Bill Frist on Chronic Disease

My former boss, Bill Frist, has a very interesting piece in today’s Miami Herald. A quote:

Chronic diseases, such as diabetes, emphysema, high blood pressure, heart disease and stroke, cause more than 60 percent of deaths around the country and almost 70 percent in Florida. Not surprisingly, they consume more than 70 percent of our healthcare budget.

America’s failure to focus on them has become a scandal. We have the best doctors in the world and spend the most on medicine. But Americans live shorter lives and have worse health than residents of other wealthy countries.

Frist and his co-author Dan Crippen (a former CBO head) could have gone even further. Although chronic disease is a more important issue than the access issues that Democrats tend to complain about or the cost issues that distract most conservatives, even it’s only part of the story. The real problem is this: the U.S. spends more on health care than anyone else and can’t claim to have the best health care system in the world by any standard. It’s quite possible we should spend even more on health care–it’s not necessarily wasteful–but if we do, we should do what we can to make sure that we live even longer, better, healthier lives. Although you wouldn’t know it from reading the mainstream media, we have plenty of people concerned about costs–insurance companies, employers, and some politicians–and just as many worried about access.

But our health care system has almost nobody looking into quality and efficacy of the money we spend. Even government run-systems do this better than ours: plenty of opponents of universal coverage point out, correctly, that the UK’s National Health Service refuses all coverage of back surgery. This sounds awful until one realizes that America spends billions on back surgery and, while operations help some people, they are just as likely to hurt people as they are to help. People should obviously be able to pay for them themselves but, until we know they work, I find it difficult to believe that any government-run program should cover back surgery or that the government should mandate that any private insurer do the same.

Nobody, to date, has really figured out a way to get private citizens really concerned about this. Switzerland’s system–which has a larger private sector component than the U.S.’s–seems the closest. But it’s still far from perfect–or truly market oriented.