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.
March 23, 2010; 6:28 PM ET
Categories: Explaining health-care reform , Interviews
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