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Health care reform.

I read with interest the roundtable on health care reform (Issues, Fall 1992). I wanted to discuss another facet of the issue that is often not addressed: the long-term effects of health behavior on our health budgets.

I think that it is certainly correct to attack the administrative excess in the health care field. In addition, managed competition should help reduce costs in the long run. However, to be truly effective at reducing the total health care budget, while providing coverage to the uninsured and keeping in check the escalating costs of advanced medical technology, I think it will be necessary to be very bold in promoting preventive health care measures.

A recent study by the American Medical Association noted that at least $1 of every $4 Americans spend on health care each year goes to treat conditions that result from substance abuse, smoking, street and domestic violence, and other potentially changeable behaviors. If we really want to cut health care costs, we must realistically look at the effects of our national health behaviors and take responsibility for the costs associated with those behaviors.

As preliminary budget measures, we need to consider:

(1) A $2 per pack tax on cigarettes. Such a tax would be expected to generate $38 billion in revenues each year. Increased excise taxes will raise revenue to reduce the deficit or pay for universal health care access, and they will lower the incidence of these behaviors (thus lowering health care costs in the long run, and also lowering the deficit).

(2) Increased liquor taxes. The taxes on alcohol should be made uniform and increased four- or fivefold so as to cover direct costs that are external to the alcohol user, the excess medical costs for the user, the lost productivity, and the costs to the United States due to decreased economic competitiveness. That would generate roughly $20 billion per year.

(3) Decreased health care costs within five years from preventive measures. These measures would include intensive educational programs to decrease smoking, decrease excess alcohol intake, increase exercise, improve nutrition habits, and promote other healthy behaviors.

(4) Decreased unnecessary medical interventions. For example, review boards and educational programs could implement a goal of 50 percent fewer Caesarean sections, which has been recommended by many studies.

Improving health behaviors might take more effort than imposition of higher excise taxes but could have tremendous effects on the health of Americans, and in the long term, greatly reduce health care expenditures. Getting Americans to follow the food pyramid guidelines and increase exercise levels would have dramatic effects. Besides the $58 billion per year in revenue that could be generated by the excise taxes listed above, I think that the national health care budget could be decreased by roughly $60 billion per year (from where it would be without such actions) within four to five years if the preventive measures related to items three and four were implemented.

The message about preventive medicine is so simple, and yet so important: In the long run, it really may be one of the best weapons in reducing health care costs in this country.

MICHAEL D. RABINOFF President Biogenesys, Inc. Albany, California
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Title Annotation:response to article in Issues, Fall 1992
Author:Rabinoff, Michael D.
Publication:Issues in Science and Technology
Date:Jun 22, 1993
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