Investing In Prevention
July 16, 2009
by Robert Ross
Not even the most brazen of hedge funds promises a 500 percent return.
While our government has recently poured hundreds of billions into auto companies, banks and financial services firms, those investments are far from a sure thing, as any GM or Washington Mutual stockholder knows painfully well. But our nation can -- today -- make an investment that will return more than five to one. And as a bonus, our nation will not just
enjoy greater wealth, but more importantly, better health.
A 2008 report published by Trust for America's Health, the non-partisan policy research organization, found that every $1 invested in prevention saves $5.60. Their results are not surprising -- a cholesterol test is always cheaper than a bypass. And helping people exercise and eat better costs even less. Yet our nation allocates just four cents of every health care dollar toward prevention.
Right now, the debate over health care "reform" is escalating to a fever pitch. But a truly effective health care system requires far more than just reform, but a complete dismantling and rebuild, with prevention as its foundation.
According to the Centers for Disease Control (CDC), 75 to 80 percent of what determines life expectancy and health has nothing to do with clinical care provided by health professionals. The largest contributor to life expectancy is determined by how we live and where we live: the type of food we eat and our ability to access it; whether or not we exercise; whether or not we smoke, drink, or use drugs; whether or not we live in a community that's safe; whether or not we live in quality housing or substandard housing.
Consider the list of our nation's leading causes of death: heart disease, cancer, stroke, diabetes, liver disease/cirrhosis, chronic lung disease and emphysema. Each of these is either completely or significantly avoidable -- or their effects minimized -- through prevention. But under the current system, these diseases claim 1 million lives a year and cost the nation $450 billion.
Our nation's health care system costs Americans more than $2 trillion a year. Changing our health system's focus from treatment to prevention would boost our entire economy, from the federal budget to the corporate bottom line to the family checking account.
In reforming our health system, the American people are leading the way. When Americans are surveyed for their views about health reform, there is significant disagreement about a broad range of options. But no single item polls consistently higher than the importance of investing in prevention. A May 2009 poll, conducted by Greenberg Quinlan Rosner Research and Public Opinion Strategies, found that investing in prevention is popular across the political spectrum, with 86% of Democrats, 71% of Republicans, and 70% of Independents supporting investing more in prevention.
And they're being joined by business leaders like Safeway CEO Steve Burd, who has clearly documented the health care savings to his company generated by a focus on prevention for his employees.
President Obama has preached the virtues of prevention in health reform, and he has been eloquent and persuasive when the issue has been raised. But history tells us that there is a canyon-sized gap between extolling the virtues of prevention and having it firmly anchored in public policy. Prevention is not a quick fix -- like cutting services -- that immediately shows up on the balance sheet. Policymakers, especially elected officials who must run for office as frequently as every two years, generally have little appetite, and even less patience, for long-range benefits. But a reliance on quick fixes have created the failed system we must now contend with.
Our President and legislative leaders must act to create a "culture of prevention" as we work to fix our health system. First, we must overhaul the current paradigm of health care policy to one of "health in all policy" by examining opportunities to advance prevention in education (healthy eating and fitness in schools); transportation (pedestrian-friendly planning); agriculture (financial incentives for healthy food options); and work (incentivizing employee health and well-being). Second, we need concrete financial incentives that improve reimbursement for prevention-oriented services and primary health care. Third, we need to establish a national Wellness Trust Fund, which makes resources available for evidence-based, cost-effective prevention strategies.
Despite the overwhelming support of the American people and proven research that backs a shift toward prevention, the status quo -- in which resources are concentrated on paying for treatments -- is zealously defended by powerful interests who sell and support those treatments. Their clout is wielded through campaign checks and lobbyists who can stop anything remotely threatening to their interests dead in its tracks.
The research and data tell us that investing in prevention is the smart thing to do. The public tells us it is the right thing to do. We must be vigilant to ensure that it is not impossible to do.
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