Federal Prevention Fund: Two Steps Forward, One Step Back

When President Obama signs payroll tax cut legislation today at a White House ceremony, with him will be working Americans who represent the 160 million taxpayers the bill will benefit. Based on best estimates, a third of the men and women expected to be at Obama’s side are at risk for diabetes and have two or more risk factors for heart disease. Two-thirds will be overweight or obese and a third will have high blood pressure. In that light, the payroll tax cut extension loses much of its luster, as the bill also will cut $5 billion from the Prevention and Public Health Fund to help avert a scheduled 27 percent drop in Medicare physician reimbursements.

It’s a penny wise pound foolish approach to Medicare’s dysfunctional sustainable growth rate (SGR) that kicks the can down the road at the expense of programs to fight the very conditions that drive most health care spending. We fully support fair payment to physicians and understand the magnitude of the threat they face with the scheduled SGR adjustment. But gutting badly needed federal support for wellness and prevention isn’t a solution. It’s an exclamation point on the short-sightedness of this legislation and a disheartening step back just as the federal government appeared to be moving firmly forward toward supporting workplace and community health promotion initiatives.

We wrote recently about the “glaring disconnect” that remains between the strong evidence base for programs targeting diabetes and other chronic conditions and the broader application of those care strategies. Throttling back federal spending on wellness and prevention robs us of a promising opportunity to close that gap. Yes, we must find payment strategies that satisfy providers and promote greater quality, value and accountability in care—and there are lawmakers working toward this sensible goal, such as Rep. Allyson Schwartz, D-Pa. But until we’re there, let us not dig the spending hole deeper with stop-gap solutions that diminish our best chance to climb out: wellness, prevention and care management.

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