“House Democrats pull together on health care” — Washington Post, by Shailagh Murray and Lori Montgomery (October 30, 2009)

“The Defining Moment” — New York Times, by Paul Krugman (October 29, 2009)

“Beyond public option, big decisions loom for healthcare reform bill” — The Hill, by Jeffrey Young (October 29, 2009)

“House to Unveil Health Plan With Public Option, Millionaire Tax” –  Bloomberg (October 29, 2009)

“IBM to Drop Co-Pay for Primary-Care Visits” –  Wall Street Journal, by William M. Bulkeley (October 29, 2009)

In an interview with CBS News last weekend, Health and Human Services Secretary Kathleen Sebelius called obesity data “alarming.”  The Centers for Disease Control and Prevention estimates that one-third of American adults are overweight, and another third are obese.  Sebelius says the epidemic impacts our costs, quality of life, and economic productivity.  She asserts, “we are really putting ourselves at a huge disadvantage in a global economy by having a nation that is vastly overweight.”

Sebelius is right on. Never before has our nation faced a public health crisis that has grown more rapidly than obesity.  And, if the trend continues, 103 million American adults will be considered obese by 2018 according to my new research (to be released next month).  That’s just 9 years down the line, and the associated costs will be crushing. 

As Sebelius noted, when measured in terms of cost, obesity is already worse than cancer: “About $147 billion a year are spent directly related to obesity and the underlying health conditions related to that. That compares with all the cancers that people have across America, which cost a little under $100 billion a year.”

Yet, as a nation, we are utterly immobilized – figuratively and literally – unable to take appropriate action to control our weight, live healthfully, and divert billions of dollars from away from medical care and back into our economy.  If Congress wishes to control costs in health care, they must put the obesity epidemic at the top of the agenda.

“Obesity: A Weighty Issue” — CBS News, by Seth Doane (October 26, 2009)

“Can ‘Bundled’ Payments Help Slash Health Costs?”   –  USA Today, by Phil Galewitz (October 26, 2009)

As the Senate and House consider what to include in a final health reform package, now is a good time to revisit the issue of how current proposals address the high and growing cost of health care.

I had the opportunity to comment on this issue twice in the past week:

In a Denver Post piece Michael Riley explores the degree to which Congress has stuck to one of health reform’s basic goals: “instituting widely agreed upon ideas that would curb runaway inflation in the cost of delivering care.” To put it nicely, my belief is that while the current provisions in bills are a good start, many of these reforms can stand to be strengthened in the existing legislation.

It’s worth reviewing a few key facts to remind us of where our priorities should lie as we craft a final bill:

We can only truly hope to expand access and affordability, and improve the quality of health care, in the U.S. if it can be financially sustained – and that means tackling what’s driving cost: high and rising rates of chronic disease.

The healthier our population becomes the fewer instances of chronic disease and the more money we save. A phrase the PFCD often uses: if we were healthier, we’d be wealthier. This slogan is not only catchy, but true. Nine chronic ailments account for nearly 60% of the recent rise in Medicare spending. One third of the growth in health care spending is due to the doubling of obesity rates since 1990 and three-fourths of health care spending in the U.S. is linked to treating those with chronic illnesses.

Fortunately, delivery system reforms are also cost-saving – and life-saving and –sustaining – measures.

There are many evidence-based delivery system reforms, including the community health teams (CHTs) referenced by Riley that would greatly improve the quality of care available and access to that care. To put it nicely, many of these reforms can stand to be strengthened in the existing legislation.

If we could reduce rates of preventable chronic diseases, and help the chronically ill stay healthier and out of the hospital, we could lower health care costs and get a better value for each dollar spent.

CHTs are good examples of how we can make smart, cost-effective investments that improve the quality of care: by investing $30 billion over 10 years in a CHT infrastructure, we could save $100 billion over 10 years due to reductions in hospital readmissions and improving existing care management protocols.

On a related note, in an interview with Fox Business’s Dagen McDowell, I had the chance to talk about Congressional proposals to allow employers to do more to encourage “good” health behaviors among employees (and conversely, penalize employees for “bad” behaviors) as a means of reigning in rising health care premiums.

As I noted during the interview, there are many ways to incentivize workers to change behaviors that have been proven to save the system money – and “carrots” work better than “sticks”.   

A growing body of evidence demonstrates that economic incentives can prompt workers to make healthier choices.

However, we must remember that financial incentives are just a piece of the puzzle in helping people live healthier lifestyles.  These initiatives work best in combination with other programs that get the workforce heavily engaged such as diet/lifestyle programs and medication management.

The overall design of health and wellness programs is a key to their success.  Those that work the best share several key features:

By-in from leadership.

Use carrots – not sticks. Positive financial incentives work.

They are voluntary, have a well-designed and communicated structure, and are easy to access.

As Senate leadership works to meld the Finance and HELP bills into one, I hope they remember our catchy phrase– if we were healthier, we’d be wealthier—and vote in favor of cost-saving delivery system reforms so that we make a wise investment in our nation’s health.

Fox Business — October 21, 2009

“Growing obesity epidemic is raising health care costs” — Houston Chronicle, by H. Edward Hanaway (October 21, 2009)

“Chronic illnesses more often undiscovered, undertreated in uninsured” — Boston Globe, by Elizabeth Cooney (October 20, 2009)

“Public Option Gets New Life in Senate” — Wall Street Journal, by Greg Hitt and Janet Adamy (October 20, 2009)

“In health debate, those numbers are just numbers” — Washington Post, by Lori Montgomery (October 19, 2009)

“Finance Releases Full Health Bill” — Congressional Quarterly, by Alex Wayne (October 19, 2009)

“Hangin’ With Health Care’s New In-Crowd” — Congressional Quarterly, by John Reichard (October 14, 2009)

“White House Team Joins Talks on Health Care Bill” — New York Times, by David M. Herszenhorn and Robert Pear (October 14, 2009)

“Finance Committee Passes Bill With One GOP Vote” — Washington Post, by Lori Montgomery and Shailagh Murray (October 14, 2009)

“Next Step: Combining Senate Health Bills” — Congressional Quarterly, by Drew Armstrong (October 13, 2009)

“A Business Lesson for Health Care Reform” — Huffington Post, by Tommy G. Thompson (October 13, 2009)