Health Care Reform: Who Says Prevention and Wellness Costs More?

I have been involved almost daily in health care reform activism since Fall 2008 and now I am going to write a regular blog about what I have learned and how I see the health care reform debate unfolding in Washington and elsewhere. Much of my interest has been in researching ways to transform our current health care system from an emphasis on “sickness” into an emphasis on prevention and wellness.

             Currently, not much happens in this system until someone gets sick. That never made any sense to me. It is probably the least cost-effective way to run a health care system. As a result, we now have a sickness-oriented adult population with 2/3rds of us classified as obese.

            There are some signs of hope. The current legislation under consideration in Congress seeks to change this. HR3200 in the House has allocated $126 billion in funding for public health promotion over ten years to be used to support prevention and wellness. The Senate bill, out of the HELP Committee, has about $100 billion a year over ten years to promote prevention and wellness.

            What isn’t clear, however, is how this money will be spent. Some money will go to doing preventative screening tests on more people and this category is called “Clinical Prevention Services.”  The rest will go to building a foundation that can support a shift in consciousness in the entire population from “sickness” to “health” called “Community Prevention Services.” The former may actually increase health care costs, while the latter can significantly decrease health care costs over the long haul.

            There is also a problem of how to calculate the cost-savings from real community-based prevention and wellness programs. It is likely that it will remain a big part of any bill that gets hammered out in Committee after the Senate and House pass their versions of the health care reform bill because it has bi-partisan support.  If that does happen, it could mean enormous cost-savings over a ten-year period. However, the Congressional Budget Office, which is considered to be the “gold standard” on estimating the costs of legislation, says that these parts of the bills will not yield any cost-savings and might actually increase the cost of health care reform. How can they say that?

            Well, they are partially right. If they are only looking at the possible increased cost of more preventative screening tests, the most concrete variable they can measure, they will conclude that prevention means increased costs. Actually, this should not even be classified as prevention and should be called “early detection” and “early intervention.” There is even some recent evidence that the screenings for breast cancer with mammograms does not increase survival rates and neither does PSA screenings for prostate cancer. Wait a minute, that is the subject of another blog.

            Second, The CBO has no accurate way of measuring the potential cost-savings from the creation of “Community Prevention Services.” Their predictions work best when they can isolate a single variable such as the current cost of preventative screening tests and then estimate the cost of insuring an additional 50 million people and offering them screening tests they do not now get. They can easily predict increased health care reform costs from these additional screening tests. However, they cannot easily isolate the variables involved with creation of community prevention services because they are varied and cannot be easily grouped into a single variable. In addition, much of what is being proposed is new and there is no good base line information available to use for making predictions. So what happens?? They guess.           

Finally, it turns out that the Congressional Budget Office isn’t perfect, in fact far from it. On three occasions recently they grossly under estimated the cost-savings of various pieces of health care legislation. It appears that when they have to estimate more than one variable at a time, their accuracy goes down to almost zero.

            If the members of Congress rely solely on the cost-cutting estimates supplied to them by the CBO in making their decisions, it could result in  significantly reduced expenditures in the area of community prevention services. Please urge your representatives to use some plain common sense and help them see that we have to invest in community prevention services that promote health and teach people how to stay well. This is where the future of health care reform has to be. We simply cannot afford to pour more taxpayer money into a very expensive “sickness” oriented health care system and hope that we will be able to reduce the cost of health care, that is already the highest in the world. It ain’t going to happen.

 Stay healthy and keep well.

 Barry

Comments

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