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Thanks to preventive medicine, older Americans have healthier hearts. Which also means, incidentally, that federal budgets are healthier, too.

Catherine Rampell mug

Catherine Rampell

At the turn of the millennium, health-spending growth was spiraling out of control. Economists projected that the already ginormous health-care sector would soon gobble up monster portions of the federal budget and the entire economy. But something strange happened during the past decade and a half.

Rather than rocketing upward at ludicrous speed, health-spending growth slowed — dramatically so.

That’s true whether we’re talking about public- or private-sector health spending; for Medicare, Medicaid, private insurance and out-of-pocket spending, annual outlays have been way lower than the doomsday forecasters anticipated. Curiously, too, the sharpest slowdown has occurred with Medicare.

In fact, about three-quarters of the health-spending slowdown nationwide was due to slow-as-an-(almost)-trickle growth in spending on the elderly.

From 1992 to 2004, per-capita spending among Medicare beneficiaries grew by 3.8 percent each year, adjusted for economy-wide inflation; since 2005, the rate has been a mere 1.1 percent, according to a new Health Affairs study.

In plain English, that means total spending per elderly person hasn’t fallen, per se, but we’re spending thousands of dollars less today than was projected to be the case back in the early 2000s.

So who gets credit?

Some have attributed the spending slowdown to lousy economic conditions, although in retrospect the timing isn’t exactly right. The deceleration appears to have begun before the Great Recession, and it continued long after it ended.

Some have credited structural changes to the health-care system, including some of Obamacare’s cost-control measures. Maybe bundled payments and accountable care organizations are responsible — though studies so far suggest their effects have been modest compared with the magnitude of the overall changes in health-spending trends. What’s more, the slowdown pre-dates Obamacare.

That new study suggests a different cause: Americans taking better care of their hearts.

The study, from a team of researchers led by Harvard economics professor David M. Cutler, focuses specifically on medical spending for the elderly. The authors began by disaggregating spending into categories, based on the condition a patient was being treated for — cancer, dementia and so on.

They noticed something striking. The categories with far and away the biggest slowdown in spending were related to heart health. Spending on cardiovascular and cerebrovascular diseases (heart attack, cardiac arrest, stroke, etc.) declined by $827 per person, relative to earlier trends. Spending on a related category called cardiovascular risk factors (high blood pressure, high cholesterol, diabetes) also fell $802 per person below the trend line.

Altogether, the researchers calculated that more than half of the elderly spending slowdown was because of slower spending on cardiovascular diseases and conditions. In dollar terms, this means the slowdown in cardiovascular spending growth effectively saved the Medicare program about $34 billion in 2012 (the most recent year of data available).

You can see similar results in other health stats. Elderly death rates for cardiovascular diseases, for instance, have plummeted, according to data from the Centers for Disease Control and Prevention.

These are significant findings, with major policy implications.

The conventional wisdom among health-policy experts has long been that preventive medicine does not save money. It has other virtues — including, well, making people healthier. That’s quite a good thing! But study after study has found that in dollar terms, at least, investing more in preventive care doesn’t pay off.

This new paper suggests that at least when it comes to heart health, that’s not the case.

Lower-than-expected cardiovascular spending appears to be primarily due to successful use of preventive measures, the authors find. Greater use of statins, anti-hypertensives, diabetes medications and aspirin has helped prevent lots of expensive health events and contributed to outright declines in hospital admissions for heart disease and stroke.

“We think that half of the reduction in cardiovascular cost growth is a result of more people taking medications and taking them more regularly,” Cutler said.

Why are people taking their meds more regularly? There’s more awareness of the need for treatment, for one. But also, a bunch of existing drugs went off patent and got cheaper. And in 2006, we got Medicare Part D, which reduced out-of-pocket prescription costs for many older people.

Whether policymakers can duplicate these results for other health conditions and preventive therapies remains to be seen. But as the country debates the fiscal and moral merits of expanding health coverage, these latest findings are useful — and heartening — datapoints.

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Washington Post Catherine Rampell can be reached at crampell@washpost.com.

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(29) comments

oldhomey

No! No! No! DMoney has assured us already that rising healthcare expenditures are due to obese, nicotine-addicted alcoholic Americans who do not make good choices, unlike him. How dare Ms. Rampell use silly facts and statistics to dispute him!

PhysicsIsFun

I think a pretty good argument could be made that obesity, tobacco use, and alcohol use are in fact not choices that people make. Obesity is a complex issue. No one chooses to be obese. Our food delivery system and food marketing are about quantity over quality. It sells foods which are profitable, high in calories, low in nutrition, and in many regards addictive in nature. Tobacco is an extremely addictive product with no redeeming value. It should be illegal like many other less dangerous products are. No one chooses to be addicted to nicotine. Most people become addicted at an age when its use is illegal, and by the time they grow up and realize what they have done it is too late. There is an entire industry selling products to help people quit, Alcohol is another product some people become addicted to. It causes may deaths each year and much heartache. Many people struggle to break its destructive grip on their lives. All three of these industries lobby congress extensively, employ lots of people, and enjoy a protected status in our country and the world. Unregulated capitalism puts profits over people. People do not chose to be unhealthy.

DMoney

Congratulations, I literally don't know what to say to this. Blows my mind.

PhysicsIsFun

Yeah I feel your pain. Reality can be a tough thing to swallow, especially when it conflicts with a strongly held opinion.

DMoney

I've recovered from the mini-stroke that reading this originally caused me. I'll send the medical bill down to Mexico if you send me the address of the resort you are at.

I have to look no further than myself to discredit your stance. I eat too much fast food. That's because I don't prioritize taking time and effort to eat healthier. I use chewing tobacco. Quitting is extremely hard. But I'm the one in the store buying it and shoving it in my lip. Nobody is doing that and nobody made me start. And nobody will quit for me. I love a cold beer or three. I have no plans on quitting that. Thank God beer is made in such variety and for relatively cheap. But I don't abuse it. I will say alcoholism and addiction is a disease. But it's self inflicted and self-curable. It's like someone giving themselves cancer and then someone curing themselves of cancer. It's terrible, deadly, dreaded, but unlike cancer--100% survivable if the victim is willing to cure it.

oldhomey

Well, let me say this about your 5:21pm post, D: I would certainly not ridicule you for your weaknesses, as I have been victim to my own weaknesses, too, in my life, and they have been manifold. But it also illustrates most colorfully that you, D, are not always the master of good choices, as you have presented yourself often on these boards. No shaming intended here, but a little humility on your part might be appropriate.

DMoney

Quote me in an instance where I said I only make good choices. If you can, I will never comment on here again.

oldhomey

Since you offer me that challenge, D, I think I can answer it by saying that I never accused you of maintaining you always make good choices. I have often, however, said you have smugly made good choices while blaming others who do not have the opportunity to make the same choices as you for being the authors of their own problems. Can you prove me wrong?

DMoney

Easy. Scroll up to your 2/11 post at 7:45 and read second half. That's precisely what you claimed.

A homeless drug addict rapist can make good choices. Anyone can make them with a functioning brain. An accumulation of a majority of good choices will always result in an improvement on one's situation.

oldhomey

Touche, D. I DID pretty much say that about you. It is not what I meant to say, but there it is, I will accept the jacket and apologize.

On the other hand, I want to stress this: You, D, repeatedly have claimed you made "good choices" in finding employment that offered you healthcare benefits, implying people who work in jobs without such benefits or unable to work are authors of their own problems. We live in a time when the economy and corporate philosophy are shifting to a "gig" economy in which it is difficult now to find employment that offers healthcare benefits. I and others on here find your position on this to be insulting and smug.

DMoney

Can almost anyone get a job at CenturyLink? Ashley furniture? Northern engraving? There are many like positions where practically anyone, with no education or experience, even with criminal records, can gain employment and have average to good benefits within 90 days. If they choose not to work at these places, for any reason whatsoever, and then complain about lack of insurance, it's on them. If they physically or mentally can't get a job like these, or are too old--they deserve coverage, which I'm sure they receive. If that's smug, well, so be it. I'm not concerned about that.

oldhomey

Dream on, brother. There are nowhere near enough jobs in this country, let alone this area, where people with no education or a h.s. education or even a PhD can reasonably expect they will find work with benefits.

DMoney

That's just not true. There are hundreds of unfilled positions at those named companies alone. Not only do they offer good benefits, but decent living wages as well. How you don't know that or are unable to see that with a quick search of Glassdoor, Monster etc is baffling.

DMoney

As this column states, healthcare costs are riding per capital, only slower than forecasted. So I'm right there, just not as right as I thought. It's basic and universal science that poor health and higher medical costs are associated with obesity, nicotine, excessive alcohol. So I'm right there (that's an easy one). Ms. Rampell completely validated my statement. And you gave me the platform to highlight that. Thanks.

PhysicsIsFun

I'll give you an idea of the costs of healthcare if you get really sick. A good friend of mine was diagnosed with brain cancer in mid November. The entire diagnosis was messed up, but when she finally collapsed she ended up in the ER at Froedert Hospital in Milwaukee the process began. It was determined that the tumor was large and inoperable due to location. A drain needed to be inserted. She needed chemotherapy and radiation. The first bill for about 4 weeks (1 week in intensive care plus the surgery to insert the drain) was $390,000. All but $1500 was covered by insurance. Later the incision became infected. This required further surgery with skin grafts and IV antibiotic therapy with Vancomycin (the last ditch antibiotic). The IV therapy will last for 30 days. The second 4 weeks cost $285,000. Her husband has had to take a leave of absence from work so he is not collecting any salary, and he is paying for the insurance out of pocket. She is going to die, and her family is devastated. Most healthcare costs come from the few people who get really sick, or at the end of life. Choices have nothing to do with it. Pray you never get really sick in this country.

DMoney

Sounds absolutely horrible. But tell me how having insurance that costs $1500 as a deductible on a $390,000 bill is not a result of a good choice? Is this bad because the husband had to pay for insurance premiums/deductibles out of pocket? Hopefully they made a good choice about saving some emergency funds as well. And hopefully (and very unfortunately) they made good choices regarding life insurance.

DMoney

Another thing, let's replace your friend with me. Let's say that after most of a lifetime of using chewing tobacco, I develop cancer as a result. Same costs, same horror story, but no doubt how/why it happened. Let's say we have universal health care. $390,000 bill for my bad habit. That cool with you?

PhysicsIsFun

Of course people who have the means (either provided through employment or self pay) chose to have health insurance (not life insurance). My friend has it provided by his employer a municipality in SE Wisconsin (both the husband and wife are my friend). Both of them lost their jobs back in 2011 due to changes made to public employees by out illustrious ex-governor. They both needed to scramble and find new positions. He has had 3 different jobs in the past 8 years. She was unemployed for a while but had been teaching at Milwaukee Lutheran College until she got sick. Her job as adjunct professor had no benefits. Neither one of them has a good thing to say about Walker. He pretty much blew up their life and now this. The point of my original post is that her condition was not caused by a choice and the healthcare can be extremely expensive. She has lead a pretty healthy life. She has no risk factors that could have led to this. As far as my life in Mexico, not that it is any of your business. I am not on a resort. You can rent a nice 2 bedroom apartment in much of Mexico for around $800 - $1500 a month. I pay in the upper part of that range. Most things are cheaper here. In Mexico we either walk or take a bus. Sometimes we rent a car for a day or 2. It is a whole different type of lifestyle. The Mexican people are great and very patient with my bad Spanish. It is a wonderful and welcoming place to be. At home in Wisconsin I stop insurance on my vehicles. I turn down my heat. I cancel cable TV and get the cheapest internet. I keep track of my house with cameras and WiFi thermostats etc. In the past I rented my house on AirBNB and made money being away, but that got to be a hassle. We are not rich but we are comfortable. We feel very lucky. Enjoy your life when you can. It can be gone in a blink.

PhysicsIsFun

I have some advice for you quit chewing tobacco. A friend of mine was diagnosed with oral cancer probably caused by the use of smokeless tobacco. He survived, but he really suffered. Another friend had cervical cancer caused by HPV. A cancer which is now preventable with a childhood vaccination. A vaccination to which many misguided parents of boys and girls object. She suffered, but also survived. Her son is an oncologist, who treated the other friend with the oral cancer. So one cancer (the oral) was probably caused by an addiction to a harmful substance. The other cancer can be prevented through a vaccination which parents forgo due to ideology or ignorance. Their children suffer the consequences as future adults. Wrap your head around that.

DMoney

Physics--circumstances change. Good and bad. I'm not suggesting that anyone can be immune from that. But everyone can respond. Finger pointing is completely useless. As for your friends, sounds like some tough breaks. They found alternative means, which they qualified for through experience and education. So their past gave them options. Getting cancer despite being healthy, horrible luck. Nothing she could do. Good choices aren't a guarantee to prevent that. I'll lay off on the resort thing. But I will always struggle with the idea that many people who played the game of life and won want to change the rules now that they don't have to play anymore. Whatever positives or negatives about our recent past, they allowed you to achieve comfort. I'd like the same playing field.

martian2

Gee Dmoney you talk about playing the game of life and winning. To you it seems to mean all dollars and cents, that's all that matters. That is what life i all about. I once too thought that in my youth, but decades later as many of us face the sunset of life, we come away with a totally different perspective. I m not going to try and define or explain what that is. You and everyone else must find that out for themselves, what the "game of life" is all about. I know many people who were never wealthy, never had much money or a big fancy house. But I consider them modern sages who have a lot to teach the rest of us.

DMoney

Rising*

DMoney

Another thing, never once did I say I made good choices in terms of physical health. I'm slightly overweight, a nicotine user, and probably could probably drink a lighter beer. But I'm also not pushing responsibilty to others to take care of me and never will.

oldhomey

If you have a good health insurance plan, D, you already are pushing responsibility on others for your bad choices, unless you have told the insurance plan that you are on that you will make no claims should you have an illness related to chewing raw tobacco and being overweight. But you do like beer. Some of the best people like beer. Beer is good. You don't have to apologize for liking beer. Actually, some very bad and suspect people like beer, too.

DMoney

Yes, but the insurer and the insured under said plan have the ability to choose what they cover and what they pay. Choices. I'm not apologizing for any of my poor choices, just like I'm not bragging for the good choices I make, which I believe are the majority (60/40 split).

oldhomey

You are now being dogmatic, D, not sensible. If you think you or any other ordinary Joe or Jane is capable of negotiating an equitable personal, tailor-made healthcare plan with a gigantic insurance that knows ever weasel tactic in the book, you go ahead and do that, my boy. But for me and I am willing to bet the vast majority of Americans, we want some assurances that our insurance will be there when we need it.

oldhomey

I happened upon this, D, when scrolling through another string here. It is not the strongest statement you have made on here about your "good choices" in terms of your health, but is undeniably a statement in which you pat yourself on the back for your superior choices over others:

DMoney Feb 6, 2019 5:39pm

I think there ought to be some health requirements. That would be the responsible things to do. If the public is paying the health bill, would it not benefit our mutual funds to lower our mutual costs? Why should I just be healthy, active etc. if I don't receive benefit of lower cost? Why would taxes be so high to pay for people who choose to live unhealthy? If I'm paying more I'd want more say in the health of others. But...oh wait...that pesky Constitution.....

DMoney

It's a metaphor. Illustrating individual freedom and liberty against third-party coercion. I think I made it quite clear above, I'm not a poster child for the healthy and active.

oldhomey

Perhaps you should work on your metaphors and sharpen the up a bit so that they are evident and have some meaning to others before you try them out. You are fast becoming the poster boy of waffling dogmatism.

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