Healthcare: The prescription for America: Build culture of healthy living

 The current healthcare debate, which focuses on a loosely defined government-operated “public option,” has yet to address several underlying complexities within our system. But the essential question is simple: How do we improve health outcomes and reduce costs while protecting vulnerable persons? A thorough policy debate must be grounded in these cornerstone objectives to effectively improve the quality of and access to healthcare for all Americans, or else we are simply discussing a new government financing mechanism without regard to unsustainable cost projections.

In the 20th century, we witnessed a dramatic change in the profile of diseases in America. Until then, healthcare efforts were focused on treating acutely ill patients plagued by infectious, communicable diseases. Advances in sanitation, vaccinations and antibiotics produced a significant reduction in the prevalence of those diseases. However, an altogether different category of diseases associated with lifestyle practices increased simultaneously, and at exponential rates — chronic degenerative diseases.

Currently, in part due to a change in age demographics, but predominantly because of lifestyle habits and the rise in obesity, chronic diseases have displaced acute diseases as the major causes of morbidity and mortality in the U.S. For instance, diabetes, heart disease, some forms of cancer, and cerebrovascular pathologies such as stroke, are taking a costly toll on American lives. Seven out of every 10 American deaths are attributed to chronic diseases, and 75 cents of every healthcare dollar are spent on the treatment of chronic diseases. Seventy-five percent of our $2.2 trillion healthcare bill is spent on this epidemic — much of which could be prevented, or managed more responsibly, saving perhaps billions of dollars to our system.

A national Chronic Disease Prevention and Wellness Individual Achievement Matrix that defines a standard national benchmark for prevention and wellness would be a good beginning. Healthcare attorney and former registered dietitian Ingrid Sell developed the innovative concept of a health matrix upon which wellness incentives could be based, consisting of the following six measurable, demonstrable clinical factors:

• Achieve the recommended body mass index for an individual’s height and weight

• Achieve recommended lipid profile levels

• Achieve the recommended blood pressure level

• Complete all cancer screenings for age and gender

• Achieve non-smoking status

• Achieve the recommended fasting blood sugar level (or if diabetic, the recommended Hemoglobin A1c level)

These six clinical factors are correlated with the leading chronic disease killers in America, and by achieving recommended levels, individuals will significantly reduce their risk. Policies that incentivize achievements within this matrix, both in terms of payment for services and subsidies to patients, could be an important policy framework. This has implications for our public and school nutrition plans, the role of dietitians in chronic disease management, and the practice of primary care medicine. Right now doctors get paid to fix, cut or prescribe. Patients generally wait until something is broken. Why not pay to prevent?

In my home state of Nebraska, Alegent Health, with nearly 10,000 employees, achieved a 50 percent reduction in the rise of its overall medical costs, as compared to the national average. This was accomplished in large part because of its proactive, innovative employee wellness initiatives coupled with engaged healthcare decision-making by its employees. The company also employed Health Savings Accounts as a vehicle to directly pay the employee for advancing better health. Perhaps we should rebrand and expand this important policy option as Health and Wellness Savings Accounts, where tax-deferred dollars may be allocated not only toward healthcare services, but toward preventive lifestyle practices as well.

Although perhaps unintended, certain legal requirements create barriers to employee wellness programs. The American Disabilities Act, Genetic Nondiscrimination Act, Health Insurance Portability and Accountability Act (HIPAA), and Employee Retirement Income Security Act (ERISA) each independently preclude employers’ flexibility in rewarding employee participation in wellness initiatives. We should examine the interplay of these important laws to avoid conflicts.

Lastly, the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, is the vehicle by which states can participate in a 50/50 federal-state match for nutrition education funding. Currently, these funds may only be used for SNAP recipients. As the ranking member of the Agriculture Subcommittee on Department Operations, Nutrition, Oversight, and Forestry, which has jurisdiction over this program, I support allowing nutrition education to be offered to all citizens in a state through this program, perhaps through schools, community health centers, and other community-based avenues of
healthcare delivery.

These policy suggestions are only a few components of the necessary task at hand, but help address the fundamental goal of improving healthcare outcomes and reducing costs. If we incentivize wellness, and expand and promote a culture of health with a paradigm shift toward prevention rather than simply treatment of diseases, we will succeed in tackling a primary driver of our healthcare costs while strengthening the health of Americans.


Fortenberry is a member of the Agriculture Committee’s Subcommittee on Department Operations, Nutrition, Oversight, and Forestry.