America Needs a Debate About “Prevention for All”

In the last Democratic primary debate one of the most insightful comments about health care came from one of the lesser-known candidates, Marianne Williamson, who said:

“[W]e don't have a health care system in the United States. We have a sickness care system in the United States. We just wait until somebody gets sick, and then we talk about who's going pay for the treatment and how they're going to be treated.”

Williamson was right. We’re debating how to take care of the sick but we should be talking about how to help people get sick less. The moderators and candidates should explore this theme during tomorrow’s debate.

Prevention is one the few potential game changers in health care. When implemented in a smart way, it can help us prolong our lives and save billions in costs. The Medicare program already in place is set to become insolvent in 2026, just seven years from now. Policymakers will need every tool at their disposal to contain rising health care costs. Few may be more effective than prevention.

But not all prevention strategies are created equally. An analysis of workplace prevention programs published in Health Affairs found that every dollar spent on prevention reduces medical costs by $3.27. On the other hand, other surveys found prevention may not generate big saving money. The non-partisan Congressional Budget Office (CBO) has essentially said prevention works when proven interventions are targeted toward at-risk populations.

One reason that “Prevention for All” hasn’t taken off is because health insurance companies have little incentive to spend money on prevention. The reality is prevention is a long-term investment – the benefits of prevention accrue over time – but health insurance tends to be a short-term product. The median job tenure for today’s American workers is about four years and when people change their jobs they typically change their health insurance. Health insurance companies typically only get a return on their investment for prevention that impacts health care costs in a four-year window. Most of our chronic diseases are slow building and take years to incur additional costs. Health insurance companies, therefore, tend to view prevention as a cost with no pay off or return on investment. Client turnover is simply too high for them to recoup what they may spend on prevention.

Other health experts have noted this problem. As Leavitt Partners has noted, “In many cases, disease management interventions with significant potential to manage or prevent chronic diseases require upfront investments but yield returns over a long-term horizon. Frequently, these interventions may not be economical under the traditional one-year health insurance model.”

For life insurance companies, our incentives are very different. Our policies for individuals are typically in effect for 10, 20 or 30 years. The average person chooses a 20-year term. The industry wants you to live longer and has every reason to invest in prevention.

At our company, we are going even one step further by giving even lower rates to those who have shown they are health literate and live a healthy lifestyle. This is not just idle talk. We are also betting billions of dollars – from our own pockets and from our carrier partners who have vetted our data – that our conclusions correct. If we guess wrong, we go out of business.

Our insights into what works in the prevention space come from more than 10.2 million surveys that are based on 3,000 scientifically valid, peer-reviewed questions.  In essence, we have built our own primary prevention data linking health literacy with actual mortality. 

While literacy is critical, we believe more can be done to do prevention right. “Prevention for All” should be a three-legged stool that consists of targeted screenings, environmental safety interventions, and health literacy promotion to at-risk populations.

Screenings:

Routine blood tests, such as a lipid panel that tests for good and bad cholesterol, can be cost – and life – savers. One study found that annual lipid panel screenings combined with a chronic disease risk reduction program saved $9.64 for every $1.   Providing annual lipid screening for every American adult over 35 could cost as little as $3 billion a year. This is a big sum to be sure, but it’s just 0.4 percent of Medicare’s $702 billion in payment benefits in 2017. 

Promoting appropriate cancer screenings can also save lives and dollars. Increasing participation in colorectal screenings, which are now recommended at 45, could save Medicare as much as $32.7 billion while preventing thousands of early deaths.

Breast cancer screenings, especially for women over 50, are also highly effective and can reduce mortality rates by about 45 percent. My own mother is a case study. Thanks to a mammogram that identified early-stage breast cancer, she was able to beat the disease and has been cancer free for almost ten years.   

Environmental safety:

Creating a safer environment for seniors in their own homes can also help generate significant savings while helping them live longer, healthier lives. Serious falls among the Medicare population cost about $13 billion every year. Many are preventable. The return on investment (ROI) for basic exercise and fall intervention programs for seniors could be enormous – studies suggest it could be at least 36 percent and potentially as high as 509 percent.  

Hip fractures can be especially tragic for seniors. A senior is almost three times more likely to die within a year after a hip fracture. Most falls occur in the bathroom. If our nation can ship mosquito nets overseas to reduce malaria-related deaths – an accomplishment we should be proud of – we can certainly help provide seniors with a potentially life-saving non-slip bath mat, which can cost less than $10.

Health literacy:

The foundation of prevention is health literacy. There is significant room for improvement in this area. In January we released a report that showed the level of health literacy rate in the United States today is about 17 percent. This is where global reading literacy was in the 1850s.

Not surprisingly, we found a strong and clear relationship between health literacy, chronic diseases and health care costs. For example, a high health literacy score was associated with lower rates of diabetes, a disease that is on track to cost more than $622 billion a year by 2030. The report also found a strong correlation between health literacy and prescription drug costs, a major factor in skyrocketing Medicare costs. States with low health literacy spend up to $1,300 more on drug costs per senior than states with high health literacy.

Congress doesn’t agree on much these days but, fortunately, they do seem to support the need to improve the nation’s health literacy. Two members of the U.S. House of Representatives, Mike Levin (D-CA) and Greg Gianforte (R-MT), recently introduced a bipartisan resolution to create a National Health Literacy Day. If we can have a national day for donuts we can certainly have a day for health literacy.

Our political leaders should help drive a national conversation about “Prevention for All”. This should be a movement and a smart partnership between the private sector, individuals, communities and government. The data is already there. We know that increasing participation in appropriate screenings, promoting environmental safety and improving health literacy can save lives. Fidelity estimates the average retiree will need $285,000 just to pay for medical expenses. Those who are healthier will need less. Our data shows that seniors with high health literacy have up to 20 percent less hospital visits than those with lower health literacy.

Even in a polarized campaign season, “Prevention for All” can bring our country together because it can bring about the results we all desperately want to see. Let’s get started now.

Munjal Shah is CEO for Health IQ, the fastest growing Life Insurance company in the US by giving lower rates to those who are health conscious. The company developed a Health IQ test that has been taken over 10 million times and used health literacy as a way to reduce insurance costs