Sen. Edward Kennedy (D-Mass.) Tuesday said that reducing the cost and improving the quality of healthcare in the United States cannot be accomplished without changing the way patients with chronic diseases are treated and the way medical providers are paid.

“We are obviously not doing enough to reward real value in healthcare,” the Senate Health, Education, Labor and Pensions Committee chairman said, pointing out that treatments for the chronically ill with conditions such as diabetes and high blood pressure consume a grossly disproportionate share of the nation’s spending on healthcare.

Carmona homed in on the financial ramifications of healthcare, noting, “Seventy-five cents of every dollar you’re spending on healthcare is on chronic disease, much of which is preventable.” With healthcare costs continuing to mount, rates of chronic illnesses like diabetes rising and the Baby Boom generation advancing in age, the situation will deteriorate without change, he cautioned. “The bank is breaking now and it’s only going to get worse.”

The former surgeon general is national chairman of the Partnership to Fight Chronic Disease , an umbrella group of healthcare industry organizations, medical provider societies, patient advocates and labor unions, and is the president of the Canyon Ranch Institute in Tucson, Ariz. Carmona served as surgeon general from 2002 to 2006.

Government healthcare programs and private health insurance companies structure their payment systems in a way that provides incentives for doctors and hospitals to treat people after they become ill, sometimes with expensive new technologies, rather than aiding patients in maintaining their health, Carmona said, referring to the system as “sick care,” not “healthcare.”

“The system we have now is negatively incentivized. Our health providers get paid to wait for you to get sick to make you better, and they make you better” but do not have a financial incentive to teach patients how to take better care of themselves, Carmona said.

The payment system and the costs of the treatments themselves are not the only problems, Kennedy said.

“Unfortunately, a substantial part of what is spent today is … being spent on inappropriate care or on costly treatments that are of little value,” Kennedy said. “Our goal is to get the right treatment to the right patient at the right time,” he said.

Preventive medicine and more efficient care for people with chronic conditions are favorite components of health reform proposals from politicians of all political stripes. The three leading presidential contenders, Sens. John McCain (R-Ariz.), Hillary Rodham Clinton (D-N.Y.) and Barack Obama (D-Ill.), all include such prescriptions in their platforms. Moreover, theses are concepts embraced by the private-sector players in the healthcare system.

Nevertheless, enacting such changes to the way medicine is practiced and paid for will take a substantial political effort and widespread public support.

“The solution is before us. It is not that difficult, but it’s going to take a cultural transformation in our nation,” Carmona said. “This is going to be a long-term endeavor.”

Although Kennedy, who has endorsed Obama for president, did not specifically address any of the sweeping health reform proposals from the White House contenders or from Congress, he acknowledged the political obstacles to tackling healthcare on a large scale.

“That is easier said than done not only because of the challenges out there in the system but also because of the budget considerations,” Kennedy said. Indeed, lawmakers promoting legislation to encourage more preventive medicine have often run headlong into a skeptical Congressional Budget Office, which historically has not projected that prevention will lead to future savings for federal healthcare programs.

Moreover, Kennedy said, the contentious atmosphere that characterizes the political debate over healthcare must be addressed. “We’ll need to be willing to put past labels and divisions aside,” he said, citing the compromise between Democrats and Republicans that allowed his home state to enact universal health coverage in 2006.

Brennan suggested that the public and the healthcare industry are ready for change. “This is an unsustainable situation, and something that can’t be sustained won’t be,” he said. Lack of access to healthcare, which in large part is driven by high costs, is bad for business, he said. “When we spend a billion and a half dollars to get a drug to market and people can’t have access to it, it’s a terrible thing.” In addition to heading the London-based drug maker, Brennan is chairman-elect of the Pharmaceutical Research and Manufacturers of America.