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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

Book Review by Stephen Burton Ph.D. Cand., UNCC, Charlotte, NC

A Review of Conflict Resolution: The Partnership Way

Paperback: 336 pages

Publisher: Love Publishing Company; 2nd Revised edition (January 2009)

Language: English

ISBN-10: 0891083391

ISBN-13: 978-0891083399

 The first step that can save us from a modern culture that over-emphasizes a belief in ourselves as autonomous and separate individuals is learning how to resolve interpersonal conflicts through empathic understanding and the willingness to respect the needs of others equal with our own. A mistaken belief of separateness allows individuals to navigate life without taking the risk to ask for help from others or considering that others might need their help.

 It may seem like a difficult task to educate an increasingly diverse society to be more aware of the need to cooperate with each other. However, consider the role of mental health professionals who are asked to relieve the psychological pain and fallout suffered by individuals coping with interpersonal and societal conflict. What tools do they have to bring to the table in order to effectively help clients resolve their conflicts in today’s increasingly conflictual world?

 From the perspective of master’s level students engaged in learning the craft of therapeutic counseling, they soon find that conflict resolution and mediation skills are essential components of an effective professional practice. Yet most university training programs spend very little time developing the theoretical literacy necessary to understand the concepts of conflict resolution. In addition, even less of their clinical training is devoted to creating competencies in the use of conflict resolution skills.

 When the majority of graduate students in counseling and psychology embark on their practicum and internships in clinical settings they often are surprised by how much conflict is present in the lives of those they are charged with helping. Conversely, they discover how little they have been taught that might enable them to actually help their clients resolve the painful conflicts they are experiencing in their personal and family relationships as well as those in their school and work environments.

 A new generation of counselors, social workers and psychologists can now benefit greatly from the work of counselor educators, Barry Weinhold, Ph.D. and Janae Weinhold, Ph.D. This breakthrough work in the field of conflict resolution, Conflict Resolution – The Partnership Way, represents a departure from the traditional texts that can be found on this subject. It lends itself well to developing theoretical literacy on this subject. More importantly, it places emphasis on creating clinical competencies through specific types of skill training, without which little can be accomplished in the area of mediation and conflict resolution. In this increasingly important area of therapeutic practice, professionals need to be able to walk the walk with clients seeking to resolve their conflicts more than just talking the talk of traditional talk-therapy. This is an area where a pill will not fix the problem and the competent use of a specific set of conflict resolution skills must come into play in order to effectively help their clients. 

 The Weinhold’s revised 2^nd edition text addresses the theoretical literacy needs of students’ for understanding conflict and its sources by presenting an integrative meta-theory titled, Developmental Systems Theory (DST). DST utilizes a four-stage developmental model to explain why conflicts occur in all human systems. This includes intimate relationships, family, schools, organizations, legal systems, and the larger social systems of communities, cultures and nation-states. They then present practical skills to show people how to resolve the three major kinds of conflict that occur in all human systems: (a) wants and needs, (b) values and beliefs, and (c) intractable conflicts.

 As alluded to above, just using a didactic approach to teaching conflict resolution will not work in producing professional competencies in this area of therapeutic practice.  What is needed is a constructivistic approach predicated upon student involvement in their own educational process of discovery and experience. The Weinhold’s new book provides the instructor with resources to utilize this approach, including student self-inventories and writing exercises in each chapter that provide insight and direction for understanding strengths and areas of needed skill development.  Finally, the book provides readers with a clear understanding of Developmental Systems Theory as it is applied to conflicts that occur in all human systems. Practical step-by-step processes for resolving the various types of conflict are presented throughout the book that include the development of dialogue and inquiry skills critical to helping practitioners work with clients and others in resolving conflicts.

 The content of the book is laid out in four parts:

 Part One

• Describes the Partnership Way and the Developmental Systems Theory that supports it.
• Illustrates why we need a new paradigm of conflict resolution.
• Introduces new research on unrecognized and unhealed developmental trauma as the primary cause of intractable conflicts.
• Helps readers examine their personal style of conflict resolution and to determine where it is and is not effective.

Part Two
• Focuses on resolving conflicts of wants and need and values and beliefs.
• Provides step-by-step skill building worksheets and skill practice exercises to help readers learn how to resolve their conflicts as well as how to help others do the same.
• Teaches readers how to identify your own wants and developmental needs.
• Shows how to distinguish between a conflict of wants and needs and a conflict of values and beliefs.
• Presents dialogue and inquiry skills to resolve conflicts involving values and beliefs.

Part Three
• Focuses on identifying the often unrecognized developmental sources of intractable conflicts and strategies for resolving them at their source.
• Shows how to resolve conflicts in individuals, couples and families.

Part Four
• Focuses on strategies for resolving conflicts in more complex social systems, such as the mental health profession, schools and churches, the legal profession, the workplace, and cultural, national and international organizations.
• The last chapter describes how the authors have utilized these skills in their own relationship.

 The fundamental principles and suggested teaching methods laid out by the Weinholds in their newly revised book can help colleges and universities better prepare students entering the helping professions to assist clients in resolving their interpersonal conflicts. The material presented by the authors can serve as the basis for engendering the understanding, values, beliefs, and conflict resolution skills necessary for those who are increasingly looked upon to heal the pain and frustration of those involved in interpersonal conflict. The book presents a path toward developing a higher level of consciousness about the need for conflict resolution that can foster more peaceful relations among all people. It provides the information necessary to understand and settle disputes that represent the artificial divisions that separate us as individuals and community members in an increasingly diverse and conflictual world.

 Information about the reviewer: Stephen Burton is currently a second year Doctoral student in the Counseling program at The University of North Carolina at Charlotte (UNCC). He is also an experienced mediator in the field of conflict resolution and dispute settlement. During the 2009 first summer session, he co-taught the Advanced Counseling Techniques course required for Master’s level students enrolled in UNCC Community and School Counseling graduate programs. As a part of the course, he taught the segment that focused on mediation and conflict resolution techniques using material from the book, Conflict Resolution: The Partnership Way, by Barry Weinhold, Ph.D., and Janae Weinhold, Ph.D.