I'm a little bit loathe to enter this subject because I'm finishing up an article on a related topic. But suffice to say that even though the data on whether being healthier would make health care cheaper is pretty mixed, we can still be pretty sure it's a good thing.
Paul Campos offers the standard argument against assuming that better health means lower costs: Not smoking makes you healthier. But refusing to die young makes you more expensive because you have more time to develop Alzheimer's after you've already developed diabetes. Ergo, not smoking does not make you cheaper. Dying young makes you cheaper.
True enough. On the other hand, not being obese probably does make you quite a bit cheaper. The thing about chronic illnesses like diabetes is they require a lot of upkeep. It's not like dropping dead of a cardiac arrhythmia. It's frequent, sustained, and costly stays in hospital rooms. And as we get better and better at keeping diabetics and heart disease patients alive, they get more and more expensive. Reducing chronic conditions probably would lower costs.
One way of thinking about this is to just look at the numbers. National health care spending was $1.12 trillion 1997. It was $2.24 trillion in 2007. And we're not twice as healthy or twice as long-lived. Some of that cost increase comes, of course, from more old people, and some from pricier medical technology. But a lot comes because we're sicker. The economist Kenneth Thorpe has estimated that the majority of cost increases are the product of increased chronic disease. I don't quite agree with that spin on the data, but there's little doubt that we're spending more on medical care because we need more medical care.
The counterargument to this would be that if we weren't sicker, then we'd be living longer, and maybe that would cost money, too. And maybe it would. Sure seems worth a try. If the end point of health reform is not that we spend fewer dollars, but that we get a lot more health for the dollars we do spend, that'll be a good outcome.