Including prevention in health care reform |

Including prevention in health care reform

Jason Eberhart-Phillips

Hopes are running high that health care coverage will soon be extended to most of the 6.6 million Californians without medical insurance.

Three heath care reform bills that promise expanded coverage are now being considered by the state legislature. Gov. Arnold Schwarzenegger thinks the moment is ripe for lawmakers from both parties to reach agreement on a new model of universal care for the Golden State.

“The bottom line is, we will do it (because we) all agree it is a broken system and that we will fix it this year,” he said recently.

That’s good news for uninsured families who live in daily fear of financial ruin due to injury or serious illness. But our “broken system” of health care delivery will never deliver on its promise of a healthier population until we invest more of the nation’s health care dollar in prevention.

Without a greater emphasis on preventing disease and injury, health care costs will continue to escalate, putting affordable medical insurance out of the reach of employers and workers alike.

The United States already spends far more per capita on health care than any other country in the world, more than $6,000 per person each year. The average cost in the other 29 industrialized nations of the world is less than half that amount.

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Americans spend three times the average of other industrialized nations in daily hospital costs, five times the amount that Japanese spend. They also spend twice as much per capita as their international peers on prescription drugs.

You would think that America’s extra spending would lead to better health, but it doesn’t.

On important benchmarks like infant mortality and life expectancy, the United States wallows among the worst in the developed world. Our infant mortality rate is more than twice that of Japan’s, and our average lifespan is four years shorter than our Japanese counterparts.

Even Cuba, with only 8 percent of our per capita income, has us beat on these basic measures of population health.

Our technologically advanced medical care system also fares poorly in international comparisons. When the Commonwealth Fund recently compared the United States with Australia, Canada, Germany, New Zealand and the United Kingdom, we ranked second worst in terms of the quality of medical care, last on timeliness of care and last on efficiency.

So where does all the extra money we spend on health go?

Some of the spending is wasted on treatments of questionable value, or is used up on unnecessary tests and other “defensive medicine” procedures done to avoid malpractice litigation. Still more is siphoned off by staggeringly complex administrative practices.

But the lion’s share of America’s excess health care spending is lost on treating chronic diseases that could have been prevented. Long-term therapy for chronic diseases like diabetes, heart disease, emphysema and cancer, absorbs more than 75 percent of US health care spending.

More than 45 percent of Americans currently have at least one chronic disease, but with healthier diets, more active lifestyles and less tobacco use, fewer Americans would need expensive medical care. Overall health care spending could be reduced dramatically.

For example, diabetes care now accounts for one-eighth of America’s $2 trillion health care bill each year. By preventing childhood obesity, new cases of diabetes could be cut by up to 95 percent in future years.

California’s venture into health care reform is welcome news, but real reform will require more than increasing access and expanding supply. It will need to attack the root causes of common diseases that are increasing demand for health care and driving up costs.

– Jason Eberhart-Phillips is the El Dorado County Health Officer. He can be reached at