Why Rationing Preventive Services By Age is a Mistake

The agency that recommends what preventive services are paid for has come out with recommendations (often taken verbatim by Medicare) that there are not enough data to recommend any screening for men over 70 or women over 75. That means even if you live healthy and could -- with some preventive tests and care -- live vibrantly or even work as a very valuable advisor to grandkids, as a volunteer or even as a doctor (the average age for pediatricians to retire is now over 79), that agency may make you pay for such preventive care. Maybe they'll even say you can't get the flu vaccine soon.

But you can change that. Write to your senators and congressman or congresswoman, and say that preventive services should be based on your health status -- the healthier you are, the longer Medicare should pay for prevention since it doesn't have to pay for treatment. If you have five normals -- blood pressure, waist for height, LDL cholesterol, fasting blood sugar and absence of tobacco products in your urine, all with or without medication -- on entering Medicare, your lifetime Medicare health costs are 33 to 50 percent less, even though you live 33 percent longer. That's not a trivial savings; that's $6,000 to $8,000 a year, netting out to two-thirds of that at the time of your passing since you live longer. But only 4 percent of people come to Medicare with 5 normals. So maybe the U.S. Preventive Services Task Force is right for the majority. But hopefully if you're reading this, you are not majority, and you already do these five healthy behaviors that promote a health do-over:

1. Eat a largely plant-based diet, avoiding added sugars, syrups and all non-100 percent whole grains. Also avoid almost all red meat and trans fats.

2. Walk or do other exercise 30 minutes every day.

3. Keep your waist to less than half your height.

4. Avoid all tobacco products.

5. Drink alcohol only in moderation.

These five behaviors decrease your risk of heart attacks and other cardiovascular events such as stroke and impotence by 80 to 85 percent. This is confirmed in multiple studies -- involving both men and women -- and is true whether you start at age 40 or 70.

If you add a few additional behaviors -- keeping your immunizations up-to-date, doing five minutes of meditation daily and getting your blood pressure and LDL cholesterol to normal (with or without medication) -- you'll decrease your all-cause risk of dying by 80 to 90 percent, and decrease your lifetime medical costs by more than 33 percent. You'll also decrease the period of time you're disabled -- big time. You'll live longer with more energy; in my terms, you'll live with a younger RealAge*.

And the savings for the country? If 70 percent of us enter Medicare with five normals by 2030, we'll save more than $200 billion dollars in medical costs each year.

One point the USPSTF did make is that it's more appropriate for those of us over 65 to get our vitamin D levels checked. It seems that more than 60 percent of us over 65 (some studies say as many as 93 percent) have levels below 20 ng/mL, when we should be shooting for levels above 35. As we age, our skin doesn't convert inactive to active vitamin D as consistently, and we don't absorb vitamin D from food as well. Getting a normal level decreases falls and their consequences, the USPSTF concluded. And according to a study of more than 90,000 people, it decreased disability and death rates by more than 30 percent over a 23-year period.

So, your action steps today are:

1. Do the actions we recommend above, and also strive for normal blood pressure and LDL cholesterol levels.

2. Write your local politicians to lobby the USPSTF to make preventive choices heath status-adjusted, so those who are physiologically younger (in other words, have a younger RealAge) are rewarded for being healthier and costing the Medicare trust fund less.

3. Make a plan to get your vitamin D level measured (and in the meantime, take 1,000 to 2,000 IU a day).

4. Consider preordering my book: "This is Your Do-Over."

Thanks for reading. Remember these are the views of Dr. Mike Roizen only, and do not necessarily reflect those of any organization he is or was affiliated with.

*I developed the concept of RealAge and was one of the founders of the RealAge.com website, where you can calculate how much your choices effect your RealAge and risk of death and disability, and how much younger you can be. I still have a financial interest in that website, now run by Sharecare.com.

An esteemed authority on health and wellness, Michael F. Roizen, MD, chairs the Wellness Institute at Cleveland Clinic, the first such position at any major healthcare institution, where he actively coaches patients. He is a former editor of six medical journals and has published more than 175 peer-reviewed scientific papers. Board-certified in internal medicine and anesthesiology, Roizen co-founded with Mehmet Oz YouBeauty, a media company focused on helping women lead healthier, more beautiful lives, and RealAge. His RealAge series of books as well as his "YOU" series, written with Oz, are worldwide bestsellers, with four No. 1 bestsellers in the U.S. and No. 1 bestsellers in at least five other countries. Roizen and Oz write a daily syndicated column that appears in over 130 newspapers. Roizen has appeared regularly on Oprah, Today, 20/20 and Good Morning America and has a two-hour, 33-station radio show. He is 67 calendar years of age but his RealAge is 48.7 He routinely tweets the week's top medical stories @DrMike Roizen.