The Users' Guide to the Health Reform Galaxy

Obama's Budget Includes Modest Increases for Public Health and Prevention

Jeffrey Levi, executive director of Trust for America's Health, writes about advancing the agenda of prevention and public health in tough economic times.

In a time of very tight financial constraints, we all need to be realistic about our expectations. In the context of a freeze on overall domestic non-defense/security discretionary spending, the Obama Administration did show its commitment to a strong public health system that focuses on prevention. Obviously, we'd love to see big increases for public health; however, this budget, combined with large investments about to be released under the American Recovery and Reinvestment Act (ARRA), will significantly increase the capacity of communities to respond to pressing prevention needs.

But the question of health reform still looms large. Unless we take action to improve the health of Americans, we'll lose an important opportunity to rein in health spending. Treating chronic diseases is
one of the biggest drivers of health care costs,  and until we focus more on prevention in a sustained and comprehensive way, we're never going to get these costs under control.

Majority of Americans believe prevention will make us healthier and wealthier

Al Quinlan, president of Greenberg Quinlan Rosner Research, talks about why prevention is one of the most popular elements of health reform.

When it comes to health care reform, one thing is clear: Americans want prevention to play a central role in shaping a new direction for our health care system.

Our latest poll shows strong support for increasing our investment in prevention. When we asked people whether we should invest more in preventative care, 71 percent said we should invest more, as opposed to 23 percent who said we should not.

Even when people learn the potential pricetag with respect to health reform, they support the investment as a way to make people healthier and drive down health care costs in the long run.

$650M for community prevention is milestone on road to reform

Jeff Levi, executive director of Trust for America's Health, writes about how stimulus funds  for community prevention will create a laboratory for what might be achieved with health reform.

The Administration’s announcement Thursday that $650 million in stimulus money will be made available for community prevention and wellness programs is a defining moment for public health in America. It is also an important down payment on the road toward real health reform that will help make Americans healthier.

With two-thirds of Americans overweight or obese and one in five Americans still smoking, this initiative, called Communities Putting Prevention to Work, is tackling two of the biggest health crises in the United States head on.  It will help reduce rates of preventable diseases and give millions of Americans the opportunity to live healthier, higher quality lives. Evidence-based community prevention programs have shown success in improving nutrition, increasing physical activity, and preventing tobacco use by making healthy choices easier choices forAmericans.

What is unique about this initiative is its scale. The program, funded through the American Recovery and Reinvestment Act, will earmark funds for approximately 30 to 40 communities around the country and to states to build or expand upon programs that prevent chronic disease and obesity by addressing physical activity, nutrition and tobacco use. Potentially, it will direct as much as $10 to $20 million to larger cities, representing one of the great advances for prevention programs that this country has seen in decades.

The program will give strong priority to communities that suffer a disproportionate share of preventable chronic diseases and where leaders are able to assemble a communitywide consortium of partners, including the local and state health departments, schools, businesses, community and faith-based organizations, health plans and health centers. At the end of the day, these programs will be the laboratory for showing what results we can have if we invest more heavily in wellness and prevention.

At the end of the day, these investments will be the laboratory for showing what results we might achieve if we invest more heavily in wellness and prevention.

We are convinced they will have a big payoff. In 2008, Trust for America released a study, Prevention for a Healthier America, which found that for every $1 spent on proven community-based disease prevention programs, the county could net a return of $5.60 in health care costs within five years.   On Monday, we’ll release a Compendium of Proven Community-Based Prevention Programs report, along with the New York Academy of Medicine, featuring a range of evidence-based, disease prevention programs that have shown results for improving health and reducing costs.

Finally, this initiative through the American Recovery and Reinvestment Act is a milestone towards the recognition that health reform must start with prevention in order to be successful.   We must take this as a down payment towards the creation of a dependable annual funding stream to allow hundreds of additional communities around the country to benefit from these programs. The future health and wealth of our country demands we improve the health of Americans, not just how we pay for our care.

At yesterday’s briefing, I asked HHS Secretary Kathleen Sebelius where prevention programs ranked on her priority list for health reform legislation.  She replied that it was at the very top – as it was for both the First Lady and President Obama.  Between now and the end of the year when legislation lands on the President’s desk to be signed, I believe it’s the role of the public health community to cement that support, from Congress as well as from the Administration.

To learn more about the Communities Putting Prevention to Work initiative, visit http://www.hhs.gov/recovery/programs/cdc/chronicdisease.html

 

What if Benjamin Franklin ran the Congressional Budget Office?

Jim Marks writes about CBO scoring of prevention in health reform.  This post also appeared on The Huffington Post today.

While Congress is now its August recess, the country will continue to grapple with a health reform package that is likely to be significantly different from the earlier versions. Among the catalysts for the ongoing debate was the Congressional Budget Office (CBO) estimate of the projected price tag of over $1 trillion for the original proposal that almost ground the prospects of real reform to a halt. 

The CBO was established 25 years ago to “provide Congress with objective, non partisan, and timely analysis to aid in economic and budgetary decisions….” It has turned out to be a powerful voice in the discussions of many important bills.

Within its roles and responsibilities, however, lies a very significant limitation:

According to CBO’s cover letter to the original scoring report “Health Care Reform and the Federal Budget”, “the CBO does not provide formal cost estimates beyond the 10-year budget window because the uncertainties are simply too great.”

Let me repeat that, according to its mandate, the CBO does not look at any return on investment beyond 10 years.

The costs of rising obesity

Risa Lavizzo-Mourey, President and CEO of RWJF, cites the high cost of the obesity epidemic in America as she argues for investing in building healthier communities.

A new study released yesterday that demonstrates the clear link between rising rates of obesity and increasing medical costs is alarming, but not unexpected.  Right now, America's health care system is set up to focus on treating people after they already have a health problem, and that’s a sure way to drive expenditures up.  We must shift our focus to preventing people from getting sick in the first place, which will save us money in the long run.

Obesity is the driver of so many chronic conditions—heart disease, diabetes, cancer—that generate the exorbitant costs that are crushing our health care system. What’s worse is the quality of life for people living with these illnesses.

The obesity epidemic isn’t just an adult epidemic, it’s booming among our kids. Today, more than 23 million children and adolescents in the United States—nearly one in three young people—are either obese or overweight, putting them at higher risk for serious, even life-threatening health problems.  The costs are only going to continue to rise.

Reform in our health financing and delivery systems is not the only answer to rising health care costs, we must have prevention.  We must change public policy and local environments in ways that make all communities healthier—especially those that have the highest rates of obesity and the fewest resources.  All Americans deserve to enjoy the benefits of good health.

In the coming months, as Congress works to enact meaningful health reform legislation, I strongly encourage comprehensive reform that addresses the delivery of care, but also makes wholesale changes to how we address wellness and prevention in this country.

 

New Deal 2.0: Wellness for All

(Today's post comes from Dr. Maya Rockeymoore Cummings, President and CEO of Global Policy Solutions, a social change strategy firm based in Washington, DC. and Director of Leadership for Healthy Communities, a national program of the Robert Wood Johnson Foundation.) 

It is perhaps ironic that our country is at the precipice of creating a national healthcare system a full 74 years after President Franklin D. Roosevelt first tried to get universal healthcare passed as a part of the original Social Security Act of 1935.  While many people today aren’t familiar with this important history, FDR’s efforts provide important guidance for today’s healthcare reform debate.
 
Experts agree that rising rates of preventable chronic diseases are driving higher annual medical expenditures. That is why national leaders are seeking to make prevention and wellness a core component of healthcare reform. However, the proposals that have been most discussed will not provide vulnerable populations—those who experience the most sickness and death as a result of preventable chronic diseases—with equal access to prevention and wellness services.