Prevention in health care reform....

Today's post: Tuesday, 12-16-2008

President-elect Obama has a website with several ideas on how health care reform can be done effectively. (See Health Care under the Agenda tab at http://www.change.gov .)

1. I support Obama’s most important position, which is that he will continue the existing plans and coverages. So, the large group of people who have good or at least almost OK health insurance don’t have to deal with moving to a system that may well be worse or cause them to lose contact with any doctors they have worked well with until now. This also ensures that his plan won’t get torpedoed in congress by legislators who the existing companies would lobby to oppose his plan. It also enables him to add the remaining pieces much more quickly and inexpensively. That gives his reforms a chance of being doable.

2. He also wants to have a plan that gives people who are now not insured some coverage. And he wants to see to it that individuals and employees of small businesses that now get overcharged or denied coverage due to pre-existing medical conditions get group coverage and get coverage at competitive rates and get coverage even with pre-existing medical conditions just the same as employees of large companies do now.

And, most of the other points look decently good.

A. However, due to the severe recession and to help end it, he has postponed the tax rollback his agenda calls for as a funding mechanism. (This may be the correct call for a person charged with the responsibility for the whole country I think.) But it does leave much of the good ideas in this part of his agenda without a funding mechanism for now.

B. And, despite having the following two points about prevention, it is quite weak on simply preventing medical care costs. This is very important because if you don’t get sick or only get sick ten, twenty, or thirty years later, your current health care costs will drop like a stone. And, if any government plan adopts a strong preventive component and gradually begins to require existing insurers to add or upgrade their preventive components if they don’t already have better ones in place, this will eliminate or postpone costs enough to lower our health care costs. Further, these savings can in part help fund the needed added coverage.

Here are the two mentions I see of prevention in the current agenda on health care reform.:

“The Obama-Biden plan will promote public health. It will require coverage of preventive services, including cancer screenings….”

They also plan to require the insurance companies that provide malpractice insurance for doctors to lower their rates while also lowering their risks to compensate by requiring them to “….invest in proven strategies to reduce preventable medical errors.”

These two strategies will help. But I think that they need to go much farther than that.

I think they need to also ensure that all the players in the system give discounts to the individuals covered to follow the most essential preventive measures and to charge people who do not do the preventive measures at least a token amount besides.

This would include direct payments to individuals who have no income but who DO take the most important preventive measures.

It’s recently been shown that offering small payments for success to people who are too fat to lose it, does work, for example.

In addition, getting a certain minimum of exercise each week and NOT smoking have even more positive effects.

One way to help accomplish this would be for the new health care program to offer incentives to all employers to offer some kind of fitness plan; offer incentives to any employee (and anyone living in tbeir homes) who now smokes to quit and free doctor and drug programs to do it; and offer extra help to employers to set up workplaces that support good health practices. This would also mean that the coverage plan for individuals and small businesses would have a model program in these areas based on proven best practices. That would provide those people a good program plus provide a model to follow for the larger employers who have less effective plans or none.

This might also encompass passing a law specifically granting any employer the right to only hire nonsmokers and having a federal law prohibiting smoking in certain public places where the local laws do not already do so.

People who don’t smoke, exercise regularly, and eat right tend NOT to get type 2 diabetes, all cancers, heart disease, high blood pressure, strokes, and many, many other expensive diseases or only get them after age 70.

And, taking the correct supplements generally and for the issues of a particular person as needed have been shown to increase that protection. Following good health practices generally and brushing correctly and flossing daily and seeing a dentist regularly adds to the protection. Taking curcumin and very likely several other supplements in addition to following good health practices generally tends to prevent Alzheimer’s disease.

So, not only do these actions prevent disease, they prevent disability. This has the double benefit of eliminating the need for extremely expensive custodial care and to allow the people who thereby remain disability free to do economically productive work.

So, each of these preventive steps helps to eliminate costs. They prevent suffering. And they help keep people productive.

At a time when our economy needs extra help, they are even more important to include than they have been up to now.

C. All of the above will cost money. So if there is a way to raise it that does not cut economic productivity, we should certainly do that too.

There IS such a way.

It’s quite simple. It will not be totally popular; and the industries affected will lobby against it. But I think it’s long overdue to have a hefty federal tax on food and drinks that make people sick. We tax cigarettes. But many foods and drinks we now know are quite literally that bad for you do not now get taxed. Even worse, most of the people who consume them do not even know they are being harmed.

People will die if they don’t get fruit and vegetables -- and protein foods and some kinds of oils that are safe to eat.

But if they never had another soft drink or commercially made dessert or packaged snack they might feel deprived, particularly if they didn’t know how to make or find foods that support their health that they enjoy to substitute for them. But their health would improve dramatically. Their medical care costs would drop in an equally dramatic fashion.

Why not simply tax these things enough to cut their consumption by 70 %. In the short term, while they are still socially accepted; people are still unaware of their health damaging qualities; and people are used to consuming them, they would remain widely available.

But their use would go down; and the taxes would be in the tens of millions nationwide, and likely even more than that.

We could easily add a federal excise tax equal to and collected by the same people who now collect the federal excise tax on alcoholic beverages to all soft drinks and all foods that contain refined grains or refined grain flour, sugar, high fructose corn syrup, or any vegetable oil except olive oil or any kind of hydrogenated oil. Then as people become better educated and fewer use these things, the tax could be gradually increased. These foods and drinks are often quite safe if you have them once or twice a month or even once or twice a week; but they produce avoidable illness and massive medical costs if you have them five times a day.

Why not raise money and drive their use down to the levels people can enjoy without getting fat and sick and broke from avoidable medical costs by taxing them adequately?

They would become luxury goods instead of cheap bad for you treats. But the people who have enough money to get lots of them increasingly know better than to have a lot of them.

We could also add a federal tax of a dollar a pack tax on cigarettes in addition to the current taxes on them. (And, it would make sense to have at least a quarter each of the revenues generated go to enforcement; to smoking education and prevention; & to providing no-cost cessation programs.)

We need healthier people. We need lower medical costs. We need to increase the productivity of people who have jobs. And, we need to raise money for these health care reforms without harming things that provide people with essential goods and services.

Taxing and then gradually increasing the taxes on the foods and drinks that make people sick when consumed as often as they are now, would do this.

Why not raise the money for the needed reforms in a way that prevents disease too?

So, I ask the Obama health team
to add such taxes as an essential part of their health care reforms.