 19 to 64. According to data from the top 5% of healthcare spenders, people between the ages of 65 and 79, who comprise only 9% of the population, received 29% of healthcare expenditures. Similarly, people 80 years and older (3% of the population) accounted for 14% of the expenditures.

A principal reason why healthcare spending is weighted toward seniors is that a much higher proportion of seniors have expensive chronic conditions:
• Five percent of the population accounts for almost half (49%) of total healthcare expenses.
• The fifteen most expensive health conditions account for 44% of total healthcare expenses.
• Patients with multiple chronic conditions cost up to seven times as much as patients with only one chronic condition.

A May 2005 issue of The Journal of the American Medical Association cited figures that 87% of US healthcare money is spent on chronic disease. In his book Saving Lives, Saving Money, former House Speaker Newt Gingrich indicated that one of every three dollars spent by Medicare goes to the treatment of diabetes or diabetes-related costs.

Medicare spending on diabetes alone could sink Medicare. But getting older does not have to equal getting sick. Many baby boomers are vowing to not end their lives with chronic disease. One of the fastest growing specialties in American medicine has been the study and prevention of aging. Many doctors (having a vested interest in aging well themselves!) offer science-based optimal aging medicines and treatments to their patients. In addition to the financial consequences, chronic disease and disability exacts a staggering toll on one’s quality of life.

While we can debate the administrative costs of Medicare—not to mention the corruption and wasted spending—what threatens to make Medicare insolvent by 2019 is the baby boomer generation. Baby boomers, 85 million strong, will soon become Medicare recipients themselves, and we can expect to see an explosion of chronic disease spending by Medicare, particularly on diabetes.The Centers for Disease Control and Prevention (CDC) had these frightening statistics for 2002:

• Age 20 years or older: 18.0 million; 8.7% of all people in this age group have diabetes.
• Age 60 years or older: 8.6 million; 18.3% of all people in this age group have diabetes.
• Men: 8.7 million; 8.7% of all men aged 20 years or older have diabetes.
• Women: 9.3 million; 8.7% of all women aged 20 years or older have diabetes.

By 2007, according to the American Diabetes Association (ADA), 23.6 million children and adults in the United States, or 7.8% of the population, had type II diabetes. While an estimated 17.9 million have been diagnosed with diabetes, fully 5.7 million people (or nearly one quarter) are unaware that they have the disease. Other estimates indicate that one in ten Americans will soon suffer from type II diabetes.

While diabetes is not often listed as a cause of death, the complications of diabetes for Medicare-age patients are sobering. The CDC has compiled a list of possible complications of diabetes:

Heart disease and stroke

• Heart disease is the leading cause of diabetes-related deaths. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
• The risk for stroke is 2 to 4 times higher among people with diabetes.
• About 65% of deaths among people with diabetes are due to heart disease and stroke.

High blood pressure

• About 73% of adults with diabetes have blood pressure greater than or equal to 130/80 mm Hg or use prescription medications for hypertension.

Blindness

• Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years.
• Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

Kidney disease

• Diabetes is the leading cause of end-stage renal disease, accounting for 44%  of new cases.
• In 2001, 42,813 people with diabetes began treatment for end-stage renal disease.
• In 2001, a total of 142,963 people with end-stage renal disease due to diabetes were living on chronic dialysis or with a kidney transplant.

Nervous system disease

• About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems.
• Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

Amputations

• More than 60% of nontraumatic lower-limb amputations occur among people with diabetes.
• In 2000-2001, about 82,000 nontraumatic lower-limb amputations were performed annually on people with diabetes.

Dental disease

• Periodontal (gum) disease is more common among people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.
• Almost one-third of people with diabetes have severe periodontal diseases with loss of attachment of the gums to the teeth measuring 5 millimeters or more.

Complications during pregnancy

• Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies.
• Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to the mother and the child.

Other complications

• Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma.

• People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.

According to a 2002 ADA study, $92 billion was spent on direct diabetes costs, such as medical care and services, and an additional $40 billion was spent on indirect diabetes costs, such as short-term and permanent disability, work loss, and premature death. That’s a total of $132 billion on one disease alone. Medco, one of the nation’s leading pharmacy benefit managers, believes that the amount of money Americans spend on treating diabetes could jump by 70 percent by the end of 2009, due to the aging population, obesity, and more aggressive treatment.

But prescription-driven medicine has sought to lower “the blood sugar number” at all costs with drugs like Avandia—even if the drug elevates the risk of heart disease, as noted in this commentary by a physician employed by the FDA. Clearly the risk-to-benefit ratio of these diabetes drugs is now something that diabetic patients need to consider.

Integrative physicians have an enviable track record of treating type II diabetes. Their approach mirrors the research published in the 1991 issue of The New England Journal of Medicine by Dr. Walter Willett, who found that 91% of the factors that lead to the diagnosis of diabetes are related to one’s lifestyle choices. Dr. Willett summarizes much of his prolific diabetes research in this interview.

In a November 2005 presentation before the American Society of Nephrology’s annual meeting, Dr. Willett summarized the steps to prevent and reverse over 90% of all type II diabetes. His recommendations:

• eat no “bad” fats (trans fats)
• eat some good fat (omega-3 in a correct ratio to omega-6 and -9 fatty acids)
• if you eat grains, eat only whole grains
• make your diet rich in fruits and vegetables
• supplement wisely
• get regular daily activity

Interestingly, Dr. Robert Rizza of the American Diabetes Association echoes Dr. Williet’s “lifestyle prescription,” but believes that his estimation may be low—Dr. Rizza asserts that up to 95% of all type II diabetes can be prevented or reversed with tailored lifestyle changes.

This research eloquently documents what has been the integrative physician approach for decades, treat the patient’s lifestyle (with great success) rather than myopically focusing on blood sugar levels alone. Additionally, these physicians have integrated into their clinical practice the innovative research from USDA scientist Dr. Richard Anderson regarding chromium and cinnamon, insulin sensitivity, and blood sugar levels.

The work of Dr. Loren Cordain at Colorado State University has provided the scientific model underlying the integrative approach to insulin resistance and diabetes. The American lifestyle of nutrient deficient processed foods, foods laden with high fructose corn syrup, little dietary fiber, and little physical activity have set the stage for America’s epidemic of insulin resistance, a syndrome characterized by:

• carrying weight around one’s middle (being “apple shaped”)
• high cholesterol
• high blood pressure
• male pattern baldness
• adult acne
• polycystic ovarian syndrome
• fatty liver

among other symptoms. Eschewing the conventional medical model to treat each warning sign symptomatically, integrative physicians have “connected the dots” to treat the underlying cause using dietary changes, supplementation, activity recommendations, and stress management techniques. The CDC has said that there is no drug that can treat insulin resistance. Integrative medicine is uniquely positioned to address the underlying basis of this condition and resolve all of its presenting signs.

In fact, if patients were regularly treated by integrative physicians, Medicare could save billions of dollars in diabetes-related costs alone, and millions more in costs related to other chronic conditions treatable through lifestyle changes.

The Complementary and Alternative Law Blog details disciplinary actions taken against physicians solely because they used complementary and alternative medicine.

While Medicare has a looming deadline, it is time to support the efforts of AAHF to support healthcare freedom for physicians and consumers alike.

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