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POLICY: The Best-Kept Secret of Campaign ’08: A Bipartisan Solution to Health Reform by Wendy Everett

Wendy Everett is president of the New England Healthcare Institute. She thinks that the candidates for President from both parties agree on the important stuff for health care–dealing with chronic care prevention. I can’t say that I’m totally in agreement with her political analysis, but her ideas about chronic care and prevention for the basis of bipartisan action are interesting (and as Wendy used to be my boss at IFTF I thought that it would be polite of me to let her have shot on THCB!)

The presidential candidates are doing a disservice to the voters and to themselves when they emphasize their differences over how to fix the broken health care system. They can argue all they want about the likes of universal coverage, tax incentives and employer mandates, but that cacophony obscures the fact that the candidates, regardless off party, actually share a major position on health reform. Though little-noticed to date, there is a breakthrough bipartisan consensus that the key to health reform is to redirect the system to prevention and management of chronic illnesses.

This unanimity is huge. Chronic diseases – including conditions such as diabetes, asthma and hypertension – are a major threat to both our health and our economy. More than half of all Americans already suffer from one or more chronic ailments, and the rate is rising as the population ages.And the price tag is staggering. Some 80 percent of the more than $2 trillion in annual health expenditures already goes to taking care of patients with chronic diseases. A recent Milken Institute study found that in 2003, chronic care cost the country $277 billion for treatment and another $1 trillion in lost worker productivity. If nothing is done to halt the rise of chronic illness, the Milken Institute projects that treatment and lost economic output will rise to $4.2 trillion by 2023.

And yet much of this cost is completely avoidable.

With preventive programs such as early screening and health counseling,
many chronic conditions can be delayed or prevented. But sadly, our
health care is geared to sick care – providing costly treatments rather
than keeping patients healthy. We pay doctors to remove disfiguring
skin lesions but provide little incentive for regular screening or
counseling to avoid skin cancer in the first place. Gastric bypass
surgery is an increasingly popular option for obese patients, but where
was the diet and fitness counseling before the weight problems
developed?

It’s as clear as day that better prevention and management of chronic
conditions are absolutely key to health reform. Keeping people healthy
will save money and save lives. So where in the din of disagreement
over health reform are the presidential candidates on this? You
wouldn’t know it from the headlines, but they are in sync, Democrats
and Republicans alike. The bipartisan consensus around health reform
emerged last fall at a forum in Boston sponsored by the New England
Healthcare Institute. The forum featured a panel of health policy
experts from the presidential campaigns, and they all agreed that
increasing health care coverage and controlling health care costs was
necessary but not sufficient.  The real key, they agreed, was to
constrain costs by tackling the chronic disease epidemic with
prevention and management programs.

As Christopher Jennings, a top health care advisor to Senator Hillary
Rodham Clinton, put it, “”You cannot deal with the issue of coverage if
you don’t deal with the issue of costs, and you can’t deal with the
issue of costs of you don’t deal with the issue of prevention and
chronic care management.’’
Accomplishing this will require fundamental change in the way the
system reimburses doctors and other primary care providers, according
to Douglas Holtz-Eakin, a former director of the Congressional Budget
Office who is now policy director for the John McCain campaign. “We
have a system where we pay people to do things to patients instead of
having them well,’’ he told the NEHI forum. “We have to pay people for
diagnosis, for prevention, for coordination, and ultimately for better
outcomes.’’

Dr. Rahul Rajkumar, a health care advisor to Barack Obama, said that
transforming health care through better prevention and management of
chronic illnesses must be “”a shared project’’ with innovative thinking
across the board, from payers to providers to patients.

Timothy Murphy, who was secretary of Health and Human Services for
Massachusetts Governor Mitt Romney and is now advising the Romney
campaign, applauded the “unison about the issues of disease management,
prevention and wellness’’ among the presidential campaigns. And disease
prevention is a hallmark of Mike Huckabee’s health reform proposal.

So bingo, a bipartisan consensus on where to focus health reform:
Controlling costs through the prevention and management of costly
chronic diseases.It’s a shame that this bipartisan consensus has not
gained political traction or public attention. In the heat of a
campaign, it’s just too easy to trumpet for universal coverage rather
than to advocate for wholesale change in the delivery of health care.
The candidates and the media find it more compelling to focus on
dramatic differences. But in the end, this critical area of agreement
may be more important than where the candidates disagree. So spread the
word and get out the vote: there is a bipartisan route to real health
reform regardless of who is elected the next president of the United
States.

Which brings us to the crux of the issue: what exactly should be done
to help fix health care? We have identified a series of policy actions
that we call the NEHI Nine:

In prevention, first we need to find out what works; then we should
promote those services with financial incentives for physicians and
patients; and finally, we ought to make a serious national commitment
to reduce unhealthy behaviors through a wide variety of initiatives in
government programs, employer health benefits, and community and public
school outreach.

For chronic illness, we need to encourage and reward the use of proven
best practices in both clinical and employer settings; promote health
information technologies that improve the management of chronic
illnesses; and expand research to identify high-quality and cost
effective delivery systems for chronic care. 

And in primary care, we need to provide payment for innovative ways to
deliver primary care, including by non-physicians, by medical teams,
and in non-face-to-face encounters; increase payments to physicians to
reimburse them adequately for both prevention and treatment services,
especially for obesity, diabetes and other chronic conditions; and make
the redesign of primary care a high priority for the U.S.

Only by realizing these fundamental reforms will the U.S. health care
system be equipped to confront and contain the scourge of chronic
illness that is threatening our health, our health care system, and our
economy.

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BarryMGClaudiaSusanrbaer Recent comment authors
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Barry
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Barry

“you might consider supporting the cultural shift to more individual responsibility in health care”
You hit the nail on the head there… a cultural shift. I believe that’s what it’s going to take – but not just for the individual, but all facets of society; primary care, food production and delivery, media and marketing.
But aren’t all major, substantive cultural changes preceded by a major event or disaster of some kind? I think the US needs to experience some hard times, we’ve had it too easy and its showing on our waistlines.

rbaer
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rbaer

MG, I have to wholeheartedly agree with you, provided that I did understand you right. When I obtained my MPH during my last year of medical residency, I was at times a little annoyed how certain buzzwords are patched together to form “solutions” or “suggestions” that border to the meaningless in their generality (Susan, are you going for a public health degree, or already obtained it? … just kidding). I think some people saw a libertarian slant when I emphasized personal responsibility in my first post on this page. I do not think that personal responsibility and a caring society… Read more »

MG
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MG

“In prevention, first we need to find out what works; then we should promote those services with financial incentives for physicians and patients; and finally, we ought to make a serious national commitment to reduce unhealthy behaviors through a wide variety of initiatives in government programs, employer health benefits, and community and public school outreach.” I don’t mean to be glib but these recommendations are so open-ended/devoid of details as to inspire either apathy or mockery. Some of the suggestions (“we need to find out what works”) are either way too broad in scope/unrealistic for 7 reasons and others (“reduce… Read more »

Claudia
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Claudia

I don’t buy it either. This analysis commits the “capital sin” in health care, i.e., confusing financing, and equity and efficiency in financing health systems, with delivery of medical care. From the point of view of organizing the delivery of medical care, clearly emphasizing chronic disease prevention is good, whether or not it saves money to “the system” (it does not necessarily — the fact is, the cheapest is to let people die). Whichever is the case, focusing on prevention is good all else being equal — it may help people live healthier and longer lives. It is also good,… Read more »

Peter
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Peter

“Call me simplistic, but let’s say a physician is there to fix things, e.g. like a garage. Whoever owns the car is responsible for making sure changing the oil, the timing belt, and don’t wear out the clutch (the repairman should give good advice when asked or when there is obvious car neglect).” rbaer, I WOULD call you simplistic,:>) if you are thinking this is up to an individual and not a government. When an individual’s care for their car only affects them, the government does not get involved, but when the use of their car affects society (drunk driving,… Read more »

Susan
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Susan

Once one takes a view of healthcare that is preventive, and incentives hit the patient’s wallet, change is possible. We need to stop affixing blame and begin seeking solutions which make sense to the individual. This will not be a quick fix, but leadership in this area could provide opportunity for this country and its healthcare industry to innovate in ways that are not possible elsewhere in the world…let us hope that there is adequate corporate/employer will to make this happen. Neither the AMA nor the individual stakeholders have sufficient incentive or power to drive this change. And no presidential… Read more »

rbaer
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rbaer

I don’t buy it. Call me simplistic, but let’s say a physician is there to fix things, e.g. like a garage. Whoever owns the car is responsible for making sure changing the oil, the timing belt, and don’t wear out the clutch (the repairman should give good advice when asked or when there is obvious car neglect). What to do for the maintenance and care of the human body – e.g. eating healthy, exercising, self breast exams etc. – is known to most, and accessible to everyone. And if you have health coverage, one can and should ask the doctor:… Read more »

Peter
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Peter

“Chronic diseases – including conditions such as diabetes, asthma and hypertension – are a major threat to both our health and our economy.” Diet, pollution, stress. While we identify these diseases and know how to prevent them, corporations that profit from causing them and profit from treating them, will not co-operate to prevent them, and even lobby to keep poisoning our bodies. I would feel a little encouraged if the AMA spent part of its lobby/income-promotion money to help get us going in the right direction – fat chance. “we ought to make a serious national commitment to reduce unhealthy… Read more »