Posted by: audreybenenati | December 29, 2009

The simple solution: Final health care bill needs greater focus on prevention


Tuesday, December 29, 2009 at 12:01 a.m.

As much as this editorial page would like to see Congress simply start all over on health care reform, that is not going to happen as Senate and House negotiators begin next week to try to fashion a final bill. But if negotiators are truly serious about cutting the cost of health care in America, they should focus harder on preventing disease in the first place.

Neither version of reform goes as far as it ought to in the cause of prevention. But it is our hope that the conference committee starts with the House version as a prevention template and builds on it from there.

Commendably, both the House and Senate bills would create a special trust fund to finance proven, community-based prevention programs, such as efforts to reduce tobacco use and obesity.

But, as in most legislation, commitment is measured by dollars, and that is where the Senate bill falls far short. It would provide just $7 billion over the next six years for its prevention trust fund, and $2 billion annually after that. The House version would provide nearly five times as much, $34 billion, for its prevention fund for the first six years.

The nonpartisan Congressional Budget Office has said that “certain types of prevention services have been found to yield substantial net savings, largely because the initial costs are low and the long-term benefits are large.” In other words, as Ben Franklin advised, an ounce of prevention is worth a pound of cure. We urge that Senate negotiators agree to match the House funding level.

Unfortunately, both House and Senate bills are overly weak in terms of requirements imposed on employer-sponsored plans and other private insurers to cover important prevention programs, though again the House bill is preferable and should be accepted by the Senate.

Finally, it has long been documented by the government itself that low-income Americans have significantly higher rates of smoking than the general population. Yet, under the Senate bill, states would be required to provide Medicaid coverage of comprehensive smoking-cessation services only for poor pregnant women, though it would also increase Medicaid funding slightly for states that voluntarily provide coverage for preventive services to all. The House bill would require Medicaid coverage of key prevention programs, including tobacco-cessation programs, for everyone.

The Campaign for Tobacco-Free Kids, one of the more credible health care advocacy groups in Washington, reports that Americans spend more than $2 trillion every year treating and managing their illnesses. And nearly three-quarters of that is spent on diseases that we already know how to prevent. Tobacco, for example, causes 20 percent of the deaths from heart disease and nearly 33 percent of deaths from cancer, including an astounding 90 percent of deaths from lung cancer.

Reduce tobacco use, reduce obesity, and you will reduce disease and lower the cost of health care. It really is that simple.


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