Friday, August 14, 2009

Charles Krauthammer wrote a column this week slamming President Obama's claims that prevention would save money as part of health reform legislation. That column drew a response from Fred Goldstein, President of U.S. Preventive Medicine and a member of Partnership for Prevention. Goldstein sent the following letter to Krauthammer with a copy to House Minority Leader John Boehner, R-Ohio:

Dr. Krauthammer,

I read your piece on Prevention and, while the CBO did in fact state that Prevention as defined in the various bills and analyzed by them did not save money, in fact there were portions of the report that pointed to ways to do it. That was their short line or two regarding behavior change.

As the
Milken Institute study "An Unhealthy America: The Economic Burden of Chronic Disease" (October 2007) points out, changing behavior is the key to how prevention saves money. Not the medical prevention approach as studied in the CBO report, which consisted of screenings and medical interventions. Prevention is much broader, and that is the problem with much of what is in the reform bills and why the CBO report says it won't save money.

Prevention consists of Primary, Secondary and Tertiary prevention. Primary Prevention includes things such as seat belts, eat right, get your exercise get immunized. Secondary Prevention is the early detection of those at risk or who have a condition they are unaware of and Tertiary Prevention is managing those that already have a chronic disease such as diabetes. What the CBO looked at, and what people keep pushing in these bills, is secondary prevention (lots of testing) with subsequent medical interventions. They did not look at primary and tertiary prevention where behavior change is critical.

The Milken study found that if we implemented a comprehensive prevention program for 7 preventable conditions including things such as obesity, diabetes, some cancers, etc. the economic impact on the country would be $1.2 trillion annually in medical cost savings and improved work force productivity by 2023.

Another recent study found that between 2001 and 2006, about 50% of the cost increase in health care was attributed to obesity (Health Affairs). If we reverse the obesity trend, we will reverse a portion of this increase. The United States is experiencing an explosion of preventable chronic diseases, obesity being just one. If we reverse each of these trends for these conditions we can lower the growing rate of health care cost increases.

But the CBO is correct it's not so much about the current medical model and how it delivers preventable services; that model does not save money. It's about how we set up comprehensive prevention programs to change behavior, which we as a private company are doing around the country and soon around the world. Companies such as Aon, the largest benefits consulting company in the world, have put The Prevention Plan in for their employees, and in an industry first we are offering this product direct to consumers.

You can get more information at and Governor Tommy Thompson, former HHS Secretary, is our National Policy Advisor. I would appreciate the opportunity to discuss this with you further.

Frederic S. Goldstein, President
U.S. Preventive Medicine, Inc.


  1. Anonymous said...
    Great response. The need for such a response is an indication of the lack of understanding of many people about the importance of risk factor modification as opposed to "doing more tests".
    mailmike said...
    Excellent article. Thank you!
    mailmike said...
    Nice to see a well articulated response. Thank you

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