Are We Making Progress on Costs & Obesity? Let’s Step It Up…
I observe a tendency in both human nature and public policy to see progress in a difficult situation and to declare victory prematurely. Often it turns out that the early victory signs were ephemeral and an opportunity to secure more enduring change gets missed.
Two related examples of that are happening right now, both involve national and Massachusetts health policy choices. One involves rising health care costs, and the other the obesity epidemic and sugar sweetened beverages.
Let's first look at costs.
Top of the front page story in today's New York Times reports what health policy wonks, myself included, have been noting for more than a year now -- a real deceleration in rate of growth in U.S. health spending over the past two years. It's partly driven by the recession, partly by the growth in high deductible health insurance plans, and at least partly by other factors.
Like Karen Davis, the savvy head of the Commonwealth Fund, I believe part of this slowdown is tied to system reforms now unfolding, many connected to changes brought by the Affordable Care Act (aka: ACA/ObamaCare), such as accountable care organizations, penalties for preventable hospital infections and readmissions, aggressive fraud and abuse provisions, smart cuts to Medicare Advantage, and more.
We see these changes in Massachusetts, even more than nationally -- the Commonwealth Fund estimates that Massachusetts dropped from #1 to #9 in per capital health spending among the 50 states in recent year.
Yet...
We have seen progress before -- notably in the mid-1990s in the aftermath of the Clinton health reform collapse and the managed care explosion. That slowdown was more dramatic than this round, and it didn't last. After it ended, it took a decade for political will to develop to tackle again the burden of high health spending.
On the obesity front:
Surprisingly, we are seeing some progress in less consumption of sugar-sweetened beverages and leveling or declines in obesity rates among some groups. Some groups are getting the message, changing their drinking habits, and realizing health gains. Recent CDC data shows a drop in sugar consumption among girls and women accompanied by flat obesity lines since 1999, and "only modestly" increasing rates among men and boys since 2006, according to Cynthia Ogden of the CDC.
Still, sugar sweetened beverages (aka: liquid candy) is a prime target for continued progress. See this CNN report from last Friday highlighting the work of a Childrens Hospital researcher:
"Soft drinks and sugar-containing beverages are the low hanging fruit in public health today," says Dr. David Ludwig, director of the New Balance Foundation Obesity Prevention Center, at Children's Hospital in Boston. "Many children are consuming 300 calories per day or more, just in sugar-containing beverages."
So how do these stories tie together and what does it matter for the nation and for Massachusetts?
Let's consider the nation first. On costs, if the ACA is repealed either by the Supreme Court or Congress, a host of powerful cost control mechanisms in the law will be lost. A wave of promising innovation and experimentation will end. On prevention, just last week the U.S. House voted to finance lower student loans by eliminating the ACA;s Prevention and Public Health Fund; thankfully, the President and the Senate are rejecting the plan. The Fund's $10 billion is puny compared with US health spending, and still is one the largest investments in public health and prevention ever. The ACA's cost control and prevention initiatives need to be strengthened, not eliminated.
In Massachusetts, as Senate leaders prepare their next version of health reform, we should keep in mind the value of sustained pressure on cost control and prevention. Now is no time to declare victory in controlling rising health care costs -- it's time to lock in measures to keep growth low and hold costs in check when pressures reappear for resumed inflation. Pressures will return, and the question is whether we will be better prepared than we were in 2000.
Now is also time to address the major cause of rising health care spending, the unhealthy state of our collective personal health, the cause of chronic diseases such as diabetes and heart disease and the real culprit behind rising medical costs.
The Massachusetts Legislature has an opportunity to demonstrate that they get it on both fronts by creating accountable authority to control rising costs and by eliminating the state's sales tax exclusion for sugar sweetened beverages and candy. This is a great opportunity for our Legislature to show its commitment.
We seem to be making progress on rising health costs and on obesity. Now is the time to double down on both. The issues are too important.
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About the author
John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »Recent blog posts
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