These are huge amounts of money. When American life expectancy has been falling for three consecutive years after more than half a century of steady increases, it would seem that reallocation to population health initiatives of the portion of health care waste that is potentially recoverable with existing interventions, $191 to $282 billion according to the JAMA study (by comparison, annual funding for the Affordable Care Act's Prevention and Public Health Fund has yet to exceed $1 billion), would go a long way toward addressing the root causes of increasing premature deaths - problems such as poverty, segregation, and low social support which comprise the actual causes of death in the U.S.
So why don't we? In an accompanying editorial, former CMS administrator Dr. Don Berwick hit the nail on the head:
What Shrank and colleagues and their predecessors call “waste,” others call “income.” ... When big money in the status quo makes the rules, removing waste translates into losing elections. ... For officeholders and office seekers in any party, it is simply not worth the political risk to try to dislodge even a substantial percentage of the $1 trillion of opportunity for reinvestment that lies captive in the health care of today, even though the nation’s schools, small businesses, road builders, bridge builders, scientists, individuals with low income, middle-class people, would-be entrepreneurs, and communities as a whole could make much, much better use of that money.
Living in Washington, DC during the Great Recession of 2007-2009, I observed that the only two industries that managed to thrive and expand during those otherwise dismal years were the federal government and health care. While that was good for me personally, as a health care professional then employed by the federal government, it also meant that billions of dollars that otherwise could have contributed to the economy and individual incomes were, as Dr. Berwick noted, "captured" by the health care industry, most clearly in the form of rising costs of health insurance.
After the collapse of the Soviet Union and the end of the Cold War, Presidents George H. W. Bush and Bill Clinton both talked about a "peace dividend" consisting of lower military spending that could be diverted into other government programs, used to pay down budget deficits, or returned to the people in the form of lower taxes. Although it is debatable how much the military-industrial complex really shrunk in the 1990s, the gargantuan health care-industrial complex is likely to be at least as tenacious, if not more, in resisting efforts to reduce wasteful spending in order to generate a "health dividend" for all Americans.
