2+2=5

I clipped sentences while reading the last few weeks with the intent of compiling them for this post.  I want you to examine below and glean a pattern.

• It’s estimated that more than 5 million Americans have Alzheimer’s.  It helps drive the nation’s health care costs — some experts place the estimate at more than $180 billion annually.
• Cancer costs are projected to reach $158 billion, in 2010 dollars, by the year 2020, because of a growing population of older people who are more likely to develop cancer.
• Today, one in five health care dollars is spent caring for people with diabetes. A third of Medicare spending goes to treat diabetes and its complications.
• Employers are finding that it makes business sense to promote workforce health and productivity, recently linked to $576 billion in costs due to medical and pharmaceutical use, lost productivity, and wage replacement.
• In 2008, the direct medical costs of stroke were approximately $18.8 billion, with almost half of this amount directed toward hospitalization
• In 2008, obesity-related medical costs were an estimated $147 billion, up from $78.5 billion in 1998
• Cardiovascular disease causes one of every three deaths in the United States and costs this country about $450 billion annually.
• It is likely that follow-up testing from general health checks substantially contributes to the $210 billion in annual spending on unnecessary medical services
• Alcohol contributes to 79,000 deaths and $223.5 billion in societal costs annually in the United States.
• Annual health care costs are roughly $96 billion for smokers
• A new Institute of Medicine report estimates there is $750 billion annually in wasteful health care spending in the United States
• …which are expected to exceed $2 trillion, according to the Alzheimer’s Association.
• Epilepsy is a recurrent seizure disorder that affects some 2.3 million Americans, and may be responsible for as much as $10 billion in U.S. healthcare expenditures annually
• The cost of depression (lost productivity and increased medical expenses) is $83 billion each year
• Treating ESRD patients cost the United States over $40 billion in public and private funds in 2009.
• Cancer care accounted for an estimated $124.6 billion in medical care expenditures in the United States in 2010.

You see many dollar signs. If I perused every article reviewing the twenty or thirty most common diagnoses or procedures we employ in medicine, extracted cited costs, summed them up, and compared them to what we know ($2.7 trillion spent on healthcare in 2011 incidentally), I am certain the calculation would eclipse by a comfortable margin the aforementioned  total.

Researchers and advocacy groups want you to know the cost of their cause.  They will tell you, believe me.  The obligatory intro sentence with an eye-popping calculation accompanies every article, and the above sample proves it.

Due to numeracy issues, and lack of anchoring beyond a billion dollars (I am guessing once past a billion, we all lose perspective), most folks cannot prioritize high versus low, urgent versus inconsequential costs.

A policy wonk or number cruncher sees this:

Asthma care cost the United States $56 billion in 2007.

And John and Jane Q. Public?  They read this:

Yup, it’s all Greek to me.  Or in this case, Chinese.

To illustrate with an example, we spend 18 billion per year on stroke care.  However, compare 18B with cardiac care’s 45o billion.  Given the magnitude of both sums–beyond awareness for most folks, relative and absolute connections go out the window.  The 25x difference means nothing.  Household budgets encompass far fewer zeroes and no citizen can grasp the scale of figures like these without context.  Even then, I believe comprehension goes beyond expectations.

John and Jane Q. Public should see this:

I highlight the above for obvious reasons.  For most folks, including docs, using dollar figures like in the articles quoted equals useless, and inured to these totals, no one can understand their implications.

More accessible an approach might be expressing actual spending, research dollars in the case below, in relation to disease burden:

Refine the graphic, accompany the figure with some simply expressed calculations, and maybe, just maybe, folks will discern a point (like we grant fund too much on AIDS, and too little for alcohol abuse based on disease burden).

The press and journals must focus on the weaknesses of readers, in our case, interpreting the nuance of huge sums of cash.  Relative and absolute sums matter.  Zeroes matter. Writing style matters.  We have a trillion dollar healthcare headache for a reason.

To reach professionals and laypersons alike, the continued use of billion and trillion in a willy-nilly manner impedes learning and makes us numb.  We ask for the adult conversation.  We cannot participate when we cannot spell.  After all, when you read the next medicalized acronym costs us 77B per year, your bullshale detector can be put to better use.