The project to read through and summarize all the posts in my Theory of Money series is actually pretty huge, so it’s taking most of my blogging time, but I at least wanted to share a short post about a thought I had this week.
I’m reading a great book by Peter Attia, M.D. (who also, it turns out, is a Canadian-American physician!). It’s called Outlive. He’s pretty popular in the podcastosphere, among other areas, and I really appreciate his rigorous approach to looking at the science of medicine and recognizing its weaknesses. His big focus is on figuring out how to increase our “healthspan” (as opposed to lifespan, which ignores quality of life). And finally he wrote a book about the topic.
Staving off the main four causes of death and disability is a big part of his focus: metabolic disease (as in metabolic syndrome, lipid disorders, diabetes, etc.), heart disease, neurodegenerative disease, and cancer. The crazy thing is that medicine, as it is today, is totally unequipped to prevent those things.
Why?
The issue is both cultural and financial.
Culturally, there just isn’t a big focus on trying to prevent things that might happen 30 years from now. Most physicians don’t spend a lot of time talking about that stuff, which I’m guessing is because (1) the evidence is not plentiful when you’re trying to look further than 10 years down the road, (2) we as physicians don’t learn about it enough, and (3) we get tired of being ignored when we tell patients over and over to make lifestyle changes that go against everything our culture is pushing on them. I can’t blame patients for this–will power can only take you so far when you’re surrounded by a modern industrialized culture that does everything it can to make us eat a lot and move very little. Case in point: Why is it that every person who encounters my children has to give them a treat (even without asking me)? Because it’s our culture’s way of being friendly. And driving kids from house to house when they’re Trick-or-Treating? Abominable.
Financially, if insurance companies stand to save a lot of money down the road for giving a little prevention upfront, wouldn’t they be all over pushing preventive things on us? Well, yes, but that assumes their upfront investments will save more money in the long run. They might, but if you’re on a different insurance plan by then, they don’t get to reap the savings from their investment.
But even if this kind of prevention is not cost-saving, wouldn’t the patient be motivated to save all that money and have a great quality of life up until they keel over at 100 years old? Yes, but this is far too long of a time horizon for us to be strongly motivated by it, especially when our culture pushes us so hard the other direction.
A better healthcare system is not going to be enough to fix this. Sure, it will help when the culture of our healthcare system changes and doctors start talking more about how to avoid those dwindle years where you’re alive but not very functional. But the primary solution here is a culture change. And I’m thankful that Peter Attia is pushing that change forward!
Clear Thinking on Healthcare 