Note to Congress: An Ounce of Prevention Can Save a Pound of Deficit
November 26, 2012
by Rob Waters
“Elections have consequences and at the end of the day, I won.” So said Barack Obama shortly after he took office in 2009 and it bears repeating today as Obama and Congressional leaders begin negotiating a budget deal to avoid the so-called fiscal cliff.
In the immediate aftermath of the election, there was a fleeting moment when House SpeakerJohn Boehner acknowledged one of the consequences of President Obama’s 3.5 million-vote margin in the national popular vote. “Obamacare is the law of the land,” Boehner declared. But within hours he was walking that statement back and saying Congressional Republicans still want to repeal the Affordable Care Act. He later repeated that position in an Op-Ed, arguing that the Act itself must be on the table during deficit-reduction negotiations.
Those negotiations are now shaping up as a critical test of the future of the Act, and the various pieces of it that are essential to transforming our bloated, ineffective and inequitable healthcare system. For Boehner and the Republican leadership, Target Number One is likely to be the Prevention andPublic Health Fund, the most significant effort ever by the federal government to help communities around the country combat disease by promoting wellness and prevention. The victors of the last election should understand what a tragic and historic mistake it would be to bargain away a key element of the health-reform effort.
Let’s review some history. Obama made transforming the system of the U.S. a central issue of his 2008 presidential campaign. His primary emphasis was on universal access to health insurance—and that became the core focus of “Obamacare”—but he also talked about public health and prevention. He won.
He and his allies in Congress introduced the Affordable Care Act and with it, created the Public Health and Prevention Fund to provide real support for a vastly underfunded part of the health system. Opponents fought against the bill. It passed. They derided it as Obamacare and made it a central issue of the 2012 campaign. Obama won again. And so did supporters of heath reform, who increased their numbers in both the House and Senate.
Obamacare—the Affordable Care Act—is here to stay, but the details matter. For the Act to succeed in transforming the U.S. medical system and making people healthier, it must do three key things:
1. Shift the health system away from an expensive fee-for-service model that rewards providers for delivering tests, procedures and other services—whether they’re needed or not—to a more integrated one that emphasizes keeping people healthy and rewards practitioners and health organizations that do so.
2. Provide universal access to care so people don’t wait to see doctors until they’re so acutely sick that they end up seeking urgent medical treatment in emergency rooms and hospitals, getting expensive care that really can’t solve the kinds of chronic health conditions that cause most serious illness.
3. Put prevention at the center of our thinking about health. This means finding ways to help people eat nutritious food, breathe clean air and be physically active so they stay healthy and disease-free in the first place.
This last item may be the most important. Without a strong focus on prevention, there’s little chance of slowing the relentless rise in the national cost of healthcare, which now accounts for almost 18 percent of U.S. economic activity, the highest level in the world. As we weigh the importance of prevention efforts, a couple of facts are worth considering. I’ve discussed these before but they bear repeating.
The U.S. spends about $2.7 trillion on healthcare and three-quarters of that is spent treating chronic, often preventable conditions such as heart disease, stroke and diabetes, according to the Centers for Disease Control and Prevention. About 40 percent of premature deaths are linked to smoking, poor diet, lack of physical activity and other unhealthy behavior, according to the Institute of Medicine.
In the coming weeks, the battle over the budget in the face of the fiscal cliff will have an enormous impact on the future of prevention efforts. It’s worth remembering that Americans now oppose repealing the Affordable Care Act and that, according to a recent Gallup poll, 55 percent think it’s extremely or very important that the federal government support programs that “address health risks associated with” obesity and smoking.
For the past two years, that kind of work has been supported by the Prevention and Public Health Fund. For the first time ever, the federal government set aside a dedicated pot of money to improve the capacity of research laboratories to track disease, increase the number of children receiving needed vaccinations, and help communities create safe, walkable streets. The Fund has helped health officials and residents of Nashvile, a city with one of the highest rates of obesity and diabetes in the country, to create programs that help people get more exercise. It has enabled the health department of Tuolomne County, California, to work with local residents to reduce secondhand smoke in a community where many people still use tobacco. (I’ll profile these and other community-prevention efforts supported by the Fund in articles this week.)
The Fund has been under threat since the day it was passed. It was denounced as a “slush fund” by some Republican Congressional leaders. It was slashed by $6.25 billion—40 percent of the $15 billion it was originally allocated for its first 10 years—as part of another deficit-reduction deal early this year. Now, according to a Talking Points Memo story, the Fund tops a list of three Obamacare elements that Republicans plan to try and cut.
The other two targets, according to TPM: 1. Trimming subsidies to help low-income people purchase health insurance. 2. Cutting the $10 billion allocated to set up the Center for Medicare and Medicaid Innovation to develop and test new ways of delivering and paying for health care. These are terrible ideas. Taken together, such cuts could cripple the ability of Obamacare to actually improve the way healthcare in this country is delivered.
Prevention advocates will be fighting hard to defend the Fund. Earlier this month, the American Medical Association’s House of Delegates voted in favor of a resolution to “oppose policies that aim to cut, divert, or use as an offset” money earmarked for the Fund by the Affordable Care Act. Organizations like the American Public Health Association, Trust for America’s Health and my colleagues at Prevention Institute are mobilizing support for the Fund. And all this week, I’ll be using this space to talk about the impact prevention funds are having in communities across the country. If you think prevention is important, you can do your part too by telling your representatives in the House and Senate to support the Affordable Care Act—and the Prevention and Public Health Fund.
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