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Harkin: Preventive Care Needs Emphasis

In his speech to Congress last month, President Barack Obama stated his intention to see health care reform passed this year. He also made it clear that the heart of his reform plan will be a sharp new emphasis on wellness and disease prevention. As the president said, 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.”

Sen. Edward Kennedy (D-Mass.), chairman of the Senate Health, Education, Labor and Pensions Committee, asked me to lead the Prevention and Public Health working group, which will craft elements of health reform legislation focusing on wellness, disease prevention and strengthening our public health infrastructure.

As leader of this working group, the message that I will carry to the administration’s Midwestern Regional White House Forum on Health Care Reform in Des Moines, Iowa, today is this: It is not enough to talk about how to extend insurance coverage and how to pay for health care — 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 broken and unsustainable. We also have to change the health care system itself. We need to rethink not just the way that we do medicine, but the medicine that we choose to do.

The fact is, we currently do not have a health care system; we have a sick care system. If you’re sick, you get care, whether through insurance, Medicare, Medicaid, the State Children’s Health Insurance Program, community health centers, emergency rooms or charity. The problem is that this is all about patching things up after people develop serious illnesses and chronic conditions.

We spend a staggering $2 trillion annually on health care — 16.5 percent of our gross domestic product and far more than any other country spends on health care — yet the World Health Organization ranks U.S. health care only 37th among nations, on par with Serbia. Meanwhile, we spend peanuts — less than 5 percent of our health care dollars — for prevention.

Incentives in the current system are overwhelmingly biased toward conventional medicine — surgery, pills and hospitalization. For example, insurance companies pay more than $30,000 to amputate a diabetic foot, even though most amputations can be prevented by techniques that are not covered by insurance. Medicare and insurance companies will reimburse for nutrition counseling after a person becomes diabetic, but not if a person is pre-diabetic.

What gets reimbursed the most gets practiced the most, and what gets practiced the most gets taught in our medical schools and thereby perpetuated. Alternative therapies and integrative health care — often low-tech, low-cost practices with excellent records of success — continue to be largely marginalized and discriminated against.

If left unchanged, this broken status quo will bankrupt us. That’s why health care reform cannot focus only on extending health insurance to the 46 million Americans who currently don’t have it. We also need a major overhaul of the system itself, with the aim of transitioning from our current sick care system to a genuine health care system. Our goal must be to transform America into a wellness society where people are given the information, screenings and counseling that they need to take charge of their own health.

To this end, we must adopt an integrative approach that takes advantage of the very best scientifically based practices, whether conventional or alternative. We must stop reimbursing on the basis of quantity of care and start reimbursing on the basis of the quality of care. Let’s reward health care professionals not for how many procedures they perform, but for how they help their patients stay well and avoid serious medical conditions.

In the HELP Committee, I have already held four hearings to explore the contours of a reformed, transformed health care system. I have also laid down a marker by which to judge our final legislative product: If we pass a bill that greatly extends health insurance coverage but does nothing to implement a national prevention and wellness structure and agenda, then we will have failed the American people.

And we do not intend to fail. The good news is that, unlike in 1994, when health reform crashed and burned, there is broad agreement among ordinary Americans, corporate America and health care providers that the current system is dysfunctional and wasteful. It is time to extend health insurance to every American and to give our citizens access to a 21st-century health care system — one that emphasizes wellness, disease prevention and public health.

Sen. Tom Harkin (D-Iowa) is chairman of the Prevention and Public Health working group of the Senate Health, Education, Labor and Pensions Committee.

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