---

Media Relations

Health reform will fail unless prevention becomes a priority

Lloyd Kolbe is a professor of applied health sciences at IU's School of Health, Physical Education and Recreation. He was a member of the U.S. Biomedical Senior Research Service, and for nearly two decades served as founding director for the Division of Adolescent and School Health at the U.S. Centers for Disease Control and Prevention. He offers his thoughts on access to health care.

Assuring access to health care for all is a noble and ambitious goal. But if the only thing we do is provide coverage, without preventing the problems for which people increasingly will need access, we're not going to solve the dire fiscal dilemma that the nation and its businesses are in.

In 2005, we spent $2 trillion on health care. That's $6,700 per capita. It amounts to 16 percent of our gross domestic product. By 2009, expenses are projected to reach $2.9 trillion. By 2015 -- less than a decade away -- we are going to reach $4 trillion in medical expenses. And already, we can't pay the $2 trillion. Not even close. We're in debt up to our ears.

It's a mistake to characterize health care as a Democratic issue, because it's an even more pressing problem for Republicans as the most urgent threat to our businesses and economy. Health expenditures are rising at twice the rate of inflation. That means that unless something drastically changes, health insurance costs soon will overtake profits.

The only way to reverse this process is to focus on preventing the diseases that are causing such poor health in this country. And actually, doing so is neither complicated nor expensive. The majority of the high-ticket items like heart disease, diabetes, stroke and many cancers are enormously preventable. But the policies that can prevent them just haven't been put into place.

Prioritizing prevention means that at the clinical level, we provide convenient and low-cost immunizations, mammograms, colorectal cancer screenings, aspirin therapy for those at risk for heart disease, and counseling services for smoking cessation. At the community level, especially in schools, we put in place systematic means to provide physical activity and access to the healthiest types of foods. We use safety policies to reduce unintentional injuries and provide prevention programs and counseling for drug and alcohol abuse.

Twenty years ago, we didn't have much scientific evidence about prevention. But now we have studied these policies and systems, and the data is rock solid. We know how to improve health outcomes. And it doesn't cost much. So how do we make this happen?

Here's the bottom line: if you and I allow ourselves the option of not becoming involved, not trying to understand what can and should be done, and not acting on our sense of what is most appropriate to do -- if we don't at the very least ask the candidates what they will do and vote our conscience -- then we're in for a rapid downward spiral. At the very moment when we as a people come to believe the problems are too big and powers too ensconced for us to turn things around, we've written our own conviction.

Make no mistake about who is responsible. In a democracy, we get what we deserve.

---

---