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What does the bill do for prevention?

Dr. Jeff Levi is executive director of the Trust for America’s Health and a member of the faculty at the George Washington School of Health Policy. I spoke to him today about the prevention components of the health-care bill.

So tell me, as simply as you can, what this bill does for prevention.

It ensures that group-health plans offer first-dollar, no co-pay, no-deductible coverage of clinical preventive services. But there’s also a recognition that what happens outside the clinic can have a bigger impact than what happens in the clinic. There’s $15 billion over 10 years for a Prevention and Public Health Fund that will support community prevention programs that try to change the policies, the physical and social environment, that make it hard for people to make healthy choices.

Give me some examples of the types of programs and initiatives it will fund.

The focus tends to be on structural change. So anything from a national campaign to promote immunizations and a better understanding of the safety of vaccines to a narrower, neighborhood approach that puts lights in a playground or negotiates a mixed-use agreement with a school so the playground can be open after hours. It could be used to improve the walkability of neighborhoods or the nutrition standards at schools. Some of this money will go to help state and local health departments build their capacity to do this kind of prevention.

And then there are things that don't cost money, like the menu labeling initiative. Are there other policies like that one tucked away in the bill?

In normal circumstances some of the small parts of this bill would be considered huge victories. There’s menu labeling for chain restaurants, which is a huge change. There are a bunch of demonstration programs, some of them simple things that you’d think would already be the case but aren’t. Coverage of tobacco-cessation service for pregnant women in Medicaid, for instance. Incentive grants in states to do more chronic disease prevention. And the most important clinical piece is that all group-health plans offer first-dollar – no co-pays, no deductibles -- coverage for anything rated A or B by the National Prevention Task Force.

This seems a bit small to me. In the context of the bill, $15 billion isn't very much. It's hard to imagine it transforming our public health sector.

There’s not enough money to truly transform public health, if we’re honest. But if it’s leveraged right, it can be transformative. It can be leveraged as an incentive to get state governments to rethink their community health programs, and it’s a signal from Congress that this is a new direction, and some of our federal programs need to be reshaped with this program in mind.

You've implied here that part of this money is about moving prevention and public health in a different direction, that we've been doing it wrong and this is a chance to do it right. What's the new theory?

It’s thinking about a community. It could be a city, a neighborhood, or even a defined population. And you need to think about the impediments to them making healthy choices. There are parts of D.C. where you can’t walk at night or let your kids play. In those neighborhoods you could do better lighting, safer playgrounds, supervised playtime for kids. That gives them more exercise and healthier lives.

Another way to think about it is, what are the risks populations experience, and how do they contribute to other risks they take? Unsafe communities make it hard to exercise and also create stress and anxiety that comes out in drinking, in smoking, in drugs. Starting with the elements of the community that create risk and trying to change them comprehensively so you have an effect on many diseases, not just one disease.

By Ezra Klein  |  March 23, 2010; 6:28 PM ET
Categories:  Explaining health-care reform , Interviews  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati   Google Buzz   Previous: Poll: Health-care reform more popular after passage than before
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Honestly, how much money does it cost to tell people to move their bodies, not sit so much, and to prepare real food at home, with old time recipes from plants and animals.

It doesn't take money. It takes will. Some people have it, and don't need healthcare services or pills. Some people will continue to remain dependent, on smart folk like you to teach them -- as adults -- how to eat and exercise.

Why don't you teach them on your own dime, and not assume everybody needs remedial help?

Posted by: Mary42 | March 23, 2010 6:34 PM | Report abuse

"And the most important clinical piece is that all group-health plans offer first-dollar – no co-pays, no deductibles -- coverage for anything rated A or B by the National Prevention Task Force."

I guess that means no first-dollar coverage for mammograms for women under 50 (Grade C).

Posted by: bmull | March 23, 2010 7:19 PM | Report abuse

"And then there are things that don't cost money, like the menu labeling initiative. Are there other policies like that one tucked away in the bill?"

Are the sign makers going to work for free? I like that "things that don't cost money."

NEWSFLASH: Everything in this bill costs money, it's just that usually it's somebody else's money.

Posted by: kingstu01 | March 23, 2010 7:22 PM | Report abuse

"And then there are things that don't cost money, like the menu labeling initiative."

You've got to be kidding me! This doesn't cost money?

Posted by: ab13 | March 23, 2010 7:34 PM | Report abuse


i'm sure they could spend billions on menu labeling.

I especially LOVE this amendment that Senator Coburn proposed.

Congress Should Not Lecture Americans About Fiscal Responsibility - This amendment would strike the creation of a new $375 million government program the new health bill (The Patient Protection and Affordable Care Act) intended to promote personal and financial responsibility. It is ironic that Congress, that amassed a $12 trillion deficit, should lecture Americans about financial responsibility. This government “responsibility” program duplicates existing government programs and adds hundreds of millions of dollars to the tax burden funds. In short, there is nothing responsible about the new responsibility program.

Posted by: visionbrkr | March 23, 2010 7:58 PM | Report abuse

the prevention is nice but most insurers have been doing this for years. Its just now FINALLY that Medicare got on the bandwagon and is offering seniors ONE free preventative visit per year.

MA for example has no limitation on preventative care visits.

Posted by: visionbrkr | March 23, 2010 8:00 PM | Report abuse

I agree with Mary42. If people happen to live in a neighborhood where it's too dangerous for kids to play, why don't they just move? Or if their neighborhood only has liquor stores, why don't they drive to a Safeway to get some decent food. I mean, how hard is it to make some decent organic food for your kids; Whole Foods is everywhere. If people are working two jobs to make ends meet and can't be at home to cook, they should just find a higher paying job. I'm sick and tired of all their whining.

Posted by: Lonepine | March 24, 2010 12:22 AM | Report abuse

Sounds like a job for those "community organizers" to me. Would Acorn marchers qualify to Preventative Health Services providers.
Perhaps they could get fatties out of McBurgers and onto the treadmills.
Could some of the 15 billion be given to the local gyms for those who can't afford membership? There are all sorts of possible recipients for all this "stash" money. You could even make a case for donating some of it to the local animal shelters - adopt a dog, give it a good home, take it for long walks, feed it nibbles from your plate, etc, etc.

Posted by: bronco23 | March 24, 2010 12:00 PM | Report abuse

Lonepine, you have a lot to learn about the world.
I'd love to know how, in this economy, you make it sound so simple to just "find a higher paying job."
I hope you were being sarcastic because if you weren't, you live in a very sad and narrow-minded world.

Posted by: newyorker123 | March 24, 2010 12:55 PM | Report abuse

Lonepine, you've got a wicked sense of humor. Obviously, you also realize now that Washington is an irony-free zone.

But I appreciate it all the same.

Posted by: word2thewyz | March 24, 2010 3:55 PM | Report abuse

Thank you for posting this. Prevention is often overlooked but an important part of this law.

Posted by: chiquita2 | March 25, 2010 1:47 PM | Report abuse

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