By JIM STOMMEN Medical Device Daily Contributing Writer
The recent decision by the Obama administration to propose big-time funding cuts for medical prevention and wellness programs is, like many of the decisions that come out of Washington, puzzling to say the least.
Done as part of the extension of the payroll tax cut, the prevention/wellness cuts supposedly are the political quid pro quo for the lawmakers agreeing to maintain Medicare payments to physicians at existing levels for the remainder of this year — the so-called “Doc fix.”
With a snip-snip here and a snip-snip there, seemingly worthwhile wellness efforts such as those aimed at diabetes prevention, smoking cessation and getting school-aged children to eat more fruits and vegetables were goners. In all, $5 billion worth of prevention/wellness programs have been deemed expendable from the Prevention and Public Health Fund, or roughly one-third of its present funding.
The goal of the fund, created as part of the healthcare reform law, is to provide communities around the country with billions of dollars over the next decade to invest in prevention efforts against heart ailments, cancer and strokes and to target obesity and cut tobacco use (something that might be useful to President Obama, as well as tens of millions of others).
The Oakland, California-based Prevention Institute said that federal funding “is critical to support the health . . . of our communities,” and added that such expenditures offer some form of salvation for “a struggling economy being sunk by healthcare expenditures for preventable conditions.”
Without prevention programs, it said “our workforce will be less healthy and productive, our chronic disease and injury rates will continue to climb, and hundreds of thousands of children, families and communities will still be isolated from healthy foods, safe places to play and smoke-free environments.”
The institute trumpeted: “We need more investment in prevention, not less.”
Part of the reason these programs are vulnerable to being cut is that their results, if achieved, are achieved over long periods of time and tend to be relatively obscured. As Rick Mayes of the University of Richmond told the Washington Post recently, “Public health professionals, programs, and policies are largely invisible to the public and taken for granted.”
Merrill Goozner, who authors a popular healthcare blog known as GoozNews.com, had an apt response to the vote: “Would you sell your home’s storm doors to pay for this winter’s heating bills? That’s what Congress did Friday to pay for part of a 10-month ‘doc fix.’”
Lisa Aliferis, writing in the KQED State of Health Blog from KQED, a Northern California-centered public radio/TV station, said, “Lawmakers figured out a ‘Doc Fix,’ but at the cost of the Prevention and Public Health Fund, part of the healthcare reform law. The deal is not yet final, but it looks like lawmakers will slice $5 billion — or about one-third of its total funding. Public health advocates had fought hard against these cuts, but to no avail.”
She quoted Mary Pittman, president of the Oakland-based Public Health Institute: “I know we’re at a place where difficult decisions have to be made, but it just doesn’t make sense that all of the difficult decisions end up focused on prevention. If we’re to change the way we think about health and we’re trying to find a way to reduce cost, all directions point to prevention.”
Sana Chehimi, program director for the Prevention Institute, told Aliferis that it costs “each and every one of us every day as taxpayers, as residents of communities, when we say we’re going to let people get sick first and then deal with it afterwards.” That’s unnecessary,” she said. “We know how to prevent illness. If we do that, we’re making sure that people don’t have to go to the doctor or emergency room. So it makes our healthcare system that much more efficient.”
As to whether prevention money is well spent, Aliferis cited American Heart Association research from last year that such funds can yield a dramatic return on investment, with community programs to increase physical activity, improve nutrition and prevent smoking being credited with saving more than $5 on every dollar spent within five years.
The AHA added that lifestyle changes reduced the incidence of diabetes by 58%, vs. 31% for drug therapy, and that building bike and pedestrian paths saves almost $3 in medical costs for every dollar spent in building the trails.
As part of his lament at the budget-cutting, Goozner rolled out comments from a couple of other interested parties. “The idea of paying for a 10-month fix in physician payments with a 10-year cut in prevention programs is the ultimate penny-wise, pound-foolish move,” said Richard Hamburg, deputy director of Trust for America’s Health, which lobbies for community prevention programs and more funding for state and local health departments.
Kenneth Thorpe, director of the Partnership to Fight Chronic Disease and a professor at Emory University in Atlanta, said, “We’re robbing from the one place in the Affordable Care Act where we can really do something about prevention. The fact that it ends up propping up a collapsing fee-for-service system is the ultimate irony.”
Speaking of ironies, the Prevention Institute noted that, even as the administration’s budget cuts were revealed, the Senate Appropriations Committee voted to support a proposed budget that includes a more than doubling of Community Transformation Grants, which are part of the Prevention and Public Health Fund. “These mixed messages make one thing clear,” the institute said. “Our government sees the value of prevention, but this funding continues to be vulnerable.” That seems very true, and lamentably so.
(Jim Stommen, retired executive editor of Medical Device Daily, is a freelance writer focusing on healthcare issues.)