WSJ Editorial Questions Prevention and Disease Management

Today’s Wall Street Journal looked at the Massachusetts health care program, which they say "previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else."

There are many lessons to be learned from the Massachusetts model, as with other state reform efforts like that in Vermont, which may be the model that Obama and Congress should follow at a national level. For Massachusetts, the biggest lesson is that any attempt at universal coverage must also include cost controls at the beginning, and this is where the state is running into problems now.

As the Journal points out, Gov. Deval Patrick has set up a commission to figure out how to control costs. To quote the writers, “One objective is to change the incentives for preventative care and treatments for chronic disease, but everyone says that. It sometimes results in better health but always more spending."

In fact, that’s not true. Well-designed programs implemented in multiple community settings have been proven to reduce costs and improve patient outcomes. That’s one of the reasons why "everyone" (including our President) is advocating for a greater focus on preventive care (and it should be noted that in most cases "prevention" means primary prevention efforts).

The key to making prevention—and many other elements of health care reform—a success is by working through public-private collaboration. Many of the most successful programs are implemented through employers and schools, but that trend is still relatively new.

This is clearly an area where Congress has indicated that it will look for cost-savings. My recommendation is that elements like these programs should be carefully coordinated in the design of health insurance benefits (e.g., no cost sharing for services clearly needed to manage and treat chronic disease) and in the redesign of our delivery system.