Sarasota County has announced that cremations will now cost a further $35.  Since there are over 6,000 deaths a year, that represents over $200,000 in added county revenue.

         Is this $35 a carbon tax, to offset the effects of global warming that threaten to leave our region under water?  No.  The money goes to the coronerÕs office, which must sign off on bodies whose deaths might have come from foul play or medical mishaps.  Yet the number of autopsies continues to decline.

         You learn a lot from autopsies, but medical quality control is something else that costs too much.
        
Doing Better and Feeling Worse

         In the early seventies, Dr. John Knowles, chief of Massachusetts General Hospital, edited an issue of the journal Daedalus entitled ÒDoing Better But Feeling Worse.Ó  Knowles and others noted the ÒexcessiveÓ increases in health care costs. With health care costing 5% of American GNP, the authors worried that the massive increases might soon start to  bankrupt the economy.

         Ask General Motors.  Today, health care alone is approximately 15% of GNP.  In the over 35 years since that issue of Daedalus, American lifespan has arguably increased two years.  With our GNP now around $12.5-13 billion, each added year of life is costing about $625 billion.

         Naturally this metric is very unfair, not taking any account of the quality of life improvements of modern medical care.

         However, it does not consider advances in national public health.  Many researchers would ascribe the increased lifespan of Americans more to decreased smoking than improved medical technology.

         Unfortunately, America remains fixated on health care, not health.  Partly due to our peculiar kind of special interest politics, much of that money goes to medical industries and ever expanding insurance and hospital empires, not to programs that cost effectively improve national public health.

Statins for Tots

         The tragic state of American health care is illustrated by the American Academy of Pediatrics recent recommendation that 8 year olds with high cholesterol levels be given statins, and that perhaps some a year old be placed on the same drugs.

         The committee making the recommendations was not, like so many others, made up of members directly paid by companies making such drugs.  However, the crucial importance of Big Pharma to clinical academic research is now so unconsciously ingrained that the committee only paid lip service to those public health bugaboos, physical activity and food.

         Our considered national response: got a problem Ð take a pill.

         Do people know what taking statins will do to an eight year old?  Do they know what effects it will have in forty or fifty years?

         Absolutely not.  We have the example of baycol of how statins can destroy the lives of some people. Yet our myopia is more profound.

         What makes more sense Ð getting kids to take a statin or ride their bike or walk to school?  What makes more sense Ð government subsidies to high fructose corn syrup in the further subsidized school lunches that help make our children among the fattest in the world, or subsidizing school garden plots where kids learn about food and get a little exercise?

         The results of our national policies are just outside my office window, as I watch hundreds of Sarasota High School students park their cars. Many disabled patients canÕt find a  place to park.

         These are systems issues, which speak to more than our public health but to our economic competitiveness, even our survival. Having people walk or bike to school and work decreases energy dependence on regimes that want us dead; can prevent the epidemic wave of diabetes and obesity that will quickly bankrupt our overstressed health care system; will produce less global warming, that threatens our homes; and can lead to a more interconnected and ecologically balanced community, where people look out for children and workers as they move past homes and stores.

         Our medical care system remains a crazy political football, where proximity to Wall Street profits translates into far higher medical incomes that taking the time to listen to and care for patients.  General Electric has a lot more clout and lobbyists than your GP does.  Three thousand medical insurance schemes, which change their rules every day are something out of Kafka, not the standard of the  Òleading nation in the world.Ó

         Our slow economic death on the installment plan will continue until we recognize that public health, energy independence, and communities that will survive and thrive through global warming require  national policies that simultaneously stimulate all three.

         So called Òmarket forcesÓ that brought us the American health care system and our mortgage mess will not save us.  American ingenuity and a little bit of political thinking will.  Otherwise, everything, including death, will cost more.

Dr. Matthew Edlund practices sleep medicine and psychiatry in Sarasota.  His new book, Designed To Last, is available online. He can be reached at 365-4308 and via his Web site at doctoredlund.com.