Caring for People with Chronic Diseases
Dr. Elizabeth Rosenthal’s recent
article in the New York Times shows how our health care system is failing
people with chronic diseases that require expensive, ongoing treatment. Our
failure causes unnecessary suffering and at the same time wastes a great deal
of money. Millions
of Americans suffer from chronic diseases like diabetes, heart disease, stroke
or cancer, and more than three quarters of American health care spending goes
to pay for care for their care.
Patients suffering from end-stage kidney failure are
eligible for Medicare, and Dr. Rosenthal suggests that patients with other
chronic diseases should be similarly covered. I believe that she is correct in
this because we have a moral responsibility to provide health care for ever
American who needs it. However, covering treatment through Medicare is only one
of the things that we should do about chronic diseases.
Preventing Chronic Diseases is Key
We should also work to prevent people from becoming victims
of such diseases in the first place. According to the federal government’s Center
for Disease Control. “Chronic diseases and
conditions—such as heart disease, stroke, cancer, type 2 diabetes, obesity, and
arthritis—are among the most common, costly, and preventable of all health
problems.”
Working to prevent
diseases is not a new idea. For more than a century, we have used public health
measures to reduce the occurrence of food and water borne diseases. We do not
deal with cholera or typhoid fever merely by hospitalizing hundreds of
thousands of people when they get sick. Instead, we build sewage systems to
separate human waste from our drinking water; we treat the water to make it
safe to drink; we inspect food to make sure that it is clean; and we educate
our children to wash their hands after going to the bathroom. These methods are
expensive, but they are far cheaper than hospitalizing hundreds of thousands of
sick people, and they have all but eliminated food and water borne diseases
from our country.
Similarly, we can focus on preventing chronic diseases. The
methods will be different, but they will be effective. To prevent chronic
diseases, we can focus on two things: education and primary care.
Health Education Can Help to Prevent Chronic Illness
First, we can educate ourselves and our children to live in
healthy ways. The CDC says, “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.” Through education, we can encourage
people to live in healthy ways, and we can reduce the number of people who
suffer from chronic diseases. We cannot eliminate
them completely because health risk behaviors are not the only causes of
chronic diseases. (Other causes are genetic.) However, we can save a lot of
money and improve life for many people if we succeed in persuading them to live
in healthier ways than they do now. So, if we are serious about preventing chronic
illnesses, we should put money into health education.
Primary Health Care Has an Important Role to Play
We can also invest in primary care, which is very cheap
compared to hospitalization. The
role of primary care is important. Primary care providers can assess
patients’ health and behavior, educate them about changing their behavior, refer
them to services to help them to change their behavior and monitor their progress. We cannot change the behavior of all of the
patients, but we can improve many people’s lives and save a lot of money.
In short, while we should expand our Medicare program to
provide care for patients with chronic illnesses, we should not stop
there. We should act to improve people’s
lives and to reduce the cost of treating such illnesses by investing in health
education and primary care.
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