The first line of defense

The Baltimore Sun

As its costs continue to spiral upward, most people now agree that America's health care system is broken. And as the race for the White House heats up, politicians on both sides of the aisle are clamoring to propose ideas that rein in health spending.

Unfortunately, the policies offered thus far are misguided. As counterintuitive as it may sound, the answer to America's health care woes won't be found by harping over the price of care.

Consider prescription drugs. Americans now take more drugs - and spend more on them - than ever before. And one would be hard pressed to find a more popular target for the ire of the nation's lawmakers.

But contrary to conventional wisdom, drug prices aren't driving up the cost of health care.

In fact, only about 11 cents of every health dollar spent goes toward drugs. The rest goes to everything else - from doctor visits and hospitalizations to administrative charges and insurance.

And drugs are often the better bargain. After all, a daily cholesterol-lowering drug is far less expensive than emergency heart surgery.

So, why does it feel as if drug prices are going through the roof?

Well, from 1998 to 2003, insurance companies increased their premiums by an average of $104.62 per person. During that same time, prescription drug costs increased by only $22.48.

Meanwhile, prescription drug co-payments have increased drastically, outpacing the growth rate of prescription drug prices by 4 to 1. In 2000, for instance, people under age 65 with private health insurance paid 37.2 percent of the cost of their prescription drugs out of their own pockets. In earlier years, health insurance covered most of that cost.

Not surprisingly, this has led many Americans to believe that their increased out-of-pocket expenses are because of higher drug costs. And this has had a devastating impact on health care.

Thanks to ever-increasing co-payments, many patients have stopped using prescription drugs for controllable, chronic conditions such as high cholesterol, high blood pressure, ulcers and depression. Consequently, among patients with diabetes, asthma and gastric acid diseases, emergency room visits have increased 17 percent and hospital stays 10 percent, according to a 2004 RAND study.

So, what's driving up the cost of health care?

First, Americans are aging. Today, the fastest-growing demographic group is people over 75. And an older nation consumes more health care.

Second, America's waistline is expanding, leading to a massive increase in the number of those suffering from high cholesterol, high blood pressure and diabetes.

In 1979, for instance, 31,691 Americans had a foot amputated because of undiagnosed and untreated diabetes. By last year, that number grew to more than 80,000.

Meanwhile, hundreds of thousands of heart attacks and strokes occur each year, costing the U.S. health care system billions.

Finally, although America's health care system works miracles when people become very ill, it too often fails to keep people healthy before they get sick. And that's far more expensive than keeping people healthy to begin with.

Prevention must therefore be health care's first line of defense, as a proper diet and healthy lifestyle can stop many diseases in their tracks.

Failing prevention, earlier diagnosis and care are crucial. There are many effective treatments and maintenance medications that can stop diseases such as hypertension and diabetes from progressing, allowing millions of Americans to lead active and productive lives without breaking the bank.

In the coming weeks, the nation will learn more about the health care plans of each of the major presidential candidates. If lawmakers want to save lives, enhance the quality of care, and reduce costs, the focus needs to shift to prevention and early diagnosis.

Peter J. Pitts, a former associate commissioner at the Food and Drug Administration, is president of the Center for Medicine in the Public Interest. His e-mail is

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