12/11/2012 10:16 am ET Updated Feb 10, 2013

The Link Between Fiscal Health and Population Wellness


As I've closely watched the back-and-forth negotiations over how to avoid the so-called fiscal cliff, I've been struck that the discussions are missing a key element. When Democrats and Republicans debate over how best to "cut" the Medicare benefit, we're not hearing nearly enough about the impact these potential cuts could have on the health and wellness of the patient in this process.

We don't have to argue over which policy options will hurt Medicare beneficiaries the least. Instead, we should be discussing the approaches that will help the Medicare population stay healthier and, in so doing, put a significant dent in long-term health care costs.

There is a critical difference between looking at this issue through the eyes of a doctor instead of those of a politician. Right now, the lion's share of Medicare funds -- in fact 98 cents out of every dollar -- are being spent to treat the symptoms of chronic disease. Patients with cancer, heart disease, diabetes, respiratory illness have, for years, driven Medicare costs higher because they're sick and they need expensive interventions, acute care and frequent emergency room visits.

By focusing on how we can do a better job keeping these individuals well, the benefits not just to our society but also to our economy and the U.S. treasury will become a reality.

Over the better part of the past decade, policymakers have been following the right direction in this regard. Medicare has become a better provider of preventive services. This past year, over 20 million seniors took advantage of the free wellness visits, cholesterol checks, cardiovascular and cancer screenings that the program provides. It makes far more sense to pay the comparably small upfront costs of these preventive doctor visits and screenings than it does to pay for extended hospitalizations and expensive treatments down the road.

And we can now quantify the impact that the Medicare Part D prescription drug program has had on senior health. A November 2012 study by the Congressional Budget Office has shown that broad, affordable access to prescription medication has reduced Medicare costs for beneficiaries by anywhere from $1,200 - $7,800 per individual, per year for those with chronic disease. The logic here is not difficult to discern. When seniors were cutting their pills in half or not getting their prescriptions filled at all because they couldn't afford them, they were more prone to illness. That is now far less of a dilemma than it was before Part D.

So, how does this knowledge filter into the current budget negotiations? It's important for lawmakers to understand that taking any action to undermine Medicare's gravitation toward disease prevention may help them hit some deficit reduction targets in the short-term, but at the severe price of increasing our long-term debt and risking the solvency of the Medicare program.

With 10,000 Americans turning 65 every day, there are astronomical ramifications to any action that will increase the incidence of chronic disease. The health of our economy and Medicare's sustainability hinges on turning that curve downward instead of allowing it to rise unimpeded. So, when I see Members of Congress suggest, for example, that we should take more money out of Medicare Part D and increase seniors' out-of-pocket costs by extending Medicaid-style government controls into the program, I fear we're moving away from an emphasis on wellness and disease prevention and more toward shifting costs to the patient.

The fiscal cliff negotiations shouldn't be just about what works in 2013. Taking the long view and providing a sounder future and better health for our citizens for decades to come means we must focus resources on preventing and better managing disease in order to facilitate good health, both fiscally and medically speaking.