Preventive care: The sorely missing link in the healthcare debate
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After a brief respite, health insurance is back in the headlines. House Republicans have passed the latest version of “repeal and replace,” and the nation is waiting to see what the Senate will do. While the focus has been on coverage of pre-existing conditions and the fate of Medicaid expansion, one of the most important issues has been largely overlooked: how best to actually improve the health of the population.

Everybody knows that they need health insurance if they get sick, but to improve the health of the population, everybody also needs health insurance when they are well — that is, health insurance that covers prevention. In addition, the nation needs a robust public health system to control epidemics and perform a raft of public health activities ranging from health education to restaurant inspection.


During the 20th century, life expectancy in the U.S. increased by 30 years, with 25 of those coming as a result of public health and prevention activities. For instance, in a 2014 report, the Centers for Disease Control and Prevention (CDC) estimated that vaccinations will prevent more than 21 million hospitalizations and 732,000 deaths among children born in the past 20 years.


As infectious disease has faded as a leading cause of death, it has been replaced by heart disease and cancer, which together account for over 45 percent of deaths in the U.S. Heart disease alone causes over 600,000 deaths and 700,000 heart attacks per year. Cancer is responsible for nearly 600,000 deaths per year and together with heart disease costs about $800 billion annually.

But it needn’t be that way. About a third of heart disease deaths and half of cancer deaths are preventable, and the tools to prevent them are included in the Affordable Care Act, which the House-passed American Health Care Act would repeal and replace. Among these tools is the requirement that insurance policies cover preventive services recommended by the U.S. Preventive Services Task Force — services like blood pressure checks, colorectal cancer screening, mammograms, and assistance in smoking cessation.

In addition, the ACA includes the Prevention and Public Health Fund, which supports important public health services at the Centers for Disease Control and throughout the country. For instance, CDC’s Tips from Former Smokers ad campaign, supported by the Fund, led 100,000 Americans to quit smoking right away.

To truly move the needle on health in America, we must create the infrastructure to facilitate healthier habits. This infrastructure can be built on both ends: by expanding the preventive medicine residency training pipeline, while increasing coverage of preventive services.

It is through residency programs that new specialists in public health and preventive medicine are trained, and these programs are in jeopardy from reductions in the federal funding that supports them. This is despite the fact that the National Academy of Medicine (formerly known as the Institute of Medicine), a highly-respected government-chartered think tank, has recommended adding the capacity to train at least an additional 400 public health and preventive medicine residents per year. However, in the recently-passed fiscal 2017 federal budget, funding for preventive medicine residency programs was reduced by nearly 40 percent.

If improving the health of our citizens is the goal, it will take investment. Leaving people to go it alone doesn’t work; they need the support of a strong public health infrastructure and the ability to access preventive services from their physician. Until we invest in a physician workforce equipped to truly prevent disease and incentivize preventive services for patients and populations, healthcare costs will continue to rise and people will continue to suffer needlessly.

Yes, we absolutely need comprehensive and accessible health insurance. But to shift our healthcare paradigm to one that rewards prevention and actually improves the health of the populace, we need insurance that covers preventive services; adequate financing for public health at the federal, state, and local level; and increased federal support for preventive medicine residency training programs.


Dr. Daniel Blumenthal is the president of the American College of Preventive Medicine (ACPM).

The views expressed by contributors are their own and are not the views of The Hill.