As Congress struggles to decide how America should take care of its sick, another controversy is simmering: whether health care legislation should include billions of dollars aimed at keeping people well.
A draft Senate bill would provide up to $10billion 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.
But while some lawmakers believe these initiatives could trim American waistlines and cut costs in the long run, others consider them wasteful spending.
One critic, Sen. Mike Enzi of Wyoming — an accountant who is the top-ranking Republican on the Health, Education, Labor and Pensions Committee — called the provisions “an $80 billion slush fund for additional pork-barrel projects.”
“The (Health Committee) bill will pave sidewalks, build jungle gyms and open grocery stores,” Enzi said, “but it won’t bring down health care costs or make quality coverage more affordable.”
But advocates say preventive efforts will bring down costs.
“We know these programs work,” said Richard Hamburg, director of government relations for the Trust for America’s Health, a nonpartisan organization that works to make disease prevention a national priority. “In and of itself, prevention makes sense,” Hamburg said.
Trust for America’s Health joined more than 300 organizations in urging lawmakers to include public health and prevention money in the bill. The group also issued a 2008 report suggesting that an investment of $10 per person per year in “proven community-based programs” — access to fresh produce through farmers markets, for example — could save the U.S. more than $16 billion annually within five years in lower health care costs.
Hamburg acknowledged Republican objections. “Their talking points are, ‘Hey, this is gonna build jungle gyms,'” he said. “Frankly, building healthy parks and making them easier to access is a good thing.”
Public health has been “chronically underfunded” for years, Hamburg said, and the wellness and prevention provisions would help reduce chronic disease in the long term.
“How can you tell people to go exercise if there aren’t sidewalks?” he said.
President Barack Obama has said repeatedly that he won’t sign a bill that is not “deficit-neutral,” and a great deal of hope toward that end has been placed in preventive efforts, with health “infrastructures” being just one example.
But prevention’s potential payoffs have been largely overlooked by recent Congressional Budget Office estimates, which indicate that the drafted bill would likely keep health care costs rising.
Meanwhile, infrastructure provisions have drawn more explicit assessments from other lawmakers.
Sen. Tom Coburn, R-Okla., a physician on the health committee, also opposed the wellness provisions and offered an amendment that would have prohibited money from being used on “wasteful construction projects” like farmers markets. It failed.
Rep. Tim Murphy, R-Pa., a psychologist and co-chair of both the Mental Health Caucus and the GOP Doctors Caucus, stresses the importance of preventive measures and promoting healthy living, particularly through lower health insurance rates for healthy behaviors.
“Shouldn’t there be more credit given if someone’s a nonsmoker?” he said.
But 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.
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In a House draft of the bill, up to $8.8 billion annually would be set aside for a public health investment fund, with up to $1.6 billion for community grants that could include infrastructure projects.
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