June 12, 2014
Better health at lower cost. A new book by health economist Jack Meyer, “Investing in Public Health: A Life-Cycle Approach,” proposes sound investments to achieve these twin goals. Dr. Meyer, a health economist who has authored several prior books and about 100 reports and articles on health reform, is a Managing Principal in the Washington, D.C. office of Health Management Associates.
This book presents the concept of a “positive life spiral,” in which carefully targeted investments result in better health outcomes, health care savings, and more people working productively. This lowers public assistance costs and broadens the tax base. A portion of the savings is plowed back into high-value investments in health, continuing the upward spiral.
Many of the new investments address forces outside of our health care system. Following a life-cycle approach, Dr. Meyer presents specific recommendations in these areas: prenatal care, childhood immunizations, and timely health care screening tests; family preservation; early childhood education and greater educational attainment; smoking cessation; reductions in obesity, pollution, and poverty; healthy aging; and helping more people participate productively in the work force.
Meyer proposes that the United States invest $50-$100 billion annually in a new “High-Value Investments to Improve Public Health” Trust Fund. This Fund would be fully financed, primarily by a series of strong health care policy changes. These reforms include abandoning the obsolete and cost-generating fee-for-service payment system; developing modern ways to assess the value of advanced medical technology; practicing medicine in multidisciplinary teams; and taking our major health care spending programs, including Medicare, Medicaid, and health-related tax benefits, off their current “auto-pilot” growth path.
Meyer notes that the incentives in our health care system reward an ever-increasing volume of services, including an explosion in diagnostic imaging studies, and a “bricks and mortar” approach to health care that frequently favors building new hospitals and other health care facilities with little regard for actual local needs. The federal government routinely approves expensive new technology with insufficient attention to potential harms and no attention to its cost. This is followed by the proliferation of this technology across the patient population, including many patients who are well served by existing technology.
Government health programs, insurance plans, and many employers purchasing health care underwrite enormous differences in the price of health care services, such as by paying the same proportion of the bills for services such as hip and knee replacements, or colonoscopies, that may vary in price by as much as 10 to 1, even though the higher bills are not justified by better quality or fewer complications.
The author proposes a series of policy reforms that maintain a strong incentive for technology development, but also change the reward system to encourage evidence-based medical practices and lower fees and charges.
This book presents compelling facts that shore up the author’s call for redirecting resources from expensive outlays with a thin or nonexistent evidence base to investments with modest price tags and a potentially huge positive impact on the health of our population. Meyer estimates that the U.S. is on track to spend about $37-38 trillion on health care over the next decade under a “business-as-usual” approach. Yet only 3% of U.S. spending is devoted to prevention, while hundreds of billions of dollars are wasted each year on health care that is inappropriate and wasteful.
Dr. Meyer calls for capturing a portion of excessive health care spending, and placing it in the secure new Trust Fund. This Fund would make carefully targeted investments that address the underlying forces driving people into the health care system in the first place. Meyer cites troubling figures revealing factors outside our health care system that adversely affect population health—over 46 million people in the U.S. living in poverty; record low labor force participation; and highly dangerous air and water pollution levels. To address these and other compelling problems outlined in this book, Dr. Meyer calls for the following:
- Foster successful outreach programs that improve the health of parents prior to a pregnancy and increase the proportion of pregnant women getting care in the first trimester.
- Ensure that virtually all children are fully immunized by their second birthdays.
- Fully fund Head Start and Early Head Start.
- Mount an all-out effort to reduce the school drop-out rate and pursue education reforms that prepare students for the types of problem-solving and independent thinking needed to succeed in the work force.
- Reduce obesity, tobacco use, and teenage pregnancy.
- Expand promising models of family preservation for at-risk parents of newborns.
- Improve the built environment through transportation, housing, and urban design policies that promote healthy levels of activity.
- Raise the minimum wage and index it for inflation.
- Strengthen programs that offer job search assistance and smooth the transition from welfare to work.
- Adopt federal fiscal policies that make prudent investments in public health, safety, environmental protection, and infrastructure at the same time as the long-term growth of the federal debt is brought under control through sensible reforms in entitlement programs and our tax system.
- Make carefully targeted investments in clean air and water, and reducing carbon emissions.
- Change the dialogue away from “spending add-ons” and “government takeovers” to making sound, fully-funded, and prudent investments in public health with a positive rate of return.
“Investing in Public Health: A Life-Cycle Approach” is available in print and electronic versions (the e-book is less than $4) and can be purchased at the following websites in addition to others:
Xlibris Online Bookstore
Barnes and Noble
Dr. Jack Meyer can be reached directly at firstname.lastname@example.org or (202) 785-3669.