Cardiovascular Disease in the United States
The harms of cardiovascular disease are not limited only to an individual’s health. The cost of CVD can also create a large burden on an individual’s finances. When CVD causes hospitalizations, especially in the case of an acute myocardial infarction, commonly known as a heart attack, short-term expenses are extremely high. The costs include ambulance rides, diagnostic tests, hospital stays, and immediate treatment that may be include surgery. Short-term costs aside, CVD remains expensive for the long-term due to the price of drugs, tests to monitor the progress of the disease, and frequent doctor appointments. The high cost of CVD is compounded by the lack of productivity and income that diseased individuals may have.
With CVD affecting so many individuals in the United States, the price of the disease adds up. Through the direct cost of the disease and the indirect money lost due to lack of productivity, CVD acts as a large financial burden on the United States economy. The combined direct and indirect cost of CVD in the United States was estimated to be $444 billion in 2010. This staggeringly high number corresponds to $1 out of every $6 spent on healthcare (Centers for Disease Control, 2010). These numbers indicate that heart disease is not only a huge financial problem for the United States’ healthcare system, but it is also weighing down the general economy.
Furthermore, the cost of CVD accounts for 30% of Medicare expenditures (Trogdon et al., 2008), and 53% of individuals with Medicaid suffer from some type of heart disease (“Critical coverage”, 2011). These programs are predicted to expand in the coming years (“Critical coverage”, 2011), in part due to the increasing age of the US population. The money to finance increased expenditure on Medicaid and Medicare originates from tax dollars. Thus, along with burdening those suffering from CVD and the general US economy, CVD also serves to affect all taxpayers. Consequently, heart disease has a huge effect on the United States economy.
The graph below shows direct cost of CVD treatment in the United States (note, firstly that the treatment cost alone does not represent all the direct costs of CVD, and secondly that the Y-axis denotes billions of dollars).
The purple line represents the measured or predicted treatment expenditures related to heart disease, while the green line represents the estimated expenditures that would occur if small adjustments were made to improve heart disease prevention.
Employees suffering from heart disease require additional days off and can be less productive in the workplace. Additionally, the premature death caused by heart disease takes a toll on the output of the general workforce. In 2010, an estimated $41.7 billion in potential productivity was lost due to CVD-related employee morbidity, and $137.4 billion was lost due to CVD-related premature deaths (George & Hong, 2011). A graph of these costs can be seen below (note that the Y-axis denotes billions of dollars).
Again, the dark purple line represents the measured or predicted cost of CVD due to loss of productivity, while the light purple line represents the estimated cost that would occur if small improvements were made towards CVD prevention.
The two graphs illustrate the high existing burden of heart disease on the economy, as well as the growth potential of these costs if no changes are made. To lower the costs of CVD, individuals must be encouraged to make small changes in their lifestyles to prevent the onset of heart disease. The graphs depict the large differences in cost such small changes can achieve.
These preventative changes include monitoring weight, exercising for at least 30 minutes a few times a week, avoiding smoking and inhaling second hand smoke, and eating healthy.
Making just one of these changes can have a considerable impact on an individual’s health. Reducing one’s systolic blood pressure by 13 mm/Hg over 4 years can reduce the risk of coronary heart disease by 21%, stroke by 37%, and CVD-related death by 25% (“Heart disease and stroke”, 2012).
Small changes can have a large impact on the incidence of CVD, and these changes can also have a large effect in reducing the economic burden of CVD. A 2008 study indicates that investing just $10 per person per year on community based initiatives to increase physical activity, improve nutrition, and reduce smoking can return $5.60 for every $1 put in due to the decreased amounts of CVD expenditures that would be required (“Heart disease and stroke”, 2012). Altogether, this investment could save $16 billion/year on CVD costs, which breaks down into $5 billion saved in reduced Medicare expenditure, $2 billion saved in reduced Medicaid expenditure, and $9 billion saved in reduce private expenditure.
Arguably, this $16 billion saved in CVD costs puts little dent in the total $444 billion that is being spent. However, such an investment would be a good step towards reducing the economic impact of heart disease. Why, then, is no such step being effectively implemented on a national level? The answer may lie in the investment that such an initiative would take. While the long-term returns may prove to be fruitful, they may take a generation or two to appear. An investment now would probably do little to change the behavior of the generation that is currently affected by heart disease. Furthermore, living a preventative lifestyle is not possible if one already suffers from the disease, and thus the investment would not necessarily help older generations. The older generation, too, has already incurred a considerably large cost which is not refundable. Thus, the benefits from a healthy living initiative would be seen as younger generations age. If their behaviors reflect a healthy lifestyle, they will be less likely to develop CVD. However, it would be the older adult generations that would be paying for the initiative that would benefit the younger generations.
As we have seen in multiple environmental cases, people often avoid investing in areas that will not result in personal benefit. In this case, the short-term cost is high and the benefits are low, while the long-term cost is low (the initiative may actually ultimately save money) and the benefits are high. If such an initiative were implemented, it would benefit individuals financially since they would ultimately be paying less for national healthcare and in general because they would be likely to have better overall health. Furthermore, the US economy would benefit because less money would be spent and lost on CVD. Thus, there would be many beneficiaries from such an investment. However, the groups that benefit are temporally removed from those paying the cost. Such a distance limits the government’s ability to take action against CVD.