Bill Clinton is staking his presidency on the promise that government management of health care will lower costs and provide security for all. It won't. Government cannot solve the crisis of rising health care costs, in part because it cannot address a primary cause of this problem, a crisis of an altogether different variety: the increase in irresponsible behavior.
In the last 30 years, we have witnessed skyrocketing increases in violent crime, illegitimate birth, child neglect and hard-core substance abuse. once rare or nonexistent sexually transmitted diseases now are widespread. These trends have a significant impact on health care costs. The American Medical Association recently estimated that the health care costs of "unhealthy habits" alone amounted to $171 billion - that is, one-fifth of our health care bill. Factoring in the costs of violence and sexual irresponsibility pushes the total even higher.
Unless our behavior changes, our health care costs will continue to explode. Consider some of the costs of contemporary social pathologies: * Substance abuse: Drug, alcohol and tobacco abuse costs society between $140 billion and $238 billion a year, a figure that excludes the costs of treatment for diseases exacerbated, but not caused, by substance abuse. In addition, an increasing percentage of substance abuse costs is picked up by taxpayers. Currently, at least one in five Medicaid dollars spent on hospital care is due to drug abuse.
* Sexually transmitted diseases: The incidence and costs of STDs have exploded during the last several decades. The costs of just three STDs - gonorrhea, herpes and chlamydia - reached $5.4 billion in 1990. Syphilis, which has disappeared from most industrialized countries, is at its highest level in four decades. Twelve million new cases of STDs occur each year; if current rates of infection continue, as many as one in four Americans will have an STD at some point in life.
Most dramatic, however, is the social and economic costs of AIDS. A little over a decade ago, acquired immune deficiency syndrome was nonexistent in the United States. Today, there are around 350,000 reported cases, and the number is expected to grow significantly. Given that the average lifetime cost of treating an HIV-positive patient is more than $100,000, the costs of treating current AIDS patients will total more than $300 billion.
* Violence: Around one-third of the 150,000 deaths per year from injuries are suicide- or crime-related; more than 2 million Americans suffer from nonfatal violence each year. According to the Centers for Disease Control, the cost of firearm-related homicides alone exceeds $14 billion annually. Given that only 60 percent of homicides, and a much smaller percentage of nonfatal injuries, are caused by firearms, the total health care costs of violent crime are far higher.
* Violence also helps to explain the steep slope of health care cost increases in the United States compared to other nations. …