Health care And The Rising Rate Of Dementia

The population is aging and along with it the number of people with dementia and Alzheimer’s is likely to rise rapidly. Demented seniors and Alzheimer’s victims can live for years which creates a tremendous burden on the health care system and the families of the patients. These are the kind of diseases that are likely, as the number of people with them increase, to keep upward pressure on medical costs.

The need for health care reform, which is ultimately aimed, based on the Administration’s plan at high quality, universal coverage at low costs is likely to be challenged by the rise of chronic illnesses. A number of experts have suggested that one of the ways to offset this is to build preventive medicine into the system so that more people stay healthy for longer periods of their lives. But bad habits flourish particularly in a wealthy society in which access to food, drink, and tobacco is almost universally available. Calorie-restricted diets may prolong life span, and in some impoverished parts of the world there may be very few calories per person available. That is not, however, a problem in the United States.

A new study of nearly 10,000 people conducted by medical experts at the University of Kuopio in Finland and Kaiser Permanente’s Division of Research found that people with moderately high levels of cholesterol in their 40s were at a 52% greater risk of becoming demented in old age than people with normal or low cholesterol. Moderately high was defined as a reading between 200 and 239. People with very high cholesterol, over 240, had an elevated risk for dementia of 66%.

Reuters quoted the researchers as saying “Considering that nearly 100 million Americans have either high or borderline cholesterol levels, this is a disturbing finding.”

This news takes the debate about health care back to the issues of whether people should be forced to lead healthier lives or be taxed if they refuse to do so. It may be easy to say that heavy smokers should pay more for health care, but in an egalitarian society it simply may not be acceptable to have a penalty for those afflicted with bad habits, afflicted by them, or afflicted because of them. The basis of the current social and financial contracts among potential patients, health care providers, the insurance companies, and the government is that those with the worst habits exist within the system no more encumbered financially by health surtaxes than those who are abstemious and fanatical about their health.

The current plans for health care reform have a number of flaws. Among those is that the new programs may tax the rich to underwrite care for the poor, that small employers may be required to make insurance contributions that they cannot afford, and that tort reform is not found anywhere in the process. The value of each is a matter of debate and none of the present plans are likely to be favored by the wealthy.

What is most disquieting about the savage fights over who will pay for health care is that it is never mentioned that bad habits should be part of the discussion of health care benefits. That may be because it is un-democratic.

The issues of whether to tax the profligate are further complicated by a possible need to create a number of levels of dissolute behavior, much like those found in Dante’s Inferno.  In this case, the worst habits should be taxed most of all.

It is hart to stop smoking and boozing. Alcoholics Anonymous has been one of the greatest eleemosynary organizations of the last century, a testament to the difficulty of breaking the patterns of alcoholism. There is no place for people with high cholesterol to go to eschew bad eating practices and begin a regimen of exercising five days a week, 20 minutes per session. Almost all of the medical research shows that those with lower cholesterol would not only be physically healthier but would keep their wits for many more years.

Most people with high cholesterol can be “cured” by a pill or a little bit of weight loss, or a daily sprint on a stationary bike.  Those who refuse these options should be taxed. Some would repent their bad habits and would be better for it, as would the health care systems and its finances.

Douglas A. McIntyre