Too many fancy tests, high doctor fees, overpaid insurance companies -- all of these contribute to the unrelenting rise in the cost of health care in America. But there's one monster issue that the experts say outweighs the others: chronic disease.
Chronic diseases like diabetes and hypertension account for three-fourths of the country's health care spending, says one of the leading national experts, Kenneth E. Thorpe of Emory University.
Obesity alone, a prime cause of chronic disease, is responsible for 30 percent of the increase in Medicare spending over the past decade, Thorpe says.
That means that, to wrestle health care costs under control, we'd better get a handle on those chronic diseases -- and on our weight problem.
Fortunately, there's plenty of room for improvement. "The vast majority of cases" of chronic disease could be better managed, says Thorpe. Diabetics can be coached to keep their blood sugar under control, for example, and avoid expensive medical crises. Better managing or preventing chronic diseases saves money on hospitalizations or emergency room visits later.
One promising way to do that, experts say, is the highly coordinated care available at Mayo Clinics, where doctors share information readily with other doctors, specialists can be quickly consulted when needed, and other professionals like nutritionists play a much bigger role in helping a patient stay healthy.
These doctors are on salary and are not paid by the procedure or office visit, as most doctors are.
In Anchorage, Southcentral Foundation, which serves Alaska Natives, is successfully using a version of this model. Its data prove that hospital and emergency room visits, measured per thousand patients, have dropped.
But private doctors in Alaska get no pay for coordinating their patients' care, says Dr. Tom Nighswander, who is assistant regional dean for the WWAMI medical school program here and also works at Southcentral Foundation. They only get paid for a formal office visit or performing a particular medical procedure.
Congress and insurance companies must figure out how to promote wider use of these more efficient models for delivering cost-saving medical care.
Beyond those changes, the country has to get a grip on why we've become a nation of fat, sick people and how we can stop being overweight.
Policymakers look to the successful anti-tobacco campaign as an example of what's possible. High-profile information about the risks, an unending succession of laws, social pressure and higher taxes gradually ratcheted down cigarette use. And all that progress didn't take place so long ago. Anchorage only outlawed smoking in its last public buildings -- bars -- in 2007.
Junk food taxes and tight standards for what's available to eat and drink in schools are two areas under discussion to encourage healthier eating. The weight problem is broader than that, though. Governments also need to push policies that make walking and other physical activities attractive: zoning that encourages pedestrian-friendly neighborhoods, supporting bus systems and rail transit over autos, promoting parks and trails.
In the end, a huge part of the nation's problems with health and health care come down to the choices each of us makes -- how we take care of ourselves, what we eat and how we spend our leisure time. But public policy -- both in the health care system and outside of it -- can give a shove in the right direction.
If we don't do it, we're not only killing ourselves, we're running our economy into the ground in the process.
BOTTOM LINE: The American medical system needs to do a better job of handling chronic diseases, and the whole country needs to work off some weight.