It feels like jumping into a fire pit, but I’m compelled to offer this: The word “health” seems to be missing in the discussions about remodeling our national health care system.

The dictionary defines “health” in one of three ways: The state of being free from illness or injury” i.e. strength, vigor, wellness, well-being or “fine fettle”; Your physical or mental condition i.e. “his mental health seemed precarious.” Sometimes there’s a third meaning given, and the word “health” is used to “express friendly feelings toward one’s companions while drinking.”

If I continue to present this topic as forthrightly as I am envisioning, I may need that drink later, but let’s continue. Once you have defined health, there are certain assumptions you must make about it.

Assumption No. 1: It is in the best interests of our country that we have a healthy population, no matter what the age or circumstance. Healthy people are more productive.

Assumption No. 2: In today’s world, people, healthy or not, live longer. In 1900, the average life expectancy was 47.3 years. In 2007 it was 77.9 (www.cdc.gov). It is a fact that 10,000 people turn 65 every single day, and that will keep happening for the next 15 years. People over age 85 are the fastest-growing segment of the population.

Which brings us to assumption No. 3: Longevity does not assume absence of disease. We are destined to live longer, but we will almost assuredly end up with a chronic disease (a heart condition, diabetes, arthritis, osteoporosis, etc.). As I have observed before, “Chronic diseases are like wolves, they travel in packs.” According to the National Council on Aging (www.ncoa.org), 92 percent of adults older than 60 have at least one chronic condition; 77 percent have two or more.

The fourth assumption is couched in my own perspective, but it’s I think it’s defensible. Achieving and maintaining good health, or managing a chronic condition once you have it, costs society less if you use prevention/early-intervention approaches. It can be assumed that if people do not have access to health care or cannot afford health care, they are less able to do that and ultimately end up getting sicker and are more likely to land in expensive high-dependency living situations.

High blood pressure, untreated, can evolve into heart-related issues or stroke that require multiple medications, frequent hospitalizations or invasive surgery. High blood sugars, unchecked, can lead to diabetic fragility with a greater likelihood of debilitating neuropathy and lost mobility.

Let me be very specific and highly practical about the costs involved when we don’t put “health” at the heart of our discussions. A bathroom fall with an accompanying fracture costs $30,000 or more. A grab bar beside the tub costs $22 to $30. A shower chair is $32. The grippers that secure those slippery bathroom rugs are less than $10 for a package of eight.

If we remodel our health care system without embracing that we have increasingly larger numbers of older, longer-living, potentially sicker people, we do so at societal peril. We are smarter than that, aren’t we? Aren’t we?

— Sharon Johnson is a retired Oregon State University associate professor. Reach her at Sharon@agefriendlyinnovators.org.