Dear Senator Sanders..

I have read your ideas on controlling costs in our health care system and I agree that too many executives are making too much money while patients often have to chose between a treatment and putting food on the table. However sir, even if by some magical spell all prescription drugs were free, the cost of health care would still be rising and a lot of it is the direct result of American lifestyles.

According to the CDC:

Health risk behaviors are unhealthy behaviors you can change. Four of these health risk behaviors — lack of exercise or physical activity, poor nutrition, tobacco use, and drinking too much alcohol — cause much of the illness, suffering, and early death related to chronic diseases and conditions.

  • In 2015, 50% of adults aged 18 years or older did not meet recommendations for aerobic physical activity. In addition, 79% did not meet recommendations for both aerobic and muscle-strengthening physical activity.
  • More than 1 in 3 adults (about 92.1 million) have at least one type of cardiovascular disease.8 About 90% of Americans aged 2 years or older consume too much sodium, which can increase their risk of high blood pressure.
  • In 2015, more than 37% of adolescents and 40% of adults said they ate fruit less than once a day, while 39% of adolescents and 22% of adults said they ate vegetables less than once a day.
  • An estimated 36.5 million adults in the United States (15.1%) said they currently smoked cigarettes in 2015.11 Cigarette smoking accounts for more than 480,000 deaths each year.12 Each day, more than 3,200 youth younger than 18 years smoke their first cigarette, and another 2,100 youth and young adults who smoke every now and then become daily smokers.
  • Drinking too much alcohol is responsible for 88,000 deaths each year, more than half of which are due to binge drinking.13,14 US adults report binge drinking an average of 4 times a month, and have an average of 8 drinks per binge, yet most binge drinkers are not alcohol dependent.

In the United States, chronic diseases and conditions and the health risk behaviors that cause them account for most health care costs.

  • Eighty-six percent of the nation’s $2.7 trillion annual health care expenditures are for people with chronic and mental health conditions. These costs can be reduced.
  • Total annual cardiovascular disease costs to the nation averaged $316.1 billion in 2012–2013. Of this amount, $189.7 billion was for direct medical expenses and $126.4 billion was for lost productivity costs (from premature death).
  • Cancer care cost $157 billion in 2010 dollars.19
  • The total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity. Decreased productivity includes costs associated with people being absent from work, being less productive while at work, or not being able to work at all because of diabetes.20
  • The total cost of arthritis and related conditions was about $128 billion in 2003. Of this amount, nearly $81 billion was for direct medical costs and $47 billion was for indirect costs associated with lost earnings.21
  • Medical costs linked to obesity were estimated to be $147 billion in 2008. Annual medical costs for people who were obese were $1,429 higher than those for people of normal weight in 2006.22
  • For the years 2009–2012, economic cost due to smoking is estimated to be at least $300 billion a year . This cost includes nearly $170 billion in direct medical care for adults and more than $156 billion for lost productivity from premature death estimated from 2005 through 2009.12
  • The economic costs of drinking too much alcohol were estimated to be $249 billion , or $2.05 a drink, in 2010. Most of these costs were due to binge drinking and resulted from losses in workplace productivity, health care expenses, and crimes related to excessive drinking.23

It is also estimated that over 300,000 cases of cancer are preventable with proper diet and lifestyle modifications.

In short sir, we Americans have to do more to help control health costs than blame insurance and pharma companies . When we, as a nation, understood the dangers of smoking we took action and reduced smoking rates dramatically. The same type of effort needs to be taken to tackle preventable health problems like obesity. It requires the coordination of the government, the AMA, insurers and pharma companies to raise awareness around the dangers of sugar and lack of exercise.

Employers need and should provide employees with access to local health clubs and sponsor health related employee activities like bike rides at lunch. We also need to put pressure on the fast food industry to develop and market healthier meals.

Finally pharma companies HAVE to find a way to get life saving medications to patients who can’t afford them. Someone making $70,000 a year should not have to wipe out their life savings for cancer treatments.

In summary, there is a lot we can and need to do, but it’s going to take leadership void of special interests. I love working in the industry because I take an empathetic approach to helping patients and caregivers find help in the maze we call health care. I don’t work for the money, but rather for the thought that I can lend a helping hand. We need more people with the same beliefs.

Originally published at on September 14, 2017.



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