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Prevention $aves: Making the Debt Commission Advance Social Good

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Citizens who'd like to see the National Commission on Fiscal Responsibility and Reform---commonly known as the "Debt Commission" -- use its unique platform to move the nation in an important new direction, now have a way to be heard -- a grassroots campaign called P$: The Prevention $aves Coalition for Reducing Federal Debt While Doing Social Good.

The goal of this movement is to ensure that Prevention becomes central to how the United States sees and frames its overall approach to debt reduction. While publicly, the "debt choices" before the nation have been presented as a grim mix of slashed programs, higher taxes -- or national bankruptcy -- those are simply not the sole routes to financial stability.

It is well proven in almost every government and public endeavor -- from chronic disease to juvenile delinquency to road maintenance -- that well focused prevention can save mammoth amounts of public monies even while improving lives and communities. In his linked essay, my colleague Neil Wollman at the Bentley Alliance for Ethics and Social Responsibility of Bentley University has detailed the extensive savings available from employing proven prevention across a spectrum of activities. These giant possibilities range from a 7-to-1 dollar savings for every dollar spent on drug or alcohol treatment -- a good way to reduce nation's $364 billion annual bill for drug and alcohol abuse -- to a $45 billion annual increase in federal and state government revenues which would follow from effective programs to cut the nation's high school drop out rate by half!

Nonetheless, the "experts" tend to downplay ideas like these because they don't present the "big, quick slash" of cuts to programs like Social Security and Medicare. The focus on prevention, however, does something as important as saving money: it forces us to consider how to improve our society even as we make cuts. It works toward the goal -- succinctly stated by Jeffrey Sachs, Director of the Earth Institute -- of using debt reduction to "restore the quality and honesty of public sector management." This focus and way of thinking simply doesn't occur when cutting is confined to the "big slashes."

Let's examine one example; diabetes, with rates approaching 15% of the adult population -- black, Hispanic and white -- in low-income areas throughout the nation, now consumes $218 (!) billion a year in health care dollars and lost productivity -- with the great majority of health dollars coming from Medicaid and Medicare.

Yet, almost a decade ago, the National Institutes of Health, conclusively proved that diabetes was preventable even for most people who already had very high blood sugar, and preventable without major, costly interventions. In fact, N.I.H. research, which involved some 3,000 men and women with high blood sugar in all parts of the nation, showed that teaching "prediabetics" to lose modest amounts of weight and start exercising moderately was twice as powerful as standard medication in preventing them from developing outright diabetes; only 5% of patients taught self-care developed diabetes annually versus almost 8% in the medication group and 11% in the "no intervention" group. Teaching self-care also cost a fraction of the cost for the less successful medication intervention.

Astoundingly, in the face of these N.I.H. research results, the government's own health insurers, Medicaid and Medicare, still did not start to properly reimburse health centers to provide proven prevention counseling to patients with very high blood sugar. Diabetes continued its relentless national increase; between 2003 and 2010, the seven year period immediately after the NIH-sponsored study was released, some three million more diagnosed diabetics were added to the American toll, along with an estimated $15 billion in added medical costs plus another $80 billion in lost productivity.

Obviously, when government action, based on its own research, that could prevent millions of cases of a serious chronic disease along with billions in unnecessary health expenditures just doesn't happen, it's past time for citizen action. To overcome the deep official indifference to effective prevention, we urge you to email the Debt Commission, and demand that its final report recommend that the President issue an Executive Order requiring federal departments and agencies to include prevention as a core part of their budgeting -- both for money they spend themselves and for money to allocate for any purpose to the states. Indeed, in his essay, Neil Wollman highlights the example of Washington, a state which has already launched its own effort to incorporate "prevention budgeting" into state functions.

The Debt Commission, in sum, doesn't just concern debt; it concerns a coherent national quest to rethink government, for a country whose citizens -- left, right and center -- are now so widely alienated and angered by a deep sense that government has basically forgotten how to work for them, the Debt Commission presents an immediate and rare opportunity for real change.

In addition to urging the Commission to support a Presidential Order to make "prevention-based" savings a core principle of government programming and budgeting, you can also urge it to devote at least one day of its public hearings to comprehensive ideas for prevention savings. With the Commission mired in gaffs and bad feelings, and not having involved the public at all in its deliberations beyond the usual suspects, interest groups and think tanks, a day of hearings devoted to this coherent and forward-looking idea would give the Commission some renewed credibility. You can even email the Commission your own suggestions for savings through prevention. (Please back up your suggestions with reference to a published study or other documented support, giving them more power).

We can hardly guess how many billions could be saved by smart, coherent, evidence-based prevention. But even if the national savings from serious efforts at prevention are not enough to entirely avoid cuts in programs such as Social Security and Medicare, savings through prevention still have the consistent advantage of forcing us to focus on building a country that works better for its citizens.

Let me give a final example: juvenile delinquency. Through years of careful, dedicated work, the Missouri Juvenile Justice System has developed detention programs that work so well to put "bad" kids on their feet that fewer than 10% of kids it releases get into new trouble that brings them back into the system; by contrast, 85% of kids in New York State's horrible juvenile detention centers end up back in custody after they are released. One widely accepted estimate puts the ongoing costs for the aftermath of each year's criminal activity, costs largely paid by federal and state governments, at one trillion dollars. Can we even imagine or project the full savings to the United States in not just money saved, but in wasted lives and unnecessary heartbreak, if government, by policy, supported the implementation of juvenile detention treatment models that actually work?