Healthier, but not cheaper -

Healthier, but not cheaper


Chris Auld debunks the notion that encouraging healthier lifestyles will decrease public health care costs.

The evidence suggests that unhealthy lifestyles tend to increase health care use at any given age and reduce life expectancy, so more is spent per year but for fewer years. For example, statistical estimates from a well-known 1997 paper are displayed in the graph. The lower two lines show that if we compare a smoker and a non-smoker who are the same age, we should expect to find that the smoker consumes more health care. But the top two lines show that health care costs for non-smokers eventually become much higher than those for smokers simply because smokers on average die sooner than non-smokers. This study estimated that if every smoker were to spontaneously quit, demand on the health care system would first fall, as the quitters become healthier than they otherwise would be, but eventually rise by 7 per cent in the long run as smokers live longer.


Healthier, but not cheaper

  1. Aaron, this is the argument that the tobacco companies put forth a few years ago in defence of their product….” we are saving the healthcare system money because are customers are dying faster!” In the meantime we fret over the possible effects of WIFI, cell phones, and wheat but we do nothing to change the unhealthy habits that we KNOW will hasten our demise. 

    • Nonsense!  The tobacco companies can’t say that.  I can, though.  I’m a smoker, as was my late ex-husband.  It was the quitting that killed him.  Well, that was a joke but he was trying to quit when he had a massive heart attack and dropped dead on the spot.  Not a lick of health care was spent on account of him except for the doctor’s time to pronounce him dead.

      As for me, I’m not worrying about a healthy lifestyle because I’m one of those non-pension worker types.  I’m rather counting on it, actually. 

  2. Probably the graph to look at wrt health care costs & policy is expenditure versus “time to death”.  I would hazard a guess that such a graph shows that past childbirth, health care costs rise quite gradually as we age but then shoot up exponentially as we get into our last few years.

    • I’ve heard that same thought fairly regularly over the years.  I suspect that it is true – 80/20 rule anyone?

      Within the last year I spent an entire evening scouring the web thing, trying to locate some research papers – I wasn’t able to locate even one document that directly addressed the question, and those that skirted around the edge a bit didn’t have numbers.

      Seems to me that this type of info would help to focus our efforts.

      • Don’t know about Canada but there is lots of info from other countries that I assume would be similar for Canada.

        “A remarkable proportion of overall health-care needs and costs is now concentrated in the last few years of the life span …. During that year, a Medicare beneficiary ordinarily uses more than $25,000 in health-care costs and the preceding two years add up to about the same total (Hogan et al. 2000; Shugarman et al. 2004). But we must double the sum of these last three years because Medicare covers only about half the costs (for example, Medicare does not cover nursing-home costs or prescription drugs) (Maxwell, Moon, and Segal 2001). 

        Assuming an eighty-year life span, each tenth of the life span would be eight years. The costs of the last three years of life add up to around $100,000, and another $5,000 per year (close to average Medicare expenses) is a reasonable figure for the five years before. Thus, the last tenth of life incurs roughly $125,000 in health-care costs, probably nearly half of the costs over the person’s lifetime.”

        • Thanks!

          Perhaps the real problem is my interweb search ability… :-)

  3. Leading a supposedly healthy lifestyle increases cost to health system and not only because you live longer but because ‘healthy’ lifestyles might not be all that healthy. 

    Also, there was no mention of tax revenues lost if people quit smoking en masse. People would live longer, more expensive health care, and there would be less tax revenue to pay for it all. 

    NPR ~ Supplements Look Risky In Older Women ~ Oct 2011:

    Eating too much, rather than not enough, is the big health problem for most Americans. Yet, many of us take a supplement or vitamin in the hope of staving off illness with big doses of particular nutrients.

    A new study shows that might not be such a great idea. Use of many common supplements — iron, in particular — appeared to increase the risk of dying, and only calcium supplements appeared to reduce mortality risk.

    LA Times ~ Dec 2010 ~ A Reversal On Carbs:

    Most people can count calories. Many have a clue about where fat lurks in their diets. However, fewer give carbohydrates much thought, or know why they should.But a growing number of top nutritional scientists blame excessive carbohydrates — not fat — for America’s ills. They say cutting carbohydrates is the key to reversing obesity, heart disease, Type 2 diabetes and hypertension.

    “Fat is not the problem,” says Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health. “If Americans could eliminate sugary beverages, potatoes, white bread, pasta, white rice and sugary snacks, we would wipe out almost all the problems we have with weight and diabetes and other metabolic diseases.”

    It’s a confusing message. For years we’ve been fed the line that eating fat would make us fat and lead to chronic illnesses. “Dietary fat used to be public enemy No. 1,” says Dr. Edward Saltzman, associate professor of nutrition and medicine at Tufts University. “Now a growing and convincing body of science is pointing the finger at carbs, especially those containing refined flour and sugar.”

  4. I suspect that the problem with this apparently freak result, is that healthcare costs are allocated based on average costs by age, rather than examining actual end of life care. For example, if we were able to compare costs between people who arrive at end of life (at whatever age) who were basically healthy up to the point their cells began to shut down, vs. the end of life (at whatever age) of people with multiple chronic conditions (diabetes, COPD, etc.) we’d find that the trajectory of care for the former would be shorter and less dramatic while the person with lifestyle related disease would expereince their end of life as a prolonged period of complex care and therefore higher costs. Each would be skewing the average cost based on age in a different direction.

    In other words, death due primarily to age needs to be separated from death due primarily to disease.

  5. In similar news, if you stop eating, your grocery bill goes down.

    Sometimes the simple cost of something doesn’t approach anywhere near the whole picture.

    • You are so right Thwim.  This article doesn’t mention the obvious attributes of  healthy people…what they are able to contribute to society.  They might in the long run cost the healthcare system more but surely they work longer and pay more taxes to support the healthcare system.  They also are able to participate more fully in the raising of their children and grandchildren, the very people who then take over the payment of the system.  They are the volunteers that are vital to the success of our communities.  They show up for work every day because they don’t suffer from chronic illnesses and they are productive at work. 

      • HealthCare Insider:

        The Tobacco industry has, to the best of my knowledge, never offered any of the scientific evidence I discussed in my article in court or anywhere else.  That would require them acknowledging that tobacco tends to kill people. 

        You are right that the article does not mention many other aspects of tobacco’s effects, and it makes no mention of policy.  The article is limited to discussing the evidence on the effects of smoking and other unhealthy behaviors on health care costs.

        As you many others seem to overlook, the article does explicitly point out that policies which increase health care costs can of course nonetheless be good policies.  

        The point is that, contrary to popular belief, the evidence tells scientists that we should not expect policies which curb smoking and other unhealthy behaviors to dramatically diminish demand on the health care system.  Counterintuitively, healthier behavior may actually increase long-run demand.  Yet again, that fact does not imply that health care costs are the only consideration.   

        Chris Auld.

        • I appreciate your comment Mr. Auld but I do recall reading an article three or more years ago in The Calgary Herald about a study done by the tobacco industry asserting that they were saving health dollars because their patrons were dying younger.  I went to “google” and I found a reference to the study in an interview done by Carrie McLaren in a magazine called “StayFree”. 
          Interestingly enough the article is called “Pricing the Priceless” and discusses the “sordid world of cost-benefit analysis”.  Ms. McLaren interviewed Frank Ackerman and Lisa Henzerling and they discussed how even pollution can be seen to be a positive thing if we only look at the cost-benefit analysis in terms of dollars and cents…..think of all those people with  respiratory ailments we could rid ourselves of at a young age…
          In the interview they mention that “Philip Morris did do a meta analysis of smoking in the Czech Republich (which showed smoking saved the government health care system money because smoker died earlier).
          I did not bother to look up the original meta-analysis that Philip Morris did.

          • It is interesting you were able to find one article offered by the tobacco industry making an argument about health care costs.  Obviously, it isn’t an argument they make often.

            I restrict attention to studies published in ranked peer-reviewed journals, and the literature as developed in those journals was the basis for my piece in the Globe.  I agree with you that reading something by Phillip Morris is not worthwhile, and by the same token your article in “a magazine called StayFree” is not worthwhile. 

  6. Health care would also be cheaper if we were all sensible and just jumped off bridges when it was our time to go.  Stupid humans, insisting on battling disease and trying to live longer.  We’re so selfish.

    • I don’t think you have to jump off a bridge but have a talk with your family and tell them that when you are old you are okay with dying so that they don’t insist that the physicians do every possible thing to keep you alive.  A living will is a very good idea.

  7. I wonder if the studies take “inflation” into account. The cost of healthcare keeps going if you use it sooner, it will cost less! Those inconsiderate “healthy” people wait for prices to go up before needing treatment…  :)