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Current Clinical Issues |

Can Disease Prevention Save Health Reform?

Jennifer Fisher Wilson
[+] Article, Author, and Disclosure Information

Potential Financial Conflicts of Interest: None disclosed.

Ann Intern Med. 2009;151(2):145-148. doi:10.7326/0003-4819-151-2-200907210-00021
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When policymakers talk about reducing the cost of health care, the conversation often turns to the topic of chronic diseases. Heart disease, diabetes, and other chronic diseases underlie the growing burden of adult disability and account for 70% of all deaths in the United States and more than 75% of its $2 trillion cost of medical care. Rates of chronic disease are on the rise, according to the Centers for Disease Control and Prevention (CDC).

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Disease Deferral
Posted on August 27, 2009
Dick S. Wilbur
American Medical Foundation
Conflict of Interest: None Declared

To the Editor:

Wilson, writing on Current Clinical Issues, (1), reaches the conclusion that health costs can be reduced by changing human behavior toward a more healthy lifestyle. While measures needed to improve American health--weight reduction, increased exercise, and avoidance of harmful drugs including nicotine and alcohol-will benefit each individual, they will not reduce health care costs. They will simply defer them.

As an extreme example to highlight this, take twin brothers at age 65. Each has worked for 40 years paying into Social Security Medicare and health Insurance Premiums. One has overindulged in food, alcohol and tobacco and avoided any exercise. He is obese and on the eve of retirement, has a massive myocardial infarction and dies instantly. This is a personal tragedy, but a saving in health care costs. He has paid in to Medicare, but never used it.

His twin is abstemious, a slim, healthy, exercising, non smoker who lives another 40 years. During this time he uses Medicare benefits for various illnesses, but does not pay any further Social Security and spends his last years in assisted living with multiple age-related disabilities requiring medical, nursing and hospital care. This is a much better personal result, and highly to be desired, but it increases, not reduces overall health care costs.

The disease prevention interventions proposed by Wilson are desirable from a humanitarian aspect and are to be commended, but they will not reduce health care costs. They will probably defer some, but will not eliminate them and will probably, over the long term, increase them significantly.

These interventions are not "Disease Prevention" as much as "Disease Deferral" and will not "Save Health Reform"over the long run.


1. Wilson JF. Can Disease Prevention Save Health Reform? Ann Intern Med 2009;151:145-7

Conflict of Interest:

On Medicare for 20 years

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