The debate over the extension of the payroll tax break has dominated headlines. But as part of the same package deal was an agreement on the so-called "Doc Fix." That's the Washington shorthand for finding a way to avoid a 27.4 percent cut in fees to doctors who see Medicare patients. Naturally, doctors were not enthusiastic about having their fees cut so drastically.
Lawmakers figured out a "Doc Fix" but at the cost of the Prevention and Public Health Fund--part of the health care reform law. The deal is not yet final, but it looks like lawmakers will slice $5 billion--or about one-third of its total funding. Public health advocates had fought hard against these cuts, but to no avail.
"I know we're at a place where difficult decisions have to be made," said Mary Pittman, President of the Oakland-based Public Health Institute, "but it just doesn't make sense that all of the difficult decisions end up focused on prevention. If we're to change the way we think about health and we're trying to find a way to reduce cost, all directions point to prevention."
The goal of the Prevention Fund is to provide communities around the country with billions of dollars over the next ten years to invest in effective prevention efforts against heart attacks, cancer and strokes and to reduce tobacco use as well as prevent obesity.
And if you're wondering if prevention money is well spent, the most recent research says it is. The American Heart Association reported [PDF] in 2011 that money spent on prevention can yield a dramatic return on investment:
- Community programs to increase physical activity, improve nutrition and prevent smoking save more than $5 on every dollar spent within five years
- Building bike and pedestrian paths saves almost $3 in medical costs for every dollar spent in building the trails
- Lifestyle changes reduced the incidence of diabetes by 58 percent, versus 31 percent for drug therapy
"It costs each and every one of us every day as taxpayers, as residents of communities, when we say we're going to let people get sick first and then deal with it afterwards," says Sana Chehimi, Program Director of the Prevention Institute. She adds that the prevention approach says "'that's unnecessary--we know how to prevent illness.' If we do that, we're making sure that people don't have to go to the doctor or emergency room. So it makes our healthcare system that much more efficient."
But the reason prevention program ends up on the chopping block is not only that its impact tends to happen over years, but also because it's hard to see the results. The Washington Post talked to the University of Richmond's Rick Mayes, who has written about the political hurdles prevention efforts face. Mayes refers to the "Prevention Paradox":
“If public health measures are effective, the problems they are aimed at are often solved or never even materialize, thereby making them virtually invisible. ... When individuals are spared from a disease because the air in their office building is clean, it is not immediately clear whom to thank or if thanks are even necessary. As a consequence, public health professionals, programs, and policies are largely invisible to the public and taken for granted.”
Prevention Funds for this year were just awarded. California received 20 percent of the total nationally--more than $22 million. These "Community Transformation Grants" will fund healthier eating policies, programs to increase walking and weight loss, and the creation of safe routes to schools--to name just a few grants awarded at the local level. This line of funding is secure. But if the $5 billion in cuts become law, the grants will likely be reduced in the coming years, making the work of public health advocates harder.