President Barack Obama will unveil his budget tomorrow, and many are anxiously anticipating what this will mean for health care, as all signs, including his speech to the nation last night, show he is ready to move forward with health reform.
Indeed, the budget is a critical factor because it will lay out the administration's top priorities, which will likely center around the economy, health care, and reigning in the growing Federal budget deficit.
Obama has said that some short-term investments are needed before long-term economic recovery and fiscal stability can be realized. Health care may just be the most important of these investments. Specifically, we need to invest in a new health system that can tackle the growing problem of chronic disease, which is crippling both our health care system and our economy.
Of the $2.2 trillion we pour into health care each year, a frightening 75 cents of every dollar goes towards treating patients with chronic illnesses. In Medicaid, this figure is an even more regrettable 83 cents of every dollar; in Medicare, it's an astounding 96 cents.
Illnesses such as diabetes, heart disease, and cancer, that in many cases could have been prevented by changes in behavior or could be better managed through early detection and appropriate access to treatment, have risen dramatically over the past three decades, leaving Americans in much worse shape at earlier and earlier ages.
The rise in obesity is at the root of this increase. With younger and younger Americans suffering from overweight and obesity, the outlook is grim for finding a solution to stem rising health costs short of helping Americans transform their unhealthy behaviors.
The truth is, we can never expect to improve the affordability of health care until we face the dual crises of obesity and chronic disease. And, until we deal with cost, the chance of extending health care coverage to more Americans is grim.
The good news is, President Obama has already achieved two important down payments for health care reform through recent allocations in the stimulus package: $19 billion for health information technology and $1.1 billion for comparative effectiveness research. Both signal a promising new approach to health care -- one that seeks not only to expand coverage but also to improve efficiency and health outcomes.
In addition to the stimulus investments in health information technology and comparative effectiveness research, President Obama must realign health system incentives to prioritize prevention and chronic care management by creating new primary care models that are more accountable and better coordinate care between physicians, hospitals and other health providers.
These are not particularly controversial issues. However, there are many difficult choices that President Obama and Congress must confront in the debate.
While preventing and better managing disease will save money in the long run, a number of critical questions remain. How will we pay for the additional costs including expanding coverage? Will we change, but not eliminate, the tax treatment of employer provided health care to reductions in Medicare spending? Do we need an individual health care mandate and should there be a public health plan as part of the effort to provide universal coverage? If so, how do we make it fair?
After President Obama unveils the U.S. budgetary priorities for 2009, these are the questions and issues that will continue to be part of the debate in the coming weeks and months.
One thing is for certain though: if President Obama wants to make health care affordable for every American, we need systemic change that makes it easier for Americans to lead healthy lives. And, in light of the economy, we need that change now.
Kenneth Thorpe, Ph.D., is the Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management, in the Rollins School of Public Health of Emory University. He serves as the Executive Director of the Partnership to Fight Chronic Disease.
