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Do more, earlier, on illness

By JOHN D. PODESTA
Published February 16, 2007

At long last, everyone, including President Bush, agrees on the need to fix our broken health care system. By now, the statistics are depressingly familiar: almost 47-million Americans without medical insurance, health premiums rising four times faster than wages. Floridians understand this state of affairs better than most. Fully 24 percent of state residents under the age of 65 are uninsured, compared to 18 percent nationwide.

While the president is to be applauded for joining the national conversation on health reform in his State of the Union address, his proposals could drive people to buy policies with higher co-payments and skimpier benefits. In particular, such coverage would almost certainly shortchange preventive care, one of the glaring holes in our tattered health care system.

Studies show that only half of all American adults get needed preventive services, in contrast to people in other developed nations. In Britain, for example, 72 percent of adults got advice from their doctors on weight, nutrition and exercise compared to 48 percent in this country. Is it any wonder that Americans come in 25th in life expectancy, even though this country has the most expensive health care in the world? Or that chronic, possibly preventable diseases consume more than 70 percent of our health care spending?

Our lackluster approach to prevention has several causes. Our health care system typically places more emphasis on treating disease than on promoting wellness - which we see reflected in medical training, physicians' daily practice routines and our payment system. Insurance companies are at fault too. They don't want to pay for wellness services when the benefits may only be realized many years later - often long after the patient has switched health insurance carriers. And consumers themselves are not always aware of the value of prevention or the kinds of screening procedures that fit their medical profiles.

Given the billions of dollars and the lives at stake, we need to take a new approach. The Center for American Progress has advanced the idea of a Wellness Trust.

Managed by a panel of experts, the trust would consolidate existing public and private spending on prevention, carving prevention out of health insurance. It would also set national prevention priorities and establish a new, unconventional delivery system for preventive care. For example, it would dramatically expand the settings where people could receive preventive care, going beyond doctors' offices and hospitals to include community-based settings such as schools, supermarkets, pharmacies and workplaces. Patients and providers could keep up-to-date on prevention services through personal electronic health records.

Through new payment incentives, we can promote smoking-cessation, weight-counseling and substance-abuse programs, and encourage providers to deliver high-priority preventive services to high-risk populations. Instead of relying on doctors to deliver most preventive services, we need to build a corps of community health workers.

The economic impact of such enlightened prevention policies would be profound. If every elderly person got a flu shot, for example, government spending would be reduced by nearly $1-billion a year. If a new emphasis on prevention resulted in effective control of hypertension and a return to 1980s-era obesity levels, Medicare could save an estimated $890-billion and $1-trillion, respectively, over 25 years. But promoting wellness is not merely a matter of dollars and cents. A Wellness Trust that ensures that all Americans, regardless of income, benefit from public investments in prevention and public health would restore a measure of fairness to our health care system, reduce costs and save precious lives.

John D. Podesta is president and CEO of the Center for American Progress.

[Last modified February 15, 2007, 23:24:49]