Prevention: Divine Intervention in the Third Act? I Think Not.

Despite Charles Krauthammer’s suggestion in Friday's Washington Post that President Obama and Congress have become our modern-day Euripides, prevention is not the "deus ex machina" that he claims. Prevention has been a core part of the health reform agenda since candidate Obama ran for office– and for good reason. Without proactive efforts to increase prevention and manage disease more effectively, our efforts to stem the crisis of chronic illness in the U.S. and make health care more affordable for all Americans will be dead in the water.

It’s no coincidence that as obesity rates have doubled since the 1980s (accounting for 30% of the rise in U.S. health care costs), chronic conditions like diabetes and heart disease have skyrocketed. As a result, we have spent more, and a greater percentage, of our health care dollars treating chronically ill patients. In many of these cases, Americans would have benefited from better support and resources that could have helped them to prevent their diseases entirely, or catch and treat them earlier and more effectively.

Krauthammer claims that "preventive medical care" doesn’t save money, but he fails to recognize that "prevention" includes many different types of interventions along the spectrum of health care, many of which are targeted to those most at-risk for developing chronic conditions. No one is suggesting that every American be screened for diabetes, but if we can target screenings towards those who are most at-risk, we have an opportunity to improve their quality of life and reduce associated costs.

Intentionally or not, Krauthammer devalues the importance of both primary prevention – encouraging populations to completely avoid disease through better diet, exercise, etc. – as well as later-stage prevention (also referred to as tertiary prevention), which involves helping chronically ill patients such as diabetics more effectively manage their disease to avoid costly complications.

And along with CBO, which he cites, he completely ignores the fact that the burden of poor health extends well beyond our health care costs. At a time when we are struggling for ways to boost the economy, it’s important to recognize that four-fifths of the economic burden of the seven most common chronic illnesses in the U.S. is felt not through direct spending on health care, but through productivity loss.

Prevention is not a panacea – but neither is “business as usual." Falling back to the status quo is not acceptable. What is the value of a health care system that doesn’t actually help Americans be healthy and actively prevent disease?