The cost of health care is becoming an ever-larger portion of the federal budget. In 2011, $2.7 trillion was spent on health care in America and $551 billion was spent on Medicare alone. We cannot sustain these rapidly increasing costs. The number of Medicare patients are growing as baby boomers enter retirement age and the care of patients with chronic conditions continue to drive increasing costs of health care. The average health care cost for all Medicare patients in 2006 was $8,344, but the average cost for the top 10 percent of Medicare patients was $48,2001. In May 2013, the Medicare Board of Trustees revealed the Medicare trust fund, as currently configured, will run out of money by 2026.

The rapidly increasing prevalence of chronic conditions is an important factor. In 1987, 31 percent of Medicare patients were treated for five (5) or more chronic conditions. In 1997, that number jumped to 40 percent and by 2002 the number had increased to more than 50 percent. An estimated 96 percent of Medicare spending in 2006 was for patients with multiple chronic conditions; 79 percent for those with 5 or more chronic conditions.

The incidence of obesity doubled between 1987 and 2002, along with diabetes, hyperlipidemia and hypertension. Obesity and diabetes are increasing in all age groups including children and adolescents. Seventy-two million Americans are obese, with estimated annual health care costs of $147 billion. There are also more that 100 million chronic pain patients in the US according to the Institute of Medicine, with costs exceeding $635 billion annually.

These numbers continue to rise, showing a deterioration of Americans' health status, even as we continue to spend more and more on health care. The truth is that we spend very little in the U.S. on health care; what we call health care is mostly disease care with services and expenditures largely focused on very expensive illness and symptom treatment. This focus must change to promote the use of safer and less expensive conservative care interventions first. We must encourage increased patient education and counseling on risk avoidance and health promotion strategies, including lifestyle modifications that are necessary to avoid or mitigate costly and debilitating chronic illnesses and diseases.

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