All through the debate over health care reform, we've heard a lot about the billions we spend, how poorly we often spend them, and how we will bankrupt ourselves if we don't change our ways.
We know American medicine relies too much on expensive tests and high technology to treat disease, but invests too little on cost-effective disease prevention programs. Partly because of this, we spend much more on health care per patient than any comparable country, and don't get better results.
The most obvious way to rein in this runaway system is to keep patients from needing all those tests, scans and surgeries to begin with. We must prevent disease, not just treat it.
How To Do It
The health reform bill before the Senate, like the one that passed the House, includes a prevention and public health investment fund to promote healthy habits that are essential to disease prevention. It would finance community-based initiatives that already have been shown to save money and lives. The cost of this trust is a tiny fraction of the total price of health reform. But it has the potential to pay tremendous dividends in the future by preventing the very diseases that ultimately cost us the most to treat.
Americans spend more than $2 trillion a year to treat disease and manage illnesses. Almost three quarters of that is spent caring for people who suffer from diseases that we know how to prevent. For example, smoking causes one in five deaths from coronary heart disease, nearly one-third of all cancer deaths and 9 in 10 deaths from lung cancer. Tobacco-related diseases cost us $96 billion in health care bills every year, and the lifetime health care costs for individuals who smoke are $17,500 higher than they are for non-smokers.
More than a quarter of health expenditures are related to obesity, a significant contributor to diabetes, high blood pressure, heart disease and other coronary diseases, according to the Trust for America's Health, a nonpartisan research organization. More than half of all cancers can be prevented - not just detected early or treated - by changes in tobacco use, diet and exercise.
Preventable diseases rob our families of healthy and productive years of life, and contribute to ever-rising insurance premiums. They fuel increasing Medicare and Medicaid costs.
Let's Stop This Spiral Where it Starts.
Successful programs to promote prevention can be found in our states, cities and towns.
In Ohio, a program that recruited middle-aged women for a 12-week walking program at the Ohio State University campus reduced hypertension, cholesterol levels and glucose levels.
California's tobacco control program has helped reduce adult smoking rates by 35 percent, saving an estimated $86 billion in health care costs.
In New York, outreach workers made home visits to provide education on how to control asthma--the third-most frequent cause of hospitalizations among children. In just one year, the average asthma hospitalization rate decreased 23 percent.
The Trust for America's Health has found that for an investment of $10 per person, per year in proven initiatives to prevent smoking, promote physical activity and improve nutrition, we could save more than $16 billion a year within five years. That's a return of $5.60 for every dollar invested. Though the Congressional Budget Office has hasn't estimated short-term savings from prevention, it has said that "certain types of preventive services have been found to yield substantial net savings, largely because the initial costs are low and the long-term benefits are large."
In the tough tradeoffs that lie ahead in shaping a final health care plan, the worst outcome would be to refuse to do what we know works.
Spending money to prevent debilitating diseases isn't the same as building a bridge to nowhere. It is building the foundation of a less costly, more rational health care system--and creating a path to a healthier society.