WASHINGTON -- Prevention is the key to shrinking our nation's exploding healthcare costs said panelists at a briefing hosted by the National Coalition on Health Care (NCHC), a nonprofit focused on health system reform, at the House of Representatives on Thursday.
But public health is "chronically underfunded," said deputy director of Trust for America's Health (TFAH), a nonprofit focused on disease prevention and community health, based here.
The U.S. currently spends about $35 billion on public health and prevention, including federal, state and local costs, which is about $20 billion short of what's needed, according to a between TFAH and the New York Academy of Medicine, released in 2013.
At the briefing, health experts spoke of three ways to bend the healthcare spending curve: tackling obesity, increasing cancer screening and cutting tobacco use.
All of the panelists support the Affordable Care Act's , which would invest $15 billion in community health projects over the next decade. Under the House of Representatives' 2016 Budget Resolution, the fund could be abolished, according to the .
"F as in Fat"
More than 23 million American children are obese or overweight, said Hamburg, citing a 2013 obesity report card, "" authored by TFAH and the Robert Wood Johnson Foundation. And obesity rates for children and teens have more than tripled since 1980.
This surge in weight gain has sent obesity-related diseases soaring. By 2030, an estimated 6 million Americans will have type 2 diabetes, more than 5 million people will have coronary heart disease and another 400,000 will have obesity-related cancers. The cost burden of such diseases will jump to at least $48 billion annually, with another $390-$580 billion in lost productivity, noted the TFAH report.
By 2030, nearly every other person (44% of individuals) in every state will be obese.
But Hamburg offered a crumb of hope. If each state lowered the average body mass index of its population (BMI) by 5%, millions of Americans would avoid serious illness, such as diabetes, hypertension, arthritis, and obesity-related cancers. And the nation would save billions in healthcare costs.
Take Connecticut. If average BMI were reduced by 5% across the state by 2030, it would save $7.4 billion. But such dramatic shifts require significant behavior change, which is difficult to achieve.
A report from the American Journal of Public Health published July 15 found that, over nearly a decade, fewer than 15% of obese individuals managed to shed 5% of their body weight and keep it off without surgery.
Tobacco, still a threat
"Tobacco today, even with the progress we've made since 1964 [when the Surgeon General released a report linking tobacco to health risks], it's the leading cause of preventable death," said , CEO of Legacy, an organization dedicated to public education around tobacco use, citing
Around 500,000 people die prematurely each year from tobacco. Another 16 million people suffer from tobacco-related diseases each year, he said.
"These are misery-inducing, cost-inducing, chronic and long lead [diseases] such as asthma, emphysema, and COPD [chronic obstructive pulmonary disorder]," Dobbins added.
But there's reason to be hopeful, according to Dobbins, who cited the following:
- In 2014, the adult smoking rate fell a percentage point to 17.8%
- A 10% hike in the cost of cigarettes led to a 6%-7% reduction in the number of kids who smoke
- A public education campaign called The Truth appeared to stop 450,000 children and teens from picking up the habit, while garnering estimated savings of $1.9 to $5.4 billion in 2 years
Despite the proof that these interventions are working, state governments, in particular, have been short-sighted, Dobbins said.
"Almost none of the money states derive from [tobacco-related] settlement revenues and from taxes goes back into prevention. It goes into roads and prisons and Medicaid," he continued.
Proper investment and a forward-thinking perspective would create huge cost-savings.
Non-regulated, non-taxed products like e-cigarettes, little cigars, and hookahs present a new problem for anti-tobacco advocates.
The tobacco industry has so far successfully lobbied Congress to continue to allow these products to be marketed to kids, Dobbins said, making investments in public education even more critical.
Stopping Cancer
president of the American Cancer Society Cancer Action Network, a nonprofit nonpartisan advocacy group based here, said 1,600 people a day and nearly 590,000 people a year die of cancer.
Survival rates have grown by 20% since the early 1990s, said Hansen. That said, the population of adults over 65 is expected to double in 15 years and cancer is mainly a disease of older adults.
"Prevention is the cure," Hansen stressed.
In addition to not smoking and keeping a healthy weight, doctor-recommended screenings could eliminate more than half of cancer deaths in the country, he said.
But investment in such screenings are inadequate, Hansen said.
Approximately 4.5 million women who are eligible for cervical cancer screening following the enactment of the Affordable Care Act won't get screened, because either states haven't funded the screening programs, or the federal government hasn't supported them, he said.
"It's probably the stupidest thing I can imagine in the world of healthcare: not to invest in screenings when you're going to wind up paying for the treatment," Hansen said.
While colorectal cancer deaths dropped 30% in the last decade, it remains the second leading cause of death among cancer patients, Hansen said, and one of the most preventable.
Beyond screening, Hansen highlighted another concern: reimbursement. When a doctor finds a positive result in a colorectal cancer screening, private insurers will pay to remove cancerous polyps. Medicare will not.
The added costs to Medicare to remove polyps is about $42 million, whereas the cost of colorectal cancer treatment is closer to $7 or $8 billion, he said. Congress is currently , he said.
"That's not a tough call," Hansen said. "It would save Medicare a lot of money, it would save a lot of lives and it would save a lot of suffering."