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National Health Care Reform:
Moving from Treatment to Prevention Remarks by John Clymer President-Partnership for Prevention University of Mississippi September 8, 2008
We gather this evening in anticipation of the Presidential Debate that will take place here in 18 days, to discuss an issue that is near the top of the American people’s concerns: health reform. Why is it one of the issues that Americans care about the most?
- 45 million people are uninsured.
- 16 million are under-insured.
- People who are insured worry that spiraling costs will make coverage unaffordable for them.
- Mounting health care costs make it harder for American companies and workers to compete in a competitive global marketplace where capital and jobs move quickly around the world.
- Today, the U.S. spends $2.1 trillion on health care. That’s 16.5% of our gross domestic product. No other nation comes close. The next highest spender is the U.K., which spends just under 10% of their GDP on health care.
- What do we get for outspending every other country on earth?
- According to the World Health Organization, our health system ranks 37th in the world, just above Slovenia and below Kosovo.
- Some experts take issue with WHO’s rankings, so the Commonwealth Fund looked at it a different way. In a Health Affairs article published earlier this year, they round the U.S. ranks 15th out of 19 industrialized countries in preventable deaths – that is, deaths from treatable conditions.
Let’s zero in on this business of preventable deaths. The fact is, about 4 out of 10 deaths in the U.S. are the result, in one way or another, of unhealthy behaviors, with poor diet, lack of exercise, and tobacco use at the head of the list. Most people in the health policy arena now understand that it’s unhealthy behaviors, not lack of access to medical care, that cause most premature deaths. So, it’s not just that so many deaths are preventable; it’s that the conditions that caused them are preventable. What are we doing about that? Well, we’re spending 70% of our health care dollar on treating these conditions – cardiovascular disease, cancer, diabetes, hypertension, and so on. In fact, 95 cents of every one of the $2.1 trillion that the U.S. spends on health care go to treat disease after it occurs, leaving less than a nickel of each dollar to invest in preventing those diseases … in keeping people healthy. Talk about misplaced priorities. In fact, two of the three highest value preventive services are being delivered to fewer than half of the people who could be helped by them. Unless we do something about this, we really have no chance of curing what ails our health care system in America. Unless we invest upstream to keep people healthy, we will never be able to stop the erosion of coverage and quality – and the flood of costs – that are piling up downstream. Access to quality, affordable medical care must be joined with greater emphasis and investment in prevention, public health, and environments that promote health. How have the priorities in our health system gotten so out of whack? Two reasons are perverse incentives and a myopic system. What do I mean by perverse incentives? Doctors and other clinical professionals are paid more to treat patients with disease than to keep them healthy. Former American Medical Association President Ron Davis cites an AMA study that found that doctors are paid more to trim a patient’s toenails than to help a smoker stop smoking. Since the beginning, Medicare has been able to pay for any service to diagnose or treat disease but not to prevent it. Until this year, the only way Medicare could reimburse for preventive services was if Congress passed a law allowing it. Congress partially fixed that problem this year but prevention won’t be on a level playing field until Congress passes more reforms. Consumers (sometimes called “patients”) often pay just as much or more for preventive services as they do to treat diseases that could have been prevented. This forum is about health care reform. But it is not enough to reform our health care system—we must transform it. How should we transform our system? With respect to the organizers of this forum, we should stop talking in terms of “health care reform” and start talking about “health reform.” The goal should be to help every American live healthier, not merely to improve medical care. That said, we need a framework for a system that can improve Americans’ health at a cost we can afford. Partnership for Prevention tasked a group of experts of all political stripes to develop a set of principles to serve as a framework for a prevention-centered health system. They came up with three principles:
First: High value Clinical preventive services should be a basic benefit of health financing reform.
That means high-quality affordable health care, including high-value preventive services – screening tests, immunizations, counseling – should be available to everybody. Financial incentives should be put in place to encourage patients to use preventive services, for doctors and other providers to offer them, and for employers to become actively involved in promoting their employees’ health. [In regard to the important role employers have to play in this, Partnership for Prevention and the U.S. Chamber of Commerce have joined forces to develop and disseminate best practices for making employee health a core business strategy. Our publication Leading by Example, available on our website, www.prevent.org, is helping to map the course.]
Second principle: Community preventive services should be an integral part of health reform.
As a country we need to invest in healthy environments and healthy lifestyles. We need to create incentives for public health departments, schools, parks, recreation departments, and nonprofit organizations to offer prevention programs and services and to help implement focused public education and promotion campaigns. Leadership is needed at all levels – national, state, and local – and from all sectors – government, business, and nonprofits – to create a true multi-stakeholder partnership for this. Health effects should be factored into all our decision-making, including urban planning, land use, zoning, transportation, and agriculture. The goal should be not only to foster healthy habits, but to make the healthy choice the easy choice for all Americans.
[Sound regulatory strategies are also needed – we see the momentum building for smoking bans in public places, to take one example. Partnership for Prevention is urging Congress to give the FDA authority to regulate tobacco products; to give the FTC authority to regulate junk food advertising; and to increase the excise tax on alcohol.]
Third Principle: Health reforms should be designed to increase the impact of prevention.
Clinical and community-based prevention reinforce each other. When we link clinical services delivered through traditional settings to community services delivered through our public health system and non-traditional settings, we can make real progress, as we have done historically with such health threats as smallpox, infectious diseases, and unsanitary water and waste disposal. We need a new push now, at the federal level, to increase research funding on the effectiveness and cost effectiveness of both community-based and clinical prevention and to develop performance standards to measure our progress.
Our Principles for Prevention-Centered Health Reform are available at www.prevent.org.I urge you to check them out and share them with colleagues, other opinion leaders, and your elected officials.
Let me leave you with this. We have been doing our own research at Partnership for Prevention and have seen the tremendous impact prevention can have – in this case, clinical prevention. Last year, with support from the CDC, the Robert Wood Johnson Foundation, and the Wellpoint Foundation, we published a study showing how increased utilization of just five preventive services could save more than 115,000 lives every year in America.
- By increasing the proportion of eligible adults who take a daily aspirin to prevent heart disease from less than half to 90%, we can save 45,000 lives.
- By increasing the proportion of smokers who are advised by a health professional to quit and are offered medication or other assistance from 28% to 90%, we can save 42,000 lives.
- By increasing the proportion of adults 50 and older who are up to date with recommended screenings for colorectal cancer from less than half to 90%, we can save 14,000 lives.
- By increasing the proportion of adults 50 and older who get a flu shot every year from 37% to 90%, we can save 12,000 lives.
- By increasing the proportion of women aged 40 and above who are screened for breast cancer within a two-year period from two-thirds to 90%, we can save almost 4,000 lives.
Aspirin, breast and colon cancer screening, smoking cessation assistance, flu shots – 115,000 lives. Prevention gets results. We need to commit to it as a country. We need to make prevention central to our urgent efforts to reform health care in America – and not only to reform health care, but to transform the health system. If we do, we will be rewarded not only with a sustainable health care system, but with healthier, happier, more energetic and productive lives – becoming, along the way, a better people and a better nation.
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