“I will keep them from
harm and injustice.”
“I will prevent
disease whenever I can, for prevention is preferable to cure.”
-Classic and
modern versions of the Hippocratic Oath, from MedicineNet.Com
Senator Tom Coburn of Oklahoma is a physician. He’s familiar with the Hippocratic Oath, and
has used it to explain his opposition to health care reform.
Last November, Senator Coburn
famously termed a $15 billion appropriation for public health and prevention a
“slush fund.” That’s because it was
paying for community tobacco control programs, immunization activities, and
addiction disorder prevention and treatment services around the country.
 |
| For information on sources, see note below |
“Prevention is about focusing on an individual patient,” he
commented, apparently forgetting everything he learned about epidemiology at
the University of Oklahoma’s College of Medicine and at least some of the words
of the Hippocratic Oath.
Public health is the
basis of health promotion and disease prevention.
It focuses on the well-being of entire populations and
communities. It gets only
3% of our total health funding according to CMS data. It has been responsible for at least half of
the increase in life expectancy in America in the last century.
Now it is going to get even less funding, because Senator
Coburn’s view has prevailed.
Last week, his Congressional colleagues – in approving what
was described as the last significant piece of legislation like to pass this
year – agreed to cut $5 billion from the public health fund. (Senator Coburn voted against the final bill,
but not because it cut public health funding.)
We now know how many lives that $5 billion cut to public health will cost.
This is because of an article written by Glen Mays and
Sharla Smith and published
last July in Health Affairs. In that article, the
authors showed that increasing spending on public health reduces infant deaths
and deaths from cancers, heart disease, diabetes, and other chronic illnesses.
They found that a 10% difference in public health funding is
associated with a 6.9% difference in infant deaths, a 3.2% difference in heart
disease deaths, a 1.4% difference in diabetes-related deaths, and a 1.1%
difference in cancer deaths.
The CMS tally of U.S. spending on public health in 2010 was
$78 billion. A $5 billion dollar cut
represents 6% of that total.
So that 6% cut this year will be associated with the
following:
- 1,077 additional infant deaths;
- 7,831 additional deaths from heart disease;
- 617 additional deaths attributed directly to diabetes;
- 3,861 additional deaths from cancer.
Let’s be clear. Mays
and Smith were careful to point out that we can’t say that lower public health
spending causes more deaths – but the
association is real. The amount of disease and death go up as public
health spending goes down.
There are two levels of irony in the vote.
The first is that, before this happened, Mays and Smith
cited the public health fund as evidence of Congress’s increasing awareness of
the value of public health. So much for
awareness.
The second is that
Congress decided to use the $5 billion to pay physicians to see Medicare patients
who suffer from conditions like heart disease, cancer, and diabetes.
Physicians needed that so-called “doc fix.” Congress caused the
problem way back in 1997 when it adopted a Medicare reimbursement formula with
a flaw.
Ever since the flaw became apparent a decade ago, Congress
has plugged the reimbursement hole it created one year at a time, kicking the
solution another year down the road.
After ten years of kicking, the hole is so large that doctors’
reimbursements would have been cut by 27% without the plug.
Kaiser Health News has an excellent summary of the doc
fix dilemma on its web site for those who want to read more about it. Because Congress won’t fix it for good,
doctors are forced to waste their time and money lobbying for a fix every year.
Physicians are undoubtedly relieved that they came out okay
again this year, but I seriously doubt that most of them would have wanted the
money to be taken from public health.
After all, they’ve all sworn the same Oath as Senator Coburn.
But here’s the important
question. When Congress is able to
afford $40 billion in oil and gas tax subsidies over the next ten years for hugely profitable companies, how come,
when our health and well-being is concerned, it has to be either/or – and at
the expense of thousands of lives?
Note on Source Data for Lives Lost Calculations: Sources for numbers of deaths attributable to cancer, diabetes, heart disease, and infant mortality were websites of national chronic disease advocacy organizations and U.S. Government (CDC). Death calculations were made by OHPM using the one-year death total for the most recent year available (usually 2010) and applying a 6% change factor. The implicit assumptions is that if the 6% cut were to become annualized, so too would the annual number of increased deaths.
If you have any questions about this column, or would like to receive an email notifying you when new Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.
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