Prevention Matters

Former HEW Secretary Joseph Califano says prevention is the "only sure way" to bend the cost curve when it comes to health care expenditures.

"The overarching history lesson is this: the only sure way to bend the curve and curb the rate of increase in health care costs is to keep people out of the sick care system, to put as much profit in prevention as there is in acute care, and to put financial gain and pain into how individuals take (or don't take) care of themselves," Califano said in a column for Kaiser Health News.

Califano offered a number of suggestions along these lines:

• Pay doctors to talk to patients instead of just testing, sticking, cutting and prescribing pills for them. "Brief interventions have been shown to reduce smoking, excessive drinking and eating, couch potatoing and other bad habits that drive up treatment costs," he said.
• Require all insurers to pay for preventive services like regular physical exams and to cover things such as flu and pneumonia vaccinations (as Medicare does). "Then let patients who fail to get such vaccinations and get the disease pay the related sick care costs."
• Sharply increase alcohol and tobacco taxes. "Almost thirty percent of health care spending is attributable to smoking and excessive drinking. Making alcohol and cigarettes more expensive has been shown to reduce both. (Moreover, presently such taxes are woefully inadequate: for every dollar we collect in tobacco and alcohol tax revenues, we spend about nine dollars in health care and other costs.) "
• To reduce unnecessary expensive diagnostic tests and treatments, enact tort reform. "Today the cheapest malpractice insurance for a physician is the MRI, PET or CAT scan."
• Mount a saturation public health campaign. "There was a time when seat belts were for sissies, smoking was chic and AIDS was a social curse. Now every driver buckles up, smoking has been cut in half, and AIDS is recognized as a preventable disease. We can do the same with excessive drinking and obesity."