Healthcare: Emphasis on wellness saves lives and money

 It will ensure access to affordable, quality care for 97 percent of Americans. It will include a strong public plan, which will ensure competition and give consumers a real choice. And, just as important, it will hold down healthcare costs by creating a sharp new emphasis on disease prevention and public health.

As the lead senator in drafting the Prevention and Public Health title of the bill, I view this legislation as our opportunity to recreate America as a genuine wellness society — a society that is focused on prevention, good nutrition, fitness and public health.

Currently, we spend a staggering $2.3 trillion annually on healthcare — 16.5 percent of our GDP and far more than any other country spends on healthcare — yet the World Health Organization ranks U.S. healthcare only 37th among nations, on par with Serbia.

We spend twice as much per capita on healthcare as European countries, but we are twice as sick with chronic disease.

The reason for chronic case of overspending and underperforming is clear: We have systematically neglected wellness and disease prevention. In the U.S., 95 percent of every healthcare dollar is spent on treating illnesses and conditions after they occur. But we spend peanuts on prevention.

The good news in these dismal statistics is that, by reforming our system and focusing on keeping people healthy and preventing chronic disease, we have a huge opportunity. We cannot only save hundreds of billions of dollars; we can also dramatically improve the health of the American people.

Consider this: Right now, some 75 percent of healthcare costs are accounted for by heart disease, diabetes, prostate cancer, breast cancer and obesity. What these five diseases and conditions have in common is that they are largely preventable and even reversible by changes in nutrition, physical activity and lifestyle.

And by preventing chronic disease, we can reduce healthcare costs. For example, according to a study published in the American Journal of Cardiology, after one year in a program emphasizing rigorous changes in diet and lifestyle, almost 80 percent of heart-disease patients are able to safely avoid heart surgery or angioplasty. Mutual of Omaha calculates savings of almost $30,000 per patient in the first year alone.

A 2007 study by the Trust for America’s Health found major savings from community-based prevention programs designed to increase levels of physical activity, improve nutrition and a reduce smoking rates. The study concluded that a national investment of $10 per person per year in these kinds of community-based programs could yield net savings of more than $2.8 billion annually in healthcare costs in one to two years, more than $16 billion annually within five years, and nearly $18 billion annually within 10 to 20 years.

Workplace wellness programs — which receive generous incentives in our bill — also produce major cost savings. Employer-sponsored programs — everything from nutrition counseling to smoking cessation to in-house gyms — typically cost $20 to $200 per employee. But they have a proven rate of return, ranging from $2 to $10 within 18 months, for every dollar spent.

It’s not enough to talk about how to extend insurance coverage and how to pay for health are — as important as those things are. It makes no sense just to figure out a better way to pay the bills for a system that is dysfunctional, ineffective and broken. We have to change the healthcare system itself, beginning with a sharp new emphasis on prevention and public health.

We also have to realize that wellness and prevention must be truly comprehensive. It is not only about what goes on in a doctor’s office. It encompasses workplace wellness programs, community-wide wellness programs, building bike paths and walking trails, getting junk food out of our schools, making school breakfasts and lunches more nutritious, increasing the amount of physical activity our children get, and so much more.

As President Obama said in his speech to Congress earlier this year: “[It is time] to make the largest investment ever in preventive care, because that’s one of the best ways to keep our people healthy and our costs under control.”

Winston Churchill famously said that “Americans always do the right thing — after they’ve tried everything else.” Well, we’ve tried everything else, and it has led us to bad health and the brink of bankruptcy.

Comprehensive health reform legislation is our opportunity to change the paradigm. We are going to extend health insurance to every American. And we are going to give our citizens access to a 21st century healthcare system — one that is focused on helping us to live healthy, active, happy lives.


Harkin is a member of the Senate Health, Education, Labor and Pensions (HELP) Committee.