A little while back I saw a report entitled “Retirement and Health,” which was published by the Harvard School of Public Health, National Public Radio and the Robert Wood Johnson Foundation. Among the statistics in the report was this one: 32% of people above retirement age and 29% of people below retirement age (under age 65 for this purpose) expect to live into their 90’s or 100’s. In other words, nearly 1/3 of all Americans expect to live well beyond what is currently the national average lifespan. That is a lot of glass-half-full thinking–you go people!
Right now the average U.S. life expectancy is 76 years for men (up from 70 in 1980) and 81 years for women (up from 77 in 1980). We have made progress, but that is still a long way from living to 100. In fact, current life expectancy for those at age 65 now is 17.6 years for men and 20.3 years for women (contrary to popular belief, women do not live longer than men because they murder the men they live with, but because they have fewer health risk factors).
But here’s the thing: 30% of us are not going to get as near to getting a happy birthday from Willard Scott as we might think, at least not at given the way we are currently taking care of ourselves. At this moment, the US Centers for Disease Control (CDC) states that more than 24% of Americans over 65 are in “fair or poor health” and 10% of our entire population is characterized that way. the big culprits are the ones we all know: heart disease, stroke, cancer, high blood pressure, high cholesterol, diabetes, smoking. Unfortunately the incidence of every one of these categories, except smoking and high cholesterol, is up, up, up.
We hear an awful lot about a variety of preventive health measures we should all be taking to outrun the Grim Reaper and extend our lives. We must eat right, exercise, take our medications when we’re ill, avoid germs by hand-washing, you name it. The healthcare industry is awash in companies trying to help us wring 100 years out of that lifetime membership to TIVO that we bought before we knew about AppleTV. But what the healthcare industry never really talks about is how the decline in the state of the U.S. education system may ultimately turn the lifespan time clock backwards and make much of our healthcare cost containment efforts moot because our kids can’t get a decent education. We can save a dollar here or a dollar there through aggressive care management, more generic drug use and redcing the cost of paying claims, but if we raise the next generation to be less educated than our own, and thus less thoughtful and prevention-oriented about their health and everything else, we are, and I mean this in the most professional way, screwed.
I generally try not to get too political in this blog because I know how sensitive people can be. I don’t want to make any of my Democrat friends cry like babies or my Republican friends shoot off their firearms. But as I looked through the information in the US Department of Health and Human Services 2011 Report on Health, an effort they undertook with the CDC and the National Institutes of Health, it really crystallized for me that what our federal, local and state governments are doing to defund education in the US, intentionally or unintentionally, could ultimately render totally irrelevant all our efforts to save healthcare costs through improving hospital efficiency or reducing medical errors or making doctors accountable, or limiting health insurance company profits or inventing better medical devices or tracking our damn footsteps on iPhones or whatever the hell else we all do for a living. We might win the battle here and there, but we will lose the war.
I am addressing this rant, by the way, to the people who work in the business of delivering, supplying and insuring healthcare as an industry, not to the public health crowd. People who work in academia and public health know a lot of this information. But the people who separate themselves into the industry that makes money by selling drugs and devices, health insurance, and direct physician and hospital services don’t talk about education much at all (for shorthand I am going to call this group the “healthcare industry” in this article). Every once in a while we healthcare industry folk talk about educating consumers to be smarter consumers of the healthcare services they are using, but that is a far cry from talking about the pure topic of childhood and college education and how that impacts healthcare spending. Most of the time people in the healthcare industry don’t talk about public health issues at all, except on the first slide of their investment pitch when they are trying to convince VCs like me about the size of the market opportunity.
Why this matters is very clear: quality of health status is directly and indisputably correlated with education. Every meaningful study on this topic has demonstrated that the higher one’s level of education, the healthier one is likely to be. I’m not even going near the issues about how education reduces poverty, which is itself one of the greatest contributors to poor health status, as that might alert Rush Limbaugh to my existence, thus reducing my lifespan by making me suicidal. I’ll just stick with a very poignant few paragraphs from the HHS Annual Health Report. According to HHS, CDC and NIH:
“…the link between education and health appears to operate through several pathways. Highly educated persons are more likely to be employed and well-paid than the less educated. They have a higher sense of control over their health and lives and more social support (3). In addition, the well-educated are more likely to engage in healthy behaviors and avoid unhealthy ones (3). All of these factors are associated with better health (4) and help explain health differences by education level. In addition to the effects of high socio-economic (SES) status on health, poor health may limit the ability to work or function in society and can lead to lower income and more difficulty obtaining educational and employment opportunities (5). Health-related behaviors such as cigarette smoking and physical inactivity are more common among those with lower SES than among their high-SES peers.”
“Similarly, adults without a high school education are four times as likely to lack health insurance as those with a Bachelor’s degree. These disparities in insurance contribute to SES health disparities and help to explain why low-income and less educated people have less access to care than higher income and more educated persons. Preventive health services such as immunizations prevent infectious diseases, and screening and early detection of diseases such as cancer can substantially increase longevity and quality of life. SES disparities in receipt of such services start early in life and continue through old age. Low-SES women are less likely to use contraception at first sexual intercourse than high-SES women. Less educated and lower income pregnant women are less likely to receive adequate prenatal care. The percentage of children who receive recommended vaccinations rises with maternal education and income, although these gaps have narrowed in the 2000s. SES disparities persist into adulthood. Those with higher education and income are more likely to undergo mammography and colorectal cancer tests and procedures. Elderly adults without a high school diploma are less likely than their more educated peers to receive an influenza or pneumococcal vaccination.”
So why should this send us into a full tilt economic panic? Because our best hope for improving the health and therefore the economic health of our nation is to ensure that more and more of our citizens achieve higher levels of education. And we are working hard as a nation to make sure that doesn’t happen. We haven’t all gone full tilt Rick Santorum crazy who has suggested that college is for snobs, but our national economic ills have led Congress to adopt measures that may lead to an automatic across the board 9.1% reduction in all federally-funded education programs on January 2, 2013 if congress is unable to come up with some other way to reduce the deficit.
According to the non-partisan Committee for Education Funding, “These cuts (called “sequestration” in federal jargon) would chop funding for programs in the Department of Education by over $4.1 billion. In addition, Head Start would be cut by $725 million. This would be the largest cut ever to education programs. Additional cuts to education programs (including Pell grants) will likely occur in Fiscal Years 2014 through 2021 due to stringent “caps” on so-called discretionary-funded programs, which include all education programs (other than student loans) and Head Start.” CEF’s article details the expected cuts and points out that these cuts would be in addition to over $1.5 billion (down almost 3%) in education funding cuts adopted by Congress last year.
My own state, California, is now ranked 47th overall in how much it spends per student – $8,667 when adjusted for regional cost differences, about $3,000 below the national average of $11,665. Considering how crushing healthcare costs are in this state, making it harder to get an education isn’t going to help.
Our national leaders have been out there banging the drum about increasing the number of college graduates in the U.S. This is usually spoken about in the context of job opportunity and as a method to lift families out of poverty–both excellent goals. But one of our best reasons to meet the goal set by President Obama of adding 5 million more college graduates by 2020 is to ensure that our next generation of citizens is less expensive to care for because they are in better health. Love him or hate him, you would be foolish to disagree with him about the validity of this goal. Other key policy leaders say that we need to achieve a rate of 60% of adults getting a college education by 2025 if we are going to remain competitive as a nation.
Sadly, as it stands today, a recent report by the Center for Law and Social Policy and the National Center for Higher Education Management Systems projects a shortfall of nearly 24 million college degree-holders by 2025. The Center estimates that the cost to the U.S. of failing to produce these college graduates is about about $600 billion a year in lost wages and income taxes. But this completely leaves out the additional healthcare costs our nation will have to bear because there will be more smokers, more obese people, more heart patients, more diabetes, fewer preventative care services and fewer early detections of cancers because our populace will be less educated. FYI: the three countries with the highest college-attainment rates–Canada, Japan and South Korea–are all expected to reach the 60 % target by 2020.
To bring this full circle, it is worth noting that, according to the Annual Health Report described above, the gap in life expectancy between the least and most educated has continued to grow for both men and women. Between 1996 and 2006, the gap in life expectancy at age 25 between those with less than a high school education and those with a Bachelor’s degree or higher education increased by 1.9 years for men and 2.8 years for women. On average in 2006, 25-year-old men without a high school diploma had a life expectancy 9.3 years less than those with a Bachelor’s degree or higher; women without a high school diploma had a life expectancy 8.6 years less than those with a Bachelor’s degree or higher. So for all those people who expect to live to 100, I hope you went to college or your chances are looking bleak. Furthermore, whatever your own educational level, if you want your kids to live longer than you do, your best bet is to do whatever you can to ensure they maximize their educational careers and to vote for candidates who actually give a damn about this issue.
As for the healthcare industry, it would be well worth all of our whiles to do whatever we can to encourage our leaders to augment educational funding. Aside from directly lobbying our politicians on this point and publishing articles highlighting the health status variances in our own covered populations, maybe there are some other things we can do. A few crazy ideas: While it may give short term gratification for us to receive refund checks from our insurers when they realize “excess profits,” maybe we are better off if some of those dollars go to fund local schools. Wouldn’t it be great if some of the fines and penalties levied on hospitals for medical errors and regulatory non-compliance were redirected to education? Maybe instead of sponsoring sporting events, large healthcare companies should establish significant college scholarship programs, which could also be funded by Medicare penalties levied against those who do not ultimately adopt EMRs. Maybe for every dollar we give as pay-for-performance bonuses to ACOs we could donate a penny to education funds. How about all fines collected by the government related to Medicare fraud goes straight into Pell Grants? I’m sure there are a million reasons why these are bad ideas and I’m sure there are lots of better ones, but the dialogue, at least, should be happening.
I am quite confident that 100% of people in the healthcare industry (or at least 100% of the sane people) would agree that raising a healthier next generation of people, who practice wellness and prevention for life and make active choices that reduce chronic illness, is the only real way to break the cycle of ever-rising healthcare costs. Just as the leg bone is connected to the knee bone, the health of our children is connected to their receiving a quality education. Educating healthcare consumers to take care of their current health is important, no doubt about it, but giving all of our citizens access to a college education so they consume a whole lot less healthcare would be much more cost-effective in the long and short run.