The health reforms now in Congress are so complex, so sweeping, that few people if any can understand the whole package.

Prevention gets lost in health care reform fight

Larry Waterfield

It’s clear that the idea of prevention is getting lost in this complexity. There’s less and less talk about better diets, more fresh produce, the delaying or stopping of disease through diet and other interventions.

Instead the debate is all about $1 trillion costs, new programs, subsidies, the new insurance exchanges where anyone can get coverage, portability, Medicare revisions, and whether to offer a “public insurance option.”

It’s also clear the debate is about big bucks, not penny-ante prevention strategies. The money is in the “sick care system,” not in health care. As the head of the Mayo Clinic points out, “All the action is in treating disease.”

Yet prevention is still a key to insuring everyone at an affordable cost. This does not mean stopping diseases. It means delaying disease or lessening the impact.

For example, if Type 2 diabetes, which is an epidemic, could be delayed by an average of 5 years, it would save billions of dollars every year. This delaying effort includes better diets, more fruits and vegetables, simple monitoring and counseling.

But the system is geared to treatment. Many people don’t know they are candidates for diabetes or other diseases until the symptoms send them to the doctor. Even then, better diets can lessen the impact and costly complications.

Doctors and hospitals get paid for treatments and procedures, tests and surgeries. Drug companies reap rewards for treatment of those already sick.

Insurance companies — and that includes the biggest insurance company of all, the government — have a vested interest in delaying disease and in better diets. They need to pay for prevention.

Doctors and clinics ought to be paid for keeping people well, including dietary counseling and monitoring. “Take five servings of fresh produce — and don’t call me in the morning.”

Talk therapy might make a doctor $100 an hour, but doing procedures and tests could bring in $1,500 an hour. Professionals go where the money is.

Failure to pay for prevention and better diets will mean that insuring everyone will be prohibitively costly. Under some of the plans in Congress, middle income people will pay 20% of income for health insurance.

Low income people will be subsidized at great cost. As costs rise private employers will be faced with dropping or sharply curtailing insurance coverage, which will force people to buy insurance through the exchanges or some public program.
The end result will be mediocre coverage at great cost.

Medicare, which is not socialized medicine because it is paid for by those in the program through fees and taxes, assessments, co-pays, supplemental private insurance and out-of-pocket expenses and relies on private doctors and hospitals, is bound to grow more costly as baby boomers retire.

(Anyway, it was Republicans who boosted the Medicare cost the most by adding the drug benefit.)

There are other opportunities to improve diets and boost prevention other than in health care reform. The school lunch program is up for re-authorization in Congress.

That successful program, based on a partnership of the private sector, schools and government, serves meals to 31 million kids at a cost of $12 billion.

The Obama administration wants to add more money and push for better diets and healthier choices. School lunch is more than nourishment, it is a chance to educate about food choices and improve health. That opportunity should not be lost.

The larger food and beverage industry is running scared these days. The other day dozens of food and drink organizations bought a full-page newspaper ad to fight the idea of taxing sugary soft drinks.

There could also be taxes on fatty foods, junk foods, and snack foods. These proposals initially sounded like terrible ideas, the national nanny gone wild, but governments desperate for health care money might be able to sell the idea to a public on the lookout for villains.

There’s going to have to be plenty of taxes and fees to pay for the reforms.

The real problem is not the foods or drinks, it’s the portion sizes. The marginal cost of super-sizing food and drink, with all you can eat or drink, is so small that companies see they can sell bigger sizes at low cost and make money.

The competition pushes the portion size wars. That 40-ouncer of Coke costs $1. Some 67-ouncers can be had for $1.35.

If the super-sizers were smart, and no one is accusing them of that, they would simply assess themselves, use the money to promote better diets, including produce in the schools and poor communities, and get themselves off the tax hook.

It would be hard for government to tax an industry that is already taxing itself for a good cause. This would be cheaper in the long run.

In Congress, some kind of health care reform will probably pass. No one knows what it will look like — there are thousands of proposed amendments. Democrats might ram through a bill without the Republicans.

That’s a bad idea because that means someday Republicans, when they get back in power, will undo what the Democrats did. There needs to be some general agreement on something as big as health care.


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