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Sam Uretsky

Sam Uretsky
Wantagh, New York, US
July 31
I have two degrees in a field that no longer particularly interests me, and a growing interest in economics, history and politics. At this point, I consider myself a full fledged member of the Ancient and Hermetic Order of the Shrill.


DECEMBER 14, 2011 8:35AM

The Cost of Cutting Costs

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The United States Centers for Communicable Disease Control has reported an increase in the number of cases of type 2 diabetes among people under the age of 20.  Type 2 used to be called Maturity Onset Diabetes, and is marked by resistance to insulin.  In Type 1, which used to be called Juvenile Diabetes, the body doesn’t produce enough insulin to meet its needs; in type 2, the insulin is present, but it doesn’t function as well as it should.  Type 2 diabetes has been linked to obesity, which is a growing problem in the United States and most of the developed world.  

The American Diabetes Association estimates that 215,000, or 0.26% of all people under the age of 20 have diabetes, although this figure may be low because there is no general screening program, and the condition is more common among low income people who are less likely to see a physician than those in more affluent groups.  Estimates of the costs of diabetes care are all over the lot and shouldn’t be relied on, but one of the more impressive studies puts the cost of control of uncomplicated diabetes, where the only expense is monitoring blood sugar and basic drug therapy at $11,000 per person per year.  Once complications set in, which can include heartg attack, stroke, blindness and nervous system problems, the costs jump to $44,000/year – but complications are rarely seen in the under-20 population.  Even so, the direct medical costs for type 2 diabetes among children comes to $236,500,000, most of which is probably paid by State Children's Health Insurance Program (SCHIP).  

Most of these expenses could be eliminated by reducing the incidence of childhood obesity, by improving childrens’ diets and increasing the amount of exercise they get, but on Novermber 12, Congress, responding to lobbying from major food marketers, blocked proposed Department of Agriculture rules that were intended to reduce the calories and sodium levels in school lunches by increasing the amounts of fruits and vegetables served.  Under the proposed rules, a slice of pizza would only count as a vegetable if it contained at least a quarter cup of tomato paste.  The lobbyists protested, probably accurately, that this would result in soggy pizza.  Wjo knew that school lunches had gourmet aspirations?

Another diet related problem, this one associated with maternal diet during pregnancy, is spina bifida, a condition in which portions of the vertebra do not close fully.  While in its mildest form spina bifida patients may be asymptomatic, in more sever cases affected babies have some degree of leg paralysis and bladder- and bowel-control problems.  The exact causes of spina bifida are unknown, and there may be a genetic component, but risk factors include maternal obesity and maternal diabetes.  Fortification of some foods with folic acid has reduced the rate of spina bifida, but even then, monitoring is called for and additional supplementation may be needed.  For most poor women, the most accessible source of prenatal care has been Planned Parenthood, which provides a fulol range of gynecologic services including prenatal care, including prenatal vitamins.  Congress has defunded Planned Parenthood because the organization also provides abortion services.  Since no other organization has the resources to replace Planned Parenthood, and the anti-abortion activists have made no effort to staff their centers with qualfied clinicians who can provide gynecologic services, there may be more infants born with neural tube defects.  According to the Spina Bifida Association “The economic and social costs associated with Spina Bifida - for both the affected individuals and their families - can be significant.  The average total lifetime cost to society for each infant born with Spina Bifida is approximately $532,000 per child.  This estimate is only an average and for many children the total cost may be well above $1 million.   Estimated total annual medical care and surgical costs for persons with Spina Bifida in the United States exceed $200 million.   Currently available statistics on the cost of Spina Bifida are estimates based on the average dollar in the mid-1980s.  Therefore, due to inflationary increases over the past two decades, these cost statistics likely are higher..”  Many cases of spina bifida could be prevented with proper prenatal care, but Congress chose to cut off funds to the one organization that was providing affordable care to the uninsured.  The bills will turn up, but they’ll be charged on a different line of the ledger.

Finally, one of the factors in prematurity is maternal diet.  The full list of risk factors for premature delivery include maternal overweight and underweight.  Prenatal care can reduce the number of premature infants.  Modern medicine can save the lives of preemies, but the financial costs are dramatic.  A 2008 report in Bloomberg Business said “A 2006 report by the National Academy of Sciences found that the 550,000 preemies born each year in the U.S. run up about $26 billion in annual costs, mostly related to care in NICUs. That represents about half of all the money hospitals spend on newborns. But the number, large as it is, may understate the bill. Norman J. Waitzman, a professor of economics at the University of Utah who worked on the National Academy report, says the study considered just the first five years of the preemies' lives. Factor in the cost of treating all of the possible lifelong disabilities and the years of lost productivity for the caregivers, and the real tab may top $50 billion, Waitzman says.”  
With the exception of a single payer healthcare system, the best way tio hold down healthcare costs would be to assure a proper diet for everyone, or at least a bottle of multi-vitamins for those who are at greatest risk.  Instead of paying the price of a decent meal, we're paying the price of rectitude, and it's more than we can afford. 

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