UPI Health Business Correspondent
Washington (UPI) Oct 5, 2006
Congress should establish a new federal agency charged with promoting wellness and preventive care, advocates at the Center for American Progress, a prominent liberal think tank, said Thursday. "Today we're underutilizing and underdelivering preventive services," said John Podesta, former chief of staff to President Clinton, now president and CEO of the center.
"That is causing severe consequences for the financial and physical health of our country."
Democrats have had trouble making their health policy prescriptions heard over the din of the sometimes-raucous debate over consumer-directed health plans and other elements of President Bush's healthcare agenda.
But the proposal from the center, which has had prominent Democrats formerly in the Clinton administration and Congress among its fellows, offers a hint of what the healthcare agenda might include if one or both houses of Congress change hands in the upcoming elections.
The proposal put forth would carve money out of federal and state programs and private insurance to establish a new federal agency to be called the Wellness Trust, which would be responsible for promoting preventive care at the national and state levels, as well as in doctors' offices.
In light of the oft-mentioned financial crisis in the healthcare sector, an emphasis on wellness by creating another government agency may seem misplaced, but there is a business case to be made for prevention, advocates said at the panel.
The sickest 20 percent of patients -- most of whom have multiple chronic conditions -- account for about 80 percent of total healthcare costs. Yet some of the most expensive of those conditions, like diabetes and smoking-related illness, are highly preventable. Currently, only 36 percent of adults over 50 are vaccinated against influenza, for example, and expanding that to 100 percent could save as much as $1 billion per year.
Meanwhile, smoking, one of the most common causes of preventable disease, is responsible for $92 billion in annual productivity losses, according to a recent report by the surgeon general.
At the national level, the trust would set priorities, develop a national information center and create an infrastructure for electronic prevention health records for every American, according to the proposal.
Working with state and local governments, the trust would help develop programs to intervene at the community level in areas where preventable diseases like obesity and diabetes are rampant. These would include preventive care services at shopping centers, community centers and elementary schools.
All of the trust's community prevention services would be provided to individuals whether they were covered by insurance or not.
In the doctor's office, a pay-for-performance scheme would be developed to give doctors financial incentives to make sure that patients get the preventive care they need. Doctors would be paid not just to provide the care themselves, but also to hire preventive care specialists like health educators and specially trained nurses.
When it comes to giving doctors incentives to pay attention to prevention "money really matters," said Kristine Gebbie, professor at the Columbia University Center for Health Policy and former national AIDS policy coordinator.
To make sure there is a supply of public health workers to meet the new demand that would be created by the trust's initiatives, the level of investment in education programs should also be dramatically stepped up, Gebbie said. "Without workers, nothing works."
The definition of a "public health worker" should also be expanded beyond just doctors and nurses, she said. Environmental specialists should also be included to address the environmental factors that contribute to disease.
"You can figure out how many hours a day you need to be walking, but if you go out the door to a community with no sidewalk, you're out of luck," Gebbie said.
The proposal is being shopped around to various congressional offices, Jeanne Lambrew, one of the architects of the proposal, and former senior health analyst at the National Economic Council, told United Press International. At least some aspects of the plan could find their way into the national health policy debate as early as 2007.
The event itself was attended by staffers from prominent democrats' offices, including Sen. Barack Obama, D-Ill., and House Minority Leader Nancy Pelosi, D-Calif.
Opposition is possible, however, from some insurers, and even some doctors who do not want to see jurisdiction over preventive services passed on to nurses and public health workers. Some nurses have also expressed concern over the pay-for-performance aspect of the plan, because it could financially reward doctors for preventive care that is really a team effort.
Fiscal conservatives, meanwhile, balked at the idea of creating a new federal agency.
"It's unnecessary to have the federal government get involved in the details of wellness," said Robert Moffit, director of the Center for Health Policy Studies at the Heritage Foundation, a conservative think tank. "Your health is your responsibility and not the government's."
Market-based solutions could go a lot further to promote wellness, he said, including changing state laws so that insurers can charge higher premiums for individuals who engage in risky behavior like being overweight and smoking, Moffit said. The message to beneficiaries would be "smoke like a chimney if you want, but don't think you'll have the same premiums as people who don't."
If the country as a whole moved from employment-based to individual-based insurance, where a person would have the same policy for their entire lifespan, it would also give insurers an incentive to invest heavily in wellness and preventive services, he added.
"We don't need big mommy to tell us we should brush our teeth," Moffit said. "The market could do all that."
But the proposal is designed to have appeal across the ideological spectrum, Lambrew of the Center for American Progress said. "We know prevention works. This is about trying to use funds more effectively - which should have non-partisan appeal."
The idea of a government agency should also lift the discussion above the current debate taking place over consumer-directed health plans, she said. "This is not an insurance model. This is about taking prevention outside the insurance model."
Perhaps most importantly, the plan includes a prominent role for the private sector, Lambrew added. Private insurers, for example, which were able to demonstrate effectiveness in administering prevention programs would have the possibility of winning contracts to expand their programs.
But the biggest impetus for adopting the proposal is the inability of the current healthcare system to encourage necessary preventive care, she said. "Our system right now is just not working."
Source: United Press International
Center for American Progress
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