TEXT OF COMMENTARY
KAI RYSSDAL: If you’re sick and tired of hearing about the Iowa caucuses, just imagine what it’s like for people who actually live in the Hawkeye State. It’s all over tomorrow night. Or, perhaps, it’s all just beginning. Health care is among the top issues Democrats in Iowa say they are worried about. It’s second only to the war in Iraq for them. But commentator Susan Lee says most of the candidates’ health-care proposals ignore one vital issue.
SUSAN LEE: Medicine has been fabulously successful in treating acute and infectious disease. And so more Americans are living longer. But unfortunately living longer increases the chances of developing chronic conditions. Stuff like heart disease, diabetes, hypertension and asthma. Right now, about half of all Americans have at least one chronic disease — accounting for almost 80 percent of all health-care expenditures.
This is alarming, yes. But now for something really scary: about one-quarter of all Americans have more than one chronic disease. And 10 percent of those have an average of five chronic conditions which, by the way, accounts for fully two-thirds of Medicare spending.
Here’s a quick look at why chronic disease drives up costs. Say a person suffers from high blood pressure. Her doctor prescribes a beta-blocker. Fine. Except that the beta blocker then aggravates her asthma. Best case, she has to pay an expensive visit to her asthma doctor. Worst case, she ends up in the really expensive ER.
So the problem is that treatment for chronic disease uses what’s called a “silo” model — each disease is treated like a free-standing problem with its own specialist. And proliferating doctors and medications have predictable results — like duplicate testing and dangerous drug interactions which drive unnecessary visits to doctors’ offices or ERs.
A truly determined effort to get spending under control would attack the problem of multiple chronic diseases. But instead we have a dozen people running for president who are pretty much ignoring the issue. Only two of the candidates — John McCain and Hillary Clinton — are advancing concrete ideas to actually reform treatment.
So I’d like to add a new disease to the roster: Frustration Disorder. A condition experienced by anyone hoping to hear good ideas for reducing the cost of health care. During this election cycle, I predict Frustration Disorder will be a chronic condition among voters.
RYSSDAL: Economist Susan Lee lives in New York City.
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