Americans agree on one thing: It’s time to invest in health, not just health care


As the nation struggles with the COVID-19 curve of infection and death, the virus has insidiously birthed two other longer, deadlier, and costlier curves. 

The first is the COVID-19 health curve, which traces the long arc of unemployment and the struggle to afford food or rent — the basics we need to be healthy. This will spur a costly and even more protracted second curve, the chronic disease curve, with escalating rates of diabetes, depression, substance use, and other conditions exacerbated by economic and racial disparities.  

As unemployment claims pile up and thousands of cars wait in line at food pantries, our elected officials pontificate and flounder. But Americans know — and agree on — what to do.

Three years ago, as politicians battled over Obamacare, we enlisted Republican and Democratic pollsters to ask voters: “If you had $100, how would you spend it to buy health for your community?”

To white Republicans in Charlotte, North Carolina, the answer was obvious: spend less on health care and more on what people need to be healthy. As one said: “Instead of putting all this money into hospitals, put some of it towards housing.” 

Black Democrats in Charlotte had the same answer. So did white Republicans in Dallas; white and Latino swing voters in Seattle; and white and black Democrats in Cleveland. We are responsible for our health, asserted the voters, but we need access to the right building blocks: a safe home, healthy food, and a decent-paying job. 

With COVID-19 throwing these basics into jeopardy for millions of Americans, it is time to act on the voters’ mandate. 

How do we invest our country’s public and private dollars to buy health? Most answers are inadequate or improbable. Pouring money into food pantries will not solve a long-term hunger crisis. Nor is the federal government rushing to increase funding to safety-net programs. 

But one thing is certain: the U.S. spends almost $11 billion on health care every day. It’s time to put those dollars to work for practical solutions that put money in people’s pockets, are good for business, and buy health for Americans, not just health care. Here are three ways to start, none of which require presidential executive orders or congressional unity: 

First, incentivize health insurance plans to invest in health, not just medical care. Private health insurance companies control almost $1 trillion. The Center for Medicare and Medicare Services created the “medical loss ratio” to require that insurers spend more money on medical care than salaries and administrative costs. But there’s a catch: the MLR also disincentivizes investments in health. An insurer can buy a diabetic medicine; however, if it buys her healthy food to manage her diabetes and avoid the hospital, that’s an administrative cost. CMS recently allowed certain plans to spend premiums on healthy food and other drivers of health. With COVID-19, CMS should expedite expanding the rule to all plans, putting billions of dollars in Americans’ hands to help them get and stay healthy. 

Second, leverage corporate balance sheets to invest in health. COVID-19 has left millions facing evictions and prompted massive spending to house those at risk of infection. But COVID-19 creates the opportunity to convert now-vacant hotels into affordable homes. One seasoned innovator is raising a social impact fund that, by tapping low-interest rates and federal recovery funds, will enable communities to acquire $750 million of hospitality properties to serve as emergency housing and, eventually, affordable homes. For insurers and hospitals — who bear the cost of ER visits linked to housing instability — this is a no-brainer way to leverage billions of low-risk, low-return investments on their balance sheets. 

Third, invest in employees’ health to reduce the business risk of disease. A 2017 study found that 24 percent of those with commercial health insurance — meaning they had jobs — lacked adequate food, housing, or other basics. This means higher annual medical costs

One Fortune 50 company calculated that its employees making under $70,000 have twice the ER costs and 20 percent greater medical costs as higher-wage employees — and that it carries $60 million in excess medical costs for those employees struggling to feed their families. With COVID-19 wreaking havoc, financially astute companies are moving to reduce their health care costs by raising wages or helping pay for employees’ food, childcare, or housing. 

COVID-19 makes vivid what we’ve always known: our country spends huge dollars on the wrong things. This is the moment to act on Americans’ mandate that we invest in health — not just as an emergency response, but as a bridge to a stronger economy rooted in health.

Rocco Perla and Rebecca Onie are co-founders of The Health Initiative, a nationwide effort to catalyze a new conversation about — and investments in — health. Perla is a Deming Medalist and a former official at the Centers for Medicare and Medicaid Services. Onie is a MacArthur Fellow.  

Tags Health care reform Health economics Healthcare reform in the United States Patient Protection and Affordable Care Act

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