The Them Who'd Eat the Budget

Article excerpt


When two or more healthcare experts gather in Washington to talk about controlling healthcare costs, the discussion always turns to'behavior: How do we get them to take better care of themselves? Them means the rest of us, the flaany millions of Americans who are not lucky enough to be enlisted in the ranks of health policy analysts who combine eating nine helpings of fruits and vegetables daily with a regimen of aerobics and weight training.

Healthcare spending now gobbles up 16 cents of every dollar's worth of goods and services produced by the gigantic U.S. economy, a figure expected to swell to 20 cents per dollar during the next 10 years. Unless healthcare spending can be slowed, political pressures will increasingly push for taking some money away from Social security and Medicare, the twin pillars of modern social insurance in the United States. That is why slowing the course of healthcare spending becomes an important goal for anyone who wants to keep Social security and Medicare benefits solid and steady for the millions of Americans who rely on them now and for the 77 million boomers who will rely on them in years to come.

The powerful interest groups involved in health insurance companies-doctors, hospitals, the pharmaceutical industry, manufacturers of medical equipment, and so ondon't want to give up any of their revenues. The easy prescription becomes a call for changing behavior-getting people to live healthier lives so they make fewer visits to the doctor, spend less time in the hospital and swallow fewer pills. The policy optimists, however, will discover that this goal is much easier to talk about than it is to achieve.


Individuals know what to do, but most simply won't do it. Eating the right diet and exercising regularly can cut the incidence of cancer, heart attack, stroke and diabetes by 50% or more, according to Walter WUlett, chair of the nutrition department at the Harvard School of Public Health. But how many people follow this life-saving formula? When he studied adherence among nurses, a scant 3% of them met the standards of proper diet and exercise, Willett said at a recent discussion in Washington, D.C. If nurses won't do what they should to stay healthy, what chance is there for the rest of us?

Exercising and eating right are "hard to do, not easy like taking a pill," said Jeff Niederdeppe, research fellow at the University of Wisconsin, Madison, and coauthor of an important analysis discussing the first major study in 20 years about beliefs concerning cancer. Researchers interviewed more than 6,000 Americans between October 2002 and April 2003 as part of a survey by the National Cancer Institute.

Niederdeppe's article, written with Andréa Gurmankin Levy and titled "Fatalistic Be liefs About Cancer Prevention and Three Prevention Behaviors," appeared in the May issue of Cancer Epidemiology Biomarkers and Prevention. Key among the depressing results were:

* Nearly half of respondents (47. …