While Congress tries to control health care spending, lawmakers should be careful to make choices that are pennywise but not pound foolish.
In April, the House voted 236 to 183 to repeal the health law’s prevention and public health trust fund. Republicans said they opposed giving the Secretary of Health and Human Services wide discretion on how to spend this money. But the result is a setback for the first dedicated source of funding for national prevention efforts and could be a missed opportunity to reduce spending even further by preventing the largest driver of health care costs — chronic disease.
Largely preventable and highly manageable chronic diseases account for 75 cents of every dollar we spend on health care in the U.S. In contrast, we spend less than 5 cents on prevention, even though the World Health Organization and the Centers for Disease Control and Prevention have estimated that 80 percent of heart disease and type-2 diabetes, and 40 percent of cancers, could be prevented by doing three things: exercising more, eating better and avoiding tobacco.
Yet, we are headed in the other direction. One in five adults still smoke and one in two adults — and a tragically large number of children — are overweight or obese. Without a dramatic change, a third of American adults will have diabetes by 2050 (up from 1 in 10 today). Obesity already accounts for 10 to 20 percent of the rise in health care spending and obese adults cost 35 percent more than their normal-weight counterparts because of their risks for diabetes, high blood pressure and other related chronic conditions.
The status quo is expensive, but our future on the current course is unsustainable.
The silver lining is that we have evidence that we can prevent the onset and progression of diseases, including diabetes. These are exactly the types of efforts that the prevention fund should be used to support.
Case In Point: The YMCA, in facilities throughout the country, is offering a group-based diabetes prevention program modeled after the landmark National Institutes of Health /CDC Diabetes Prevention Program. The NIH initiative proved that, with modest weight loss, it is possible to reduce the risk of developing type 2 diabetes among those with pre-diabetes by nearly 60 percent. So far, the YMCA’s effort has been getting similar results, at costs that are dramatically lower than that of the NIH program. And the Y has scaled this program to communities in more than 20 states. Investing in the prevention fund could add the program to even more communities throughout the country.
Given that $1 out of every $10 spent on health care is related to diabetes and that people with diabetes have medical costs 2.3 times higher, preventing diabetes is a bargain. In fact, enrolling at risk adults aged 50 in this type of program could reduce the chance they would develop diabetes from 85 to 65 percent.
The NIH diabetes program is just one of the many evidence-based prevention programs vital to preventing chronic disease and curbing rising health care costs if made available nationally. It exemplifies how prevention works to not only improve health, but also to lower cost. Yes, Congress should be working to reduce costs, but lowering health care costs long-term depends on addressing what drives those costs diabetes and other chronic diseases. We have to make the investment in the ounce of prevention to realize the pound of cure.
Kenneth Thorpe, Ph.D., is the executive director of the Partnership to Fight Chronic Disease. Jonathan Lever is the vice president for health strategy and innovation at the YMCA of the USA.
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