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Jeffrey Levi

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Will We Have a Health Care System or a Sick Care System? A Tale of Two Futures

Posted: 01/19/2013 9:08 am

It's a right as old as the Declaration of Independence.

By birth, every American should have the opportunity to be as healthy as he or she can or wants to be. A government that is truly for the people provides everyone with world-class services that protect and support their health. This means access to care, but also access to safe parks and gyms and fresh affordable produce.

Unfortunately, more than half of Americans are living with one or more serious, preventable chronic disease, ranging from type-2 diabetes to cancer. And chronic diseases are responsible for seven out of 10 deaths. These rates are expected to increase significantly over the next two decades, particularly due to the obesity epidemic.

For years the United States has approached public health backwards. Indeed, the current health care system has been set up to treat people after they are sick rather than keeping them well in the first place. Our country has a sick care system rather than a health care system.

This is taking -- and will continue to take -- an enormous toll: Health care costs are spiraling out of control, and it is possible that today's children are on track to be the first generation in American history to live shorter, less healthy lives than their parents.

America's health faces two possible futures: 1) We continue on the same track, resigning millions of Americans to major health problems that could have been avoided, or 2) we increase our investment in giving Americans the opportunity to be healthier and preventing people from developing chronic conditions in the first place; in short, the nation focuses on guaranteeing that each American can be as healthy and happy as they choose.

Prevention is the most effective, common-sense way to improve health and reduce health care costs in the United States, but there's never been a strong national interest in prevention. Beginning in 2013, prevention must be a significant focus of the Obama administration's second term and the agenda of the 113th Congress.

We have a good start thanks to the past four years, most notably the Affordable Care Act, an expansion of the number of preventive services covered by insurance, the National Prevention Strategy and Action Plan and the Prevention and Public Health Fund. The wheels have begun moving. It's time to build upon the momentum.

There are a couple of high-impact steps that should be taken to put prevention first in our health care system.

1) Advance and modernize the nation's public health system.

This includes establishing a set of core capabilities that all health departments must have and developing a federal public health financing system that guarantees all communities these essential public health services, just as the Affordable Care Act guarantees all individuals certain essential health benefits.

2) Build partnerships within and outside the health field.

Public health departments play a central role as chief health strategists for communities, but they cannot reach goals to improve their community's health on their own. To be effective in improving health in neighborhoods, workplaces and schools, strategies must involve a series of common-sense partnerships, including:

  1. Partnering with health care payers, including both public and private insurers:
    • More preventive services must be covered by payers, and consumers need to be encouraged to take advantage of them.
    • Medicaid and private insurance coverage should be expanded to include community-based prevention.
  2. Partnering with health care providers, including expanding health care models to include community prevention and working with nonprofit hospitals to increase engagement in neighborhood prevention strategies:
    • Fully incorporate prevention into a reforming and evolving health care system, including new delivery mechanisms such as accountable care organizations and Medicaid health homes.
    • Maximize the community benefit investment of nonprofit hospitals into community-based prevention.
  3. Partnering with sectors beyond the health care system, including drawing the connection between all facets of society (transportation, housing, education, etc.) and health:
    • Fully maintain the Prevention and Public Health Fund.
    • Expand Community Transformation Grants to benefit all Americans.
    • Implement the National Prevention Strategy through partnerships across government and with the private sector, faith-based organizations and community groups.
    • Provide wellness programs and opportunities to all American workers.

These high-impact steps are happening in pockets across the country (from Akron to Baltimore to Billings to Boston to Delaware to Kentucky to King County to La Crosse to Muskegon to Nebraska to North Carolina to Oklahoma to West Virginia). Now it's time to take them to scale.

We need to make the pockets of prevention the norm and ensure that the healthy choice is the easy choice where people live, learn, work and play.

This blog post is part of a series produced by The Huffington Post and the George Washington University that closely examines the most pressing challenges facing President Obama in his second term. To read the companion article by HuffPost's Jeffrey Young, click here. To read the companion blog post by Drew Altman, Ph.D., of the Kaiser Family Foundation, click here. To read all the other posts in the series, click here.

 

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