From sick care to prevention and wellness

By Tom Harkin

All five congressional committees involved in health care have completed work on their health reform bills, and the core elements of this landmark legislation are now clear.

The media have done a good job of reporting that the emerging bill will crack down on abuses by health insurance companies, such as denying coverage for pre-existing conditions, and it will extend quality health coverage to nearly every American.

But a critical element has been largely overlooked. Our comprehensive health reform legislation lives up to its name by including a robust array of provisions promoting wellness and prevention and jump-starting America’s transition into a genuine wellness society. The bill creates a sharp new emphasis on fitness, physical activity, good nutrition and disease prevention — in short, keeping people out of the hospital in the first place.

The fact is, we do not have a health care system in the United States; we have a sick care system. If you’re sick, you get care, whether through insurance, Medicare, Medicaid, SCHIP, community health centers or charity. The problem is that this “disease management” approach is all about patching things up after people develop serious illnesses and chronic conditions. And it has been a colossally expensive failure.

We spend a staggering $2.3 trillion annually on health care — 16.5 percent of our gross domestic product and far more than any other country spends on health care — yet the World Health Organization ranks the U.S. health care system only 37th among nations, on par with Serbia.

We spend twice as much per capita on health care as European countries, but we are twice as sick with chronic disease.

The reason for this chronic case of overspending and underperforming is clear: We have systematically neglected wellness and disease prevention. Currently in the United States, 95 percent of every health care dollar is spent on treating illnesses and conditions after they occur. But we spend peanuts on prevention.

The good news in these dismal statistics is that, by reforming our system and focusing on fighting and preventing chronic disease, we have a huge opportunity. We can not only save hundreds of billions of dollars; we can also dramatically improve the health of the American people.

Consider this: Right now, some 75 percent of health care costs are accounted for by heart disease, diabetes, prostate cancer, breast cancer and obesity. What these five diseases and conditions have in common is that they are largely preventable and even reversible by changes in nutrition, physical activity and lifestyle.

Let me be specific about some of the things our health reform legislation will do. The bill we passed in the Senate health committee requires insurance companies to reimburse for the whole range of preventive services — everything from cancer screening to smoking-cessation to nutrition counseling — without any co-pays or deductibles.

The bill gives Americans the tools and information they need to take charge of their own health. For example, chain restaurants will be required to display caloric information on menus and menu boards, and to provide additional information on sodium, fat and carbohydrates at the request of customers.

I believe strongly that wellness and prevention are not only about what goes on in a doctor’s office. That’s why our bill encompasses workplace wellness programs as well as “Community Makeover” and “Healthy Aging, Living Well” grants to help entire cities and counties to implement activities to get people active and promote good health.

The bill includes a Prevention and Public Health Investment Fund to provide for sustained national investments in these kinds of wellness programs.

The bill allows employers to reward workers for participating in workplace wellness programs by giving them up to a 50 percent discount on health insurance premiums.

Winston Churchill famously said that “Americans always do the right thing — after they’ve tried everything else.” For decades, we have tolerated a reactive “sick care” system that has contributed to an obesity epidemic and an explosion of preventable disease.

Comprehensive health reform legislation is our opportunity to change the paradigm. Yes, we are going to crack down on health insurance company abuses and extend health insurance coverage. But, just as important, we are going to give our citizens access to a 21st century health care system — one that is focused on preventing obesity and disease, and helping us to live healthy, active, productive lives.

U.S. Sen. Tom Harkin (D-Iowa) is chairman of the Senate Committee on Health, Education, Labor and Pensions.