Prevention Matters

"The fact is that guidelines for screenings do change (quite frequently) over time based on continuing research. To have some means to continue such deliberation is to recognize the value of evidence-based medicine."

- The New Republic's Suzy Khimm, in an article entitled "Who Will Decide If Women Have to Pay for Mammograms?"

White House Budget Director Peter Orszag says prevention programs are one of four steps needed in health reform to produce cheaper, better health care.

"How can we move toward a high-quality, lower-cost system?" Orszag asks in a May 15 Wall Street Journal op-ed. "There are four key steps: 1) health information technology, because we can't improve what we don't measure; 2) more research into what works and what doesn't, so doctors don't recommend treatments that don't improve health; 3) prevention and wellness, so that people do the things that keep them healthy and avoid costs associated with health risks such as smoking and obesity; and 4) changes in financial incentives for providers so that they are incentivized rather than penalized for delivering high-quality care."

Meanwhile, The New Republic's Jonathan Cohn reveals some preliminary cost estimates from the Congressional Budget Office and says, "according to several sources familiar with the estimates, the news isn't quite what Obama and his allies were hoping to hear."

The New Republic's health care blog quotes a senior administration official as saying that health care will be a “central focus” of Obama’s first budget proposal.

“I’ve been in meetings with him and it’s clear this guy is committed to getting health care and getting coverage to everybody,” one high-ranking member of the administration told TNR’s Jonathan Cohn. “There’s no question in my mind.”

The statement is meant to reassure reform advocates who had feared that the recent Daschle debacle and subsequent elimination of public health funding in the economic stimulus plan had taken some of the wind out of their sails.

Writing for The New Republic, Harold Pollack quotes a couple of folks who shared some painful observations about the realities facing prevention advocates in the health reform debate:

"Two colleagues of mine introduced a sad note of caution. Roseanna Ander noted the perennial political challenge: There is nothing more compelling than the elaborate rescue of a cute toddler, Baby Jessica, who falls down a well. And there is nothing more boring than debating whether to put a $500 fence around wells before any identified toddler falls in.

"McCormick Foundation Professor Jens Ludwig adds a dollop of Chicago bluntness:

"'The public health constituency includes every thoughtful person who understands the value of prevention. Yet to paraphrase Adlai Stevenson, that isn't enough. I recommend making these interventions much less efficient, to broaden and intensify their political support. President-elect Obama should figure out what a sensible public health investment would be--and then triple it. For example, authorizing legislation should outsource HIV testing to Halliburton, and require that every time someone is tested, a farmer, a corrections officer, a hunter, a teacher, a firefighter, an autoworker, a former hedge fund trader, a TV evangelist, and a diversity counselor must be present, at public expense.'

"This seems a tad cynical, but hey, it might work."