Who Profits When You're Sick? The Truth About Chronic Disease in America

Nearly $4 trillion is spent on U.S. health care every year — and the CDC says most of it goes toward chronic disease. In this episode of the Healthcare Management Masterclass, we break down exactly what pushes people into the costliest 5% of patients, why that 90% statistic is more complicated than it sounds, and the honest, non-conspiratorial truth about which industries benefit financially when Americans stay sick — from fee-for-service medicine to pharmaceuticals to processed food. You'll walk away with a clear understanding of the incentives shaping the system and practical, evidence-based habits that actually keep you out of a hospital bed.

In this episode:

• Why 5% of patients drive nearly half of all U.S. health care spending
• The truth behind the "90% of spending goes to chronic disease" statistic
• How fee-for-service, pharmaceutical, food industry, and insurance incentives really work
• Five concrete, research-backed habits that lower your chronic disease risk
• What healthcare leaders should learn from the shift toward value-based care

Transcript

SPEAKER_00 0:10

America, we are the richest nation in the history of the world, and we are by numbers one of the sickest four point five trillions that is what this country spends on healthcare every single year, more than the next nine countries combined, and still heart disease is killing us, still diabetes is claiming, still our children is getting sicker younger than any generations before then. So ask yourself these questions that industrial hope you never ask. If a system spends trillions and the people inside it keep getting sicker, is that system broken or is that system working exactly as it designed? I am Paul Thomas. This is the healthcare management masterclass Paul Chaos. Now I want to say this plainly because truth does not need decorations. This is not conspiracy theory, this is economics, whole documented, referable to economics, fee for service, recurrent prescriptions, manage conditions. A patient who is cute is a patient who stopped paying. A patient who is managed pay for the rest of their life. That is not an accusation, that is a business model. Once you see it, you cannot unseen it. So today we are going to do it all. Something you can start using before the sun comes up tomorrow. Because knowledge is the one prescriptions they cannot take back. Get comfortable. This one is going to run long because the truth does not fit in a sound bag. Now, before we go on further, let's talk about how we get here. Not with opinions, not with courage, with numbers. You can check yourself because in this business, in this ministry, the truth matters. We do not deal in what we feel, we deal with what is truth. So turn the page with me. Let's look at the real numbers, the real mathematical numbers. The real numbers, you have heard the numbers before 90% of the health spending goes to chronic disease. You have seen it on the website, hear it from politicians, but here is what a preacher owns his congregation: the truth. Even when the truth is inconvenienced, even when the truth is less dramatic than the versions that go virus, that numbers is not exactly right. And I need you to understand why it is not right because the truth, when you actually look at it, is still enough to shake you. A man with high blood pressures get coveted feedback. The bill gets counted as chronic disease spending. That is not treating the disease, that is just counting a man who happened to have one. So somebody somewhere took a number that was already big and made it bigger because bigger numbers get clicks, bigger numbers get shared, bigger numbers get you mudding your head before you have checked a single source. So let us deal with the real issues. When you count the full downstream costs, the hospitalizations, the prescriptions refilled every day, the follow-up versus that never cease to end, the complications that start on top of complications. The American Action Forums using Detach Creed from a Central for Medicare and Medicaid Service put that number at 84% for Medicaid beneficiary, specifically 99%. For Medicaid, 80%. Every single honest measurement using every honest method point to the same conclusions. Every single measurement news come to the same conclusions. Chronic disease is not a cost-driven in American healthcare. Over decades, a system where the sickest among us, the one managing three, four, to five conditions at once, have become the foundations the entire industry is built to serve. So hold on to that number, hold on to the five percent in half. Because in the next part, I'm going to show you exactly why the system is built this way, not with outrage, not with speculations, but with the same discipline we just need to correct the 90%. Let's talk about mechanics, not conspiracy, not speculations, mechanics. Because if you want to understand why the system behaves a certain way, stop asking what people believe and start asking how people get paid. That is the whole lesson. A provider gets paid for what they do, not for how well you end up. A data bill for the office visit, a lab bill for the text, the hospital bill for the state. Nobody, I mean nobody sent an invoice that says patients still healthy, never came back. Please remake payment for a live well live. There is no building call for acute. A man is patients, someone who returned every night this for the rest of their life is revenue, quarter after quarter, years after years, decade after decade. Now hear me, that is not evil. I am not calling any doctor evil, any nurse, any hospital administrator evaluation. Most of them enter this field to heal people, and they do every single day in exam room or around this country. But the system they are working in was not built by accident, it was built by incentive, and that incentive says activity gets paid, outcome does not. That is why volume-based care paying for outcome instead of volume has been the single biggest refund threat in the American health policy for the last 15 years. That is why it is threatening. Years after years, budget cycles after budget cycles to change it. Second, chronic care management itself has become a product land. All on this, there are non-specific building calls, CPT core, if you want the technical language, building entirely around the ongoing management of chronic conditions, monetary check-in, care coordination core, remote monitoring, industries trade publications describe chronic care management in their own words as a significant new revenue screen, not a sour effort of caring for a patient, a revenue screen, plain, modeled, forecasted on the spreadsheet before a single patient ever erole. Every day for the rest of a person's life. A dross that kills something in two weeks' course does not. Now do the math with me. Which one generates more revenue over 30 years? A two weeks queue or a daily pill staking for three decades? You already know the answer. You knew it before I ever finished the questions. This is not hidden secret, whispering behind closed doors. This is open discussions in pharmaceutical investor call in healthcare economist journal in three publications. 4. Insurance. Insurance profit on premiums volume and risk management, not necessarily on your individual queue. With well managed predictable chronic disease, all predictable medications generate profitable premium. Predictable is profit. Q is unpredictable. When a patient sees five disphang specialists for five different pieces of warm chronic conditions, which none of those five talking to each other, that fermentation is not just an inconvenience, it draft duplicate testing, duplicate imaging, duplicate visit, each one buildable, each one separable, each one separate. Nobody quoting nothing means nobody tracking the total cost except the patient at the end, holding five different bills. Now, here is what I need you to hear, and hear clearly, because this is the difference between a sermon that just makes you angry and a sermon that actually sets you free. None of this requires a variance in the borroom cracked land over a banner sheet, it requires nothing more than ordinary company responding rationally to the incentive they were given. But the effect on the ground, on your body, in your family, at the kitchen table is exactly the same way. The system is economically optimized around management, not limitations, not cute management. Once you stop asking, is someone plotting against me and start asking, what does this incentive structure revol? You will never look at the prescription part the same way again. That is not cynicism, that is clarity, and clarity is what we deal with on this podcast. Next, we take this outside our own border. Stay with me nurs. Now I want you the lens because if you only look at America in accelerations, you can talk yourself into believing this is just how healthcare has to work everywhere. It is not.7 years 3.7 years longer. 3.7 years longer. Every single one of those countries spend less often far less per person on healthcare than we do. Let that sink in with you. We spend nearly twice as much as our peers per person on healthcare, and we get on average almost four fewer years of life for it. According to the organizations for economic co-cooperations and development, which is OEC 2025 Health, at a glance report, the United States has a preventable mortality rate of 217 deaths per 100,000 people. The OECD average is 145. Read that again. Our rate of death from costs that are preventable, not incurable, not inevitable, preventable is nearly percent higher than the average across world nations. Our treatable mortality rate death from conditions that with family and infected care should not be fatal set at 95 hundred thousand against an OECD average of 77. Now some will tell you this gap is just about young people, car crashes, violence, overdose, but here is what that exponentially odd research comparing left expectancy at 65, not at breath. At 65 after most of that, young adults' risk is already beyond you. Still show American with fewer years remaining than their peers in Germany, Finland, Denmark, Switzerland, Australia, France. And when researchers look specifically at chronic and non-communicable disease death among 15 to 49 years old and 50 to 69 years old, the United States have more deaths from chronic disease alone in those age groups than many PS countries have from all causes combined. The United States diabetes death rate among people on 70 runs about two and a half times higher than comparable countries. Kidney disease death rate nearly four times higher, liver disease 1.6 times higher. This is not a story about young people making reckless choices, putting down national Irish. This is a story about chronic disease itself, managed for decades instead of solving, quietly shortening American life at every stage of other war. And here is the number from the start news analysis of AAMC and ye public health data that US ranked in life expertise among OECDPS nations, organization for economists, co-cooperations and development while spending almost twice as much per person of clinical care as the average of OECD nations. 29 while spending nearly everyone if a business spend twice its competitor budget and deliver a worse result, you could call that business fully managed. So why do we hesitate to say the same things about the system managing our own body? I tell you why because it is not marketed to you as a business, it is marketed to you as a care, and those are two very different walls doing two very different jobs in your mind. Care as are you well? Business as are you pay? American health system currently built is. Automatic to answer the second questions for far better than the first. Now stay with me because I promise you hope early in a minute. OECD data shows something worse holding on to 75% of American report being certified with their availability of quality health care higher than the OCD average of 64%, 93% of the population's is covered. We have extraordinary specialists, extraordinary technology. The problem was never the skill of the people inside this system, the problem is the incentive structures surrounding it, and that structure is a policy choice, not a law of nature, which means it can be a different choice. Do not get to wait on Washington. We have to leave Isa, the one that exists today while working to make it better. So let us talk about how what this is actually causing you conditions by conditions. Let's make this personal because normal intradients do not mean anything to a man standing in the kitchen, wondering how he's going to afford his modern medications. So let's bring it down on earth. Condition by conditions, cardiovascular disease, heart disease and stroke caused this system 254 billion a year in direct care plus another 168 billion in lost work productivity. Some projections put total cardiovascular cost nearly 2 trillion dollars. Heart failure alone is on a piece to cost $70 billion by 2030. In hospitalizations, the repeat visit in the single biggest triggering of that number diabetes over 237 billion a year in direct medical cost. 38 million American currently diagnosed another ninety seven million with pre-diabetes one step from diagnosis one lifestyle shift from avoiding it entirely. Cancer care claim it was 240 billion annually by 2030 up from roughly 209 billion in 2020 over 2 million new cases projected every year or summer and related dementia 384 billion dollars in 2025 projected to across 1 trillion dollars by 2050 at the rate is infecting roughly one in five American adults over 53 American people costing the system over 300 billion dollars when you combine medical expense and lost wages single case of neo osteoritis runs on average over 7000 dollars more than a person with it a recent analysis from global data and the partners to fight chronic disease says this nation is on peace to spend as much as forty seven trillion dollars on chronic disease between now and 39 47 trillions that is not a number the human mind is built to hold so let me break it down to someone who can hold it by 2039 if nothing has changed the combined medical and productivity cost of chronic disease could reach almost $13,000 per person, a man, a woman, a child in this country, not a patient, per person. That is the build that is what coming if the train does not change. But here is where I start preaching hopes because hope with all truth is empty, but truth without hope is just dispersed with better footnotes. That same report says something else different. It says better preventions, early interventions and improved management, specifically of obesity could prevent 150 million new chronic disease cases. The system profit most when disease is managed for a lifetime, but you profit most in morning, in years, in morning you get to wake up beside your people you love when disease never takes hold at all. Those are two different games being played on the same fee with two different scoreboards, and for far too long, most of American has been playing the assistant game with even knowing that there was another one available. Now let's look at the myth and the facts. The myth 90% of healthcare spending treat chronic disease full stop, no context needed. Let me give you the facts that figures can all spending on people who happen to have a chronic condition, not spending specifically on treating it. The ones range depends on mentor to run from 80% to 90%, still massive, but not the sound bits you saw sharing online. Another myth: my insurance company won me sick. That is the myth. Let me give you the facts. Your insurance company won predictability, a well measured chronic condition is predictable, and all control ones will suppress hospitalizations in our faces, complication is expensive and unpredictable. That is actually why many insurers now form disease, management program, awareness incentive, and fee vintage screening. Let me give you another myth. Data keep me sick on purpose to make money. That's a myth. Let me give you the facts. Individuals physician does not set the reembrocome structures, Medicare and Medicaid and private insurer do through the code they will pay. Blame the architecture, not the person standing in the exam room trying to help you. Let me give you another myth. America has the best healthcare in the world. That's a myth. America has some of the best specialists have accurative care in the world. The technology, the specialists, the innovations are real, but on the population level outcome that matter most. Less expensive, preventable death, treatable death, we rank low most of all our peer nations, desperate outspending nearly all of the excellence at top of the 16 and poor outcome across the populations are not contradictions. Let me give you another myth. There is nothing I can do the system decide my health outcome. That's a myth. Okay, how do we win? Okay, I run it out of time, so let me give you how do we win now. Hear me clearly because I will not let anybody waste my time. I'm not telling you to be disloyal, I'm not telling you to distrust your doctor. I'm not telling you to skip your medications, I'm not telling you to go home tonight and throw your prescription in the trash. Honor treating disease will kill a man faster than any building core ever could. Be the kind of patient this system was never built to expect. Be the informed one, the one who asks why, not just what one get your screening on schedule, not when somebody already hurt Diabetes, hypertensions, hard cholesterol, cheap to catch early, catastrophic to cash later. Prevention is one of the rooms in the whole house where your interest in the industry numbers finally agree. 2. Treat food and movement like medicine because a large share of this nation chronic disease breading, heart disease, tattoo diabetes, so much of the drunk disease and cancer breaks we just talked about, a downscreen of what we eat and how little we move, a level you can control three times a day, every single day of your life. 3. Ask what the alternative every time you handle a prescription, a procedure, a test. Ask what happened if you do nothing. Ask what happened with left star changes alone. Ask what happened with the interventions. A good provider welcome the questions. Ask what happened. That is alternative. Fourth, know your courage, know your courage before you need it. Most plan under the Affordable Care Act cover the fine list of preventive service and zero other packet costs, screening, vaccination, wellness facit, most people never ask. Most people never lose half of what they have already paid for through their premium. That is money left on the table. 5. Get some second opinions and do not apologize for that. If a diagnosis carries a left hand of management with it, a left hand of pills, a left hand of visit, that diagnosis deserves a second set of hours. That because your data is wrong or because the stick is too high. 6. Know your family history. Knowing your family history is important, it's very significant because it helps you a lot. It helps you a lot to abstain from all of those things, all of those sicknesses. Now let me give you your action plan for this week. Monday, call your primary care providers and ask one's questions. What preventive screening am I doing for based on my age and family history? And write down the answer. Choose it, pull your insurance plan documents and call the number on the back of your card and ask what preventive service are covered at no cost to me. Most people have never asked these questions in their life. Wednesday, sit down with an elderly member of your family and ask about their health history, heart disease, diabetes, cancer. Break down and put it somewhere you will actually find it when you need it. Thursday, look at one meal you eat regularly and ask honestly, does this serve the body God gave me? And does it just serve convenience? Change one thing, not everything one. Friday, take 20 minutes work, not for weight loss, not for numbers on the scale, for your own heart, for your own mind and for your own discipline or showing up for yourself. Weakens, rest, actual rest, sleep. Sleeping is not laziness, the body needs rest. Now let us close. The health industry is not your enemy, it is not a conspiracy, it is not a prod, it is not a man in the back, it is a system built bricks by bricks, data by data, incentive by incentive, the happen to profit most when you are managed for a lifetime. We spend most than any nations on earth, and we rank 29 in how long we live because of it. That gap between what we spend and what we get is not your failures. Now we are reached the end of this podcast. I will ask you to get a screening, take a walk, ask questions, know your family history, my beloved. Nobody is coming to manage your health for you all of pure love.