Prevention Matters

Schools in the District of Columbia will offer testing for sexually transmitted diseases to all high school students in the coming school year. The move amounts to an expansion of a pilot program conducted last year at eight high schools found that 13 percent of about 3,000 students tested positive for an STD. About 12,000 students attend public high schools in the District.

The Robert Wood Johnson Foundation's James Marks challenges the Congressional Budget Office's scoring rules in a column appearing in The Huffington Post. Because those rules exclude any returns on health investments that occur after 10 years, the CBO attributes no budget savings to early childhood inteventions and investments in early detection and prevention -- all of which generally show gains well beyond the 10-year window.

"Benjamin Franklin once famously remarked, 'An ounce of prevention is worth a pound of cure,' Marks wrote. "Unfortunately, what this means is often, according to the CBO, an ounce of prevention isn't worth anything at all."

"...as a doctor, and more specifically, a pediatrician, I know these truths to be self-evident: a society that fails to invest in its children will not flourish, and merely scoring costs in the short term and not determining the value of health in the long term has helped us have the most expensive medical care in the world with a shorter life span than all our competitors," he said.

Can a person's health be improved outside of the doctor's office or hospital? Some Republican lawmakers apparently think not.

Rep. Tim Murphy, R-Pa., a psychologist and co-chair of both the Mental Health Caucus and the GOP Doctors Caucus, dismisses proposals to fund infrastructure projects through community prevention measures in the health reform bills being crafted by Congress.

The Chicago Tribune says he "stresses the importance of preventive measures ... (b)ut Murphy thinks infrastructure projects like bike trails would probably best belong in a transportation bill. The health care bill itself, he believes, must address how care can be delivered more effectively and efficiently by doctors and hospitals."

In making such statements, Murphy apparently overlooks the fact that the US Task Force on Community Preventive Services - an independent panel of experts sponsored by the Centers for Disease Control and Prevention - has identified more than 60 policies and programs that are proven to address the nation's most serious preventable health problems, like obesity and smoking. These policies, which are implemented outside of a doctor's office or hospital, help create environments that facilitate good nutrition choices and create safe places and opportunities in which people can engage in physical activity.

A draft Senate bill would provide up to $10 billion annually for a prevention and public health investment fund -- a portion of which could be used for projects such as bike paths, sidewalks, farmers markets and other community interventions meant to curb chronic and costly conditions like obesity.

So let's get this straight - chronic diseases are underlying drivers of our current health care expenditures; many of these chronic disesases can be largely prevented through good nutrition and increased physical activity; good nutrition and increased physical activity can be increased through non-clinical programs; but the health reform bill should only concentrate on things that happen in doctor's offices and hospitals? Hopefully, Rep. Murphy will re-think this stance.

More than 400 Mississippi school nurses will become the first in the nation to be trained by a national association to fight increasing cases of childhood obesity in the state. The nurses will be trained by the National Association of School Nurses through the School Nurse Childhood Obesity Prevention Education today and Wednesday at the Marriott Hotel. The program provides strategies for school nurses to assist students, families and the school community to promote healthy weight.

U.S. health plans "appear to be getting the message" that they should offer free tests to encourage prevention, but they aren't rushing to embrace a proposed government mandate of first-dollar coverage of clinical preventive services.

Phil Galewitz of Kaiser Health News talked to insurance officials to get their take on first-dollar coverage.

"Aetna, one of the nation’s largest insurers, this year began introducing health plans for small employers that charge patients no co-pays for preventive care such as routine physicals, vision and gynecological exams, and well-child visits," Galewitz wrote.

"The company says it is pricing that new plan the same or nearly the same as what the existing plans would have cost, although it has increased co-pays on certain other benefits.

"Aetna spokesman Mohit Ghose on Friday said the company strongly supports efforts to promote prevention in health reform. He declined to say whether the company would support a government mandate eliminating copayments for preventive services.

"America’s Health Insurance Plans, the industry’s top lobbying group, opposes the mandate, said spokesman Robert Zirkelbach. He cited the need to give insurers flexibility in designing benefit packages.

"Wellpoint, the largest Blue Cross and Blue Shield company, said it sees the benefit for waiving cost sharing but doesn’t want the government mandate.

“'Many of WellPoint’s affiliated health plans’ benefits already offer preventive services with no co-pay or deductible as we feel these are important services,' said spokeswoman Cheryl Leamon. 'We also believe it is important for our members and others to have the choice in the type of health plan and benefits that fit their needs.'”

President Obama recently cited "no cost sharing for preventive services" as one of eight protections he wanted a health reform bill to provide.

The bills currently working their way through Senate and House committees all mandate Medicaid coverage of clinical preventive services. The House Energy and Commerce Committee last week approved an amendment by Rep. Lois Capps, D-Calif., that would prohibit cost-sharing for clinical preventive services provided to Medicaid patients.

White House economic advisor Lawrence Summers says Congressional Budget Office's failure to atttribute savings to prevention programs means health care legislation will be even more fiscally responsible than expected.

"It’s what we call a “belt and suspenders” approach," Summers, who chairs the National Economic Council, said on NBC's "Meet the Press."

"There are some things - how we pay drug companies, for example - where you can do the accouinting very accurately and see what happens to the deficit," he said. "There are other things - encouraging preventive care, taking the whole reimburseement system out of politics - where it’s much more difficult to do the exact calculation. And so the CBO doesn’t give us any credit for them, although most people would say that over time they’re likely to have some benefit.

"We’re doing both sets of things," he continued. "And so I think we’ve got a lot a lot of basis for being optimistic that whatever the CBO says it’s going to end up better. This is the most fiscally responsible approach to introducing a major structural change in the economy that’s ever been pursued. And it’s right, because the center has got to be containing health care costs or it’s not going to work for most families."