Wednesday, February 22, 2012

Cutting Prevention Fund to pay for 10 month "doc fix" is medical #Linsanity

Like millions of basketball fans around the world, I've been transfixed by the story of Jeremy Lin, the undrafted Taiwanese American point guard from Harvard who has taken the NBA by storm this month as the new superstar of the New York Knicks. It doesn't hurt that we share a last name, ethnic background (both of my parents immigrated from Taiwan), and Crimson alma mater. But otherwise, the title of this blog post and the below YouTube video of Lin's latest athletic exploit (a steal and dunk en route to 28 points and a win over the defending champion Dallas Mavericks) is a shameless ploy to get you to read about a current health issue that's just as #Linsane in its own way.

Last week, Congress agreed to extend Social Security payroll tax cuts and delay by ten months a 30 percent cut to physicians' Medicare payments (also known as the "doc fix") in part by raiding the Prevention and Public Health Fund, created by the 2010 Affordable Care Act to meet critical clinical and community needs such as childhood immunizations, tobacco cessation, and obesity and diabetes prevention. The Fund was initially allocated $21 billion over ten years; this number was cut to $16 billion in President Obama's FY 2012-13 budget proposal and slashed to $11 billion by the latest Congressional action. $11 billion still sounds like a lot, but it's a paltry fraction of the estimated $2,600,000 billion that the U.S. spends on health care each year, and now nearly all of the Fund will merely offset draconian cuts to state public health programs due to the recession, rather than paying for new or expanded prevention initiatives. (If you have any doubts that we need to do much more as a nation to fight obesity, see these graphics on state obesity trends from the Centers for Disease Control and Prevention.) And of course there's no guarantee that the remaining funds will be protected when Congress looks to extend the doc fix at year's end.

Journalist Merrill Goozner tartly observed that cutting 10 years of prevention funds to pay doctors for 10 months is like "selling your home's storm doors to pay for this winter's heating bills." Alas, this penny-wise, pound-foolish decision was predictable. As Yale Prevention Research Center Director David Katz, MD argues, public health programs are chronically vulnerable to budget cuts because "prevention at its best is as dull as watching paint dry":

Let's face it -- a heart attack that doesn't happen lacks drama. The bout of influenza someone doesn't get lacks flare. When prevention and public health work well, you see just about none of what you get. You get a lot, and see ... nothing. When we talk about what prevention could do -- eliminate 80 percent of all heart disease, 90 percent of all diabetes, up to 60 percent of cancer and so on -- it is all in terms of some anonymous public. We are hard-wired to shrug our shoulders about that, and carry on. In contrast, Whitney Houston had a name and face and voice we all knew -- and for the loss of that, we readily feel passion and shed tears.

But consider for a moment the people you love who have been touched by heart disease, cancer, stroke or diabetes. Recall the visit to the hospital, the dreaded phone call. Now consider that prevention funds, used wisely, could make that experience go away fully eight times in 10. Prevention funds, used wisely, could help us give our children a world in which those horrible phone calls and anxious trips to the ER and ICU are mostly gone.

It's all too easy for the prevention fund to be about a public with no face and no name. But when we part the veil of statistical anonymity, the faces looking back at us are the faces of people we love. Those in Congress swinging the [budget] axe simply didn't pause to part the veil.