In my Baltimore Sun column today, I ask the $7 trillion dollar question few seem to be asking, no less answering:
In October 2007, the Milken Institute published "An Unhealthy America: The Economic Burden of Chronic Disease," a report analyzing the long-term economic costs of leaving unchecked just seven maladies: cancer, heart disease, hypertension, mental disorders, diabetes, pulmonary conditions and stroke. Comparing a scenario of "reasonable improvements in treatment and behavior" with a "business as usual" baseline, the report estimated that cumulative savings in health care expenditures over two decades, from 2003 to 2023, could total $1.6 trillion. That's $80 billion saved per year - no small sum.
But those savings are dwarfed by the costs to the American economy caused by an unhealthy work force. "Chronically ill workers take sick days, reducing the supply of labor - and, in the process, the GDP," the report's executive summary explains. "When they do show up to avoid losing wages, they perform far below par - a circumstance known as 'presenteeism,' in contrast to absenteeism."
Milken's estimated cumulative loss to America's GDP of doing nothing during the same period? Almost $7 trillion.
We wouldn't tolerate $7 trillion sort of inefficiency and loss if it resulted from a tax increase or proposed business regulation. Wouldn't Grover Norquist and his gang be screaming tirelessly, perhaps with cause? Yet as a nation we sit back passively and allow our capitalist economy to be hobbled by solvable problems affecting the most important infrastructural input of all: the labors of the American workforce. What's amazing is that American workers today work longer hours and are more productive than earlier generations of workers--despite our health problems.
When the government does or doesn't do something that is bad for American capitalism, relevant business interests step to the fore to correct the problem. "The business of America is business," is the famous misquote from Ronald Reagan's favorite president, Cal Coolidge. So why hasn't corporate America stepped forward--long before Barack Obama even arrived on the national scene--to complain about the business inefficiencies of an unhealthy citizenry?
But the tougher, more political question I want to ask is this: Why hasn't the president framed his calls for health care reform--either in subtle or more direct, forceful ways--in terms of American economic performance and productivity? Wouldn't that put a lot of his conservative critics back on their heels? Wouldn't it rally more corporate interests and trade associations to his side?
I can't find any polls to bolster my suspicions--typical national polls ask Americans whether they support reform legislation or whether they approve of the government's handling of the health reform issue--but I suspect that too many Americans conceive of health care reform as a purely fiscal issue, a matter of taxing and spending. Worse, a significant subset of them surely view reform in terms like those recently invoked by Mike Huckabee: that is, as some stealthy, redistributive grab, just another big-government Democratic initiative to take money from their pocketbooks for an entitlement program to help the poor, indigent or other undeserving types.
Now, it's true that reform will cover more people who don't have the means to insure themselves. But whether they're poor or middle class, the uninsured or merely underinsured also go by another name: the American workforce. And the less we think about them as patients, and the more we think about them as workers essential to American productivity, the easier it is going to be politically to fix what ails us. And instead of a national conversation about how we can't afford health care reform, the president's oft-stated macro point that we can't afford not to reform the system would be a lot easier to make.