Great discussion on this in comments over the weekend, including a smart and skeptical take from commenter JD. He argued that there was plenty of money to be made in chronic disease prevention. "In brief: employers save money, wellness companies make money, the diabetes industry loses money, and it's not clear what happens to health care [spending] overall or even an individual's medical expenses over a lifetime," he said. All true. In a sense.
The big player here are employers. If their employees are healthier, they pay less for their health care. A healthier population should benefit them. But in the political realm, employers are much more concerned with short-term goals like blocking the Employee Free Choice Act than bankshot efforts like improving long-term population-level health so that tomorrow's employees will be a healthier lot. Insofar as employers focus on employee health -- and they do -- they do it within their company, hiring nutritionists and offering incentives and changing the cafeteria. There's a lot of fascinating innovation happening in that area, but it's not on the level of lobbying the federal government for more walkable communities or fewer corn and meat subsidies.But one big player didn't get mentioned: The taxpayer. Diabetes, after all, is not randomly distributed. As you can see in the graph on the right, it's concentrated in the elderly (though every year, the average age of onset creeps forward). It also exacts a heavier toll on minority and low-income communities. Put another way: Diabetes is concentrated among populations that rely on Medicaid and Medicare and are thus subsidized by taxpayers. But taxpayers are diffuse. They're not an interest group. They don't have large meetings to settle on lobbying priorities to reduce long-term health care costs. The group that's perhaps most fiscally burdened by chronic disease is also the least able to focus its political power on public health. That's one of the fundamental asymmetries explaining why health care spending gets more attention than health.By contrast, the interest groups that treat chronic disease -- device manufacturers and pharmaceutical companies and hospitals -- have a direct incentive to set lobbying priorities that maximize profits from disease treatment. The pharmaceutical industry alone spent $168 million on lobbying the federal government. And that was just during 2007. Which is not to say diabetes is some industry plot. It's to suggest there's a good reason why the political system spends a lot more time ensuring access to costly medical interventions than reducing the need for those interventions in the first place.
The big player here are employers. If their employees are healthier, they pay less for their health care. A healthier population should benefit them. But in the political realm, employers are much more concerned with short-term goals like blocking the Employee Free Choice Act than bankshot efforts like improving long-term population-level health so that tomorrow's employees will be a healthier lot. Insofar as employers focus on employee health -- and they do -- they do it within their company, hiring nutritionists and offering incentives and changing the cafeteria. There's a lot of fascinating innovation happening in that area, but it's not on the level of lobbying the federal government for more walkable communities or fewer corn and meat subsidies.But one big player didn't get mentioned: The taxpayer. Diabetes, after all, is not randomly distributed. As you can see in the graph on the right, it's concentrated in the elderly (though every year, the average age of onset creeps forward). It also exacts a heavier toll on minority and low-income communities. Put another way: Diabetes is concentrated among populations that rely on Medicaid and Medicare and are thus subsidized by taxpayers. But taxpayers are diffuse. They're not an interest group. They don't have large meetings to settle on lobbying priorities to reduce long-term health care costs. The group that's perhaps most fiscally burdened by chronic disease is also the least able to focus its political power on public health. That's one of the fundamental asymmetries explaining why health care spending gets more attention than health.By contrast, the interest groups that treat chronic disease -- device manufacturers and pharmaceutical companies and hospitals -- have a direct incentive to set lobbying priorities that maximize profits from disease treatment. The pharmaceutical industry alone spent $168 million on lobbying the federal government. And that was just during 2007. Which is not to say diabetes is some industry plot. It's to suggest there's a good reason why the political system spends a lot more time ensuring access to costly medical interventions than reducing the need for those interventions in the first place. 
