Healthy Reforms

In the 1990s, the Department of Health and Human Services looked at health spending versus the improvements in the health of our population in the 20^th century.  The results were startling.

97 percent of our spending was in health care, versus 3 percent in wellness and prevention – the activities of public health.  Despite the meager investment in public health, however, 50% of the improvement in our health status could be attributed to it.

Managing our health and preventing disease means a longer life. 

I admit that this lesson wasn’t lost on me. 

I run or take long walks at least three times a week, eat five portions of fruits or vegetables a day and no red meat, enjoy a glass of wine with dinner, and do my best to manage my stress.  My weight today is just a little higher than it was when I was in high school forty years ago.

Those are the things I can do by myself, but they’re not enough.

Without statins my cholesterol numbers would be a nightmare.  So I also go for my annual physical.  I review my blood work and have an EKG. I discuss with my physician the vitamins and medications I may need for the coming year.

Not everyone puts that much effort into being healthy.  This is because we expect to be healthy and take it for granted until we get sick.  Then we hope modern medicine can fix us.

In a nutshell, this probably explains why we spend so much for health care, and so little for prevention.  We literally leave well-enough alone. If there’s no crisis, we’re not motivated to act.

Fifty or a hundred years ago,  when doing nothing about our wellness meant that our drinking water was polluted, communicable diseases crippled or killed our children, and our air was thick with haze, our grandparents understood the consequences of doing nothing.  So they cleaned up our environment and invested in our health, and that’s why we live longer lives than they did. 

But spending on prevention for the past few decades has been more like rowing against the current.  It has been overwhelmed by the tide of spending on health care.

That’s about to change, however.  This is because our crisis meter is ticking upward along with our weight, the number of chronic conditions from which we suffer, and the huge amount of money we’re spending to try to get well again. 

Congress noticed this year, and took some major steps this year to get our minds off of sickness and back on wellness and health.  Note that none of these provisions are affected by any of the court battles over reform.

Here are several of the most significant, cutting across populations and strategies: 

·         Beginning in 2011, all Medicare recipients will have access to a free, annual check-up, other free preventive services, and free colorectal and cancer screening.

·         Private health insurance plans established after September, 2010, must cover preventive services, including immunizations, without charging deductibles, co-pays, or co-insurance.  These provisions also apply to Medicaid as of January 1, 2011.   “Grandfathered” private plans will not be required to do this immediately, but some may anyway.  Most others will be adding this coverage over the next three years. 

·         Employers will be allowed to offer employees a health insurance discount of up to 30% if they participate in wellness programs.

·         Employers with fewer than 100 employees will be eligible for grants totaling $200 million nationwide from 2011 through 2015 to create comprehensive workplace wellness programs for employees.  If successful, these could in turn lower the premiums these employers have to pay for health insurance.

·         Up to $1.5 billion from 2010 through 2014 are being granted to states and nonprofits for maternal, infant, and early childhood home visitation programs to improve infant health, child development, and school readiness.

·         A Public Health and Prevention Fund has been established with $6 billion through 2015, and $2 billion a year thereafter, to support investments in public health and prevention programs authorized under the Public Health Services Act. 

·         Community transformation grants will allow communities to attack and mitigate environmental factors, such as a lack of playgrounds and unsafe neighborhoods, which lead to poorer health among residents.

·         Restaurants with 20 or more locations must provide nutrition labeling on standard menu items.  Vending machine operators with twenty or more machines must provide calorie counts for all machine items.   The regulations implementing these programs will be issued in 2011.

These gifts to our health will go a long way toward improving both the length and quality of our lives.  Of course, we’ll have to work just as hard to keep our bodies running well.  It’s good to know that our elected representatives are alongside us in the effort.   

Extra: Read my Guest Blog in Health Affairs Grantwatch Blog on how foundations can invest to improve access to care.