Blog was originally published on phlabs.org

It is that time of year when politicians are touting some form of universal health care plan  (such as “Medicare for All”) in order to solve our country’s health care crisis. But what most don’t seem to understand is that universal health care does not necessarily lead to healthier lives or a healthier country. Instead, universal health care may reinforce the belief that many people possess – they have a constitutional right to eat and drink what they want, smoke, not exercise, and if they get sick, well the government will pay for their health care. Their focus is not preventing disease but rather finding a doctor or hospital to take care of their health when they get sick.

In fact universal health care is perhaps akin to car manufacturers and insurance companies offering to fix any and all problems with our cars, whether or not these problems could have been avoided. And this thinking persists primarily because as healthcare consumers, we are not provided with the necessary manual, roadmap or tools – also known as health education – to properly take care of our bodies.

So, in my opinion, universal health care without comprehensive, ‘cradle-to-grave’ health education will never achieve its goal of significantly reducing costs or improving healthcare in this country.

To better understand why universal health education is so important, I will return to the car example identified earlier which almost everyone can relate to.  When we buy a new car – whether fresh off the production line or used – various regulations mandate that we are given an owner´s manual. This manual usually includes  a schedule for routine maintenance such as oil changes, tire rotation and filter changes. The cost of this maintenance is minimal when compared to, for example, the price of a new transmission or engine block.  As responsible consumers, we usually read the manual that comes with our new car. In addition, the salesperson will usually spend some time with us at the time of purchase to highlight the important features of the car and inform us how to care for it. By the time we leave the sales lot, we are usually aware that we may need to do an oil change at 5,000 miles and routinely check the fluids like coolant, brake fluid, windshield washer fluid  or power steering fluids to ensure our cars are safe and run smoothly. In other words, as consumers, we know that “driving” our cars  without appropriate instructions about how to take care of them results in us having to pay more money to repair or replace the car.

Unfortunately, we do not get an “owner’s manual” when we’re born. So most of us rely on our parents (who themselves may not be health educated), personal doctors (whose primary role is usually treating disease – not education),   celebrity doctors on television, or Dr. Google to learn as much as we can.

Credible, well-researched, practical and easy-to-understand health education that starts in grammar school and continues through adult life would  ensure that we have at least as much information about taking care of our health as we do about taking care of our cars. And, incentives for taking advantage of this universal health information could be reduced health insurance premiums – perhaps similar to reductions in car insurance for taking a driver’s education course.

Why can I make such a bold statement?  Well, throughout my 30-plus year career as a healthcare attorney, I have read literally thousands of patient cases.  Many patients were never taught how to cook food so as to preserve the nutrients they need to stay healthy. Some grew up eating fried foods and acquired a taste for it without realizing the impact it had on their health. Others simply failed to provide important and necessary information to their health care provider. As a result, their health care providers  were unable to make informed decisions about their treatment. Simply put, many of these patients were never taught the information they needed to either avoid disease, or to better manage a chronic condition such as diabetes and hypertension. If they were provided with the necessary information, they may have not gotten sick in the first place or their chronic diseases could have been better managed.

I have also lost loved ones like my parents, colleagues and friends who were never properly taught how to take care of their health. If they were properly educated, their diseases may have been better controlled.  I have learned from their mistakes and taken the necessary steps to educate myself about how to properly care for my body. All these personal experiences have convinced me that being educated about our bodies and health will usually give us the tools necessary to avoid diseases or better manage them when they occur. I refer to this as being proactive about our health. And many healthcare professionals report that patients who are educated about their bodies and health are better able to play an active – and positive – role in their healthcare decisions and treatment plans.

In addition to the population health benefits of reducing the incidence of disease, consumer health education offers significant economic benefits. Supporters of universal health like to mention research studies  which suggest it will savealmost $2 trillion in healthcare spend over the next decade.  While this number is often debated, it represents substantial savings.  But it is only a portion of the savings that could be realized if patients were better educated about their own health.  In fact, one could argue that universal health education is exactly what can make universal health financially viable by helping to reduce overall healthcare spend.

The ROI with Universal Health Education Increases Universal Healthcare Savings

Talk to any economist or business owner, and they will tell you that the number that really matters when evaluating the financial benefit of any action is its return-on-investment, or ROI.  These same studies showing the cost benefits of universal healthcare estimate that the government would need to invest around $33 trillion over the next decade to make universal, single-payer healthcare a reality.  So, if the government invests $33 trillion and the country saves $2 trillion in healthcare spend, that is an ROI of approximately 6 percent. This may be a very attractive ROI to some and most consumers would be thrilled if their 401K accounts generated 6 percent year-over-year.  So 6 percent is a good starting point.

Now, let’s look at the ROI of investing in patient/consumer healthcare education.  According to various studies as well as the National Institute of Health, on average, for every dollar invested in patient education, $3-4 is saved.  In other words, the ROI of patient and consumer health education is in the area of 300 percent. Yes, you read that correctly – 300 percent ROI on free health education versus 6 percent ROI on free healthcare treatment.

Based on this, if the government were to divert $1 trillion of the estimated $33 trillion earmarked for universal healthcare to universal health education, the country would be looking at savings of up to $4 trillion in addition to the savings of universal healthcare itself.  In other words, by investing the same $33 trillion in both universal healthcare and universal health education together, savings would be more than by investing $33 trillion in universal healthcare alone. By my calculations, this combined spend would generate $5.92 trillion in savings rather than $2 trillion.

There are many real-world examples which demonstrate how universal health education could both reduce the incidence of disease while providing an economic benefit to the country.  Take, for instance, the recent and unfortunate case of a six-year-old boy whose parents chose not to vaccinate him against tetanus.  As often happens with children, he cut himself.  His parents duly cleansed the wound and dressed it.  A few days later, the boy fell ill with tetanus and ended up spending 57 days in the hospital and another three weeks in a rehabilitation facility.  If this weren’t bad enough, his medical bill was almost $1 million. If his parents were properly educated about tetanus this may have been avoided. Information such as the fact that tetanus does not just come from rusty nails and  is easily preventable may have prevented the physical ordeal the young boy experienced as well as the unnecessary use of healthcare resources and financial damage the hospital bill probably caused.

Another area where universal health education could provide an almost immediate and very tangible benefit is nutrition.  Some estimates are that poor nutrition disproportionately contributes to the country’s ever-increasing healthcare costs and  poor eating causes nearly 1,000 deaths each day. Combine this human cost to the estimated $1.72 trillion yearly cost of obesity-related chronic diseases and it becomes clear that easy- to- understand and relevant education about nutrition and how to eat more healthily is a critical need. Imagine the savings of being able to reduce the health care costs – both direct and indirect – of diet-related diseases such as cancers, diabetes, and heart disease to name a few?

There also is ample proof that programs designed to educate people about nutrition and promote healthier eating produce positive results. According to the National Institutes of Health (NIH), introduction of nutrition education and policies in middle schools results in less obesity and helps keep weights in healthy ranges.

There may be some concern in the medical community that universal health education may shrink the patient pool, which would impact the economics of providing healthcare and private health insurance.  But providers and insurance companies need not worry about this. Currently, the US is unable to keep up with the demand for healthcare professionals like doctors and nurses. In short, we currently have too many sick people and we will have even more if we provide free health care without appropriate health education. Furthermore, there will always be a good supply of patients because unfortunately we will have accidents, unanticipated and unpreventable illness, chronic diseases sometimes resulting from genetic predisposition and natural disasters.  And in the unlikely event that we have fewer sick people, doctors and other health care professionals should be incentivized to educate consumers to live healthier lives as opposed to just being paid more to treat sicker patients.

The economic and community health benefits of providing government-mandated and taxpayer-funded health education – independent of or as a part of universal healthcare – are clear.  What is now needed is the political will to make it a reality. Overcoming the current preference of treatment over prevention, provider concerns over a medically and health literate population, and the ever-changing political winds will be an uphill battle.  But it is a battle worth fighting since, in this case, everyone wins.