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Replacing the Shouts of Recess with the Deliberations of Research

The CBO is a valuable resource for elected officials for measuring the economic value of legislation. But it doesn't automatically score what we as Americans value, especially our health.
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During the August Congressional recess much of the coverage on health care reform has been spent showing us the cacophony of shouts and yells heard around the country during Town Hall meetings.

But at the same time, with less fanfare and attention, a more measured and productive conversation has been occurring. One that actually has the potential to help make us a healthier country and provide us with a more cost effective system of care.

Since my August 5 post, "What If Benjamin Franklin Ran the Congressional Budget Office?," there has been growing interest and attention surrounding the methods of the Congressional Budget Office for scoring costs and savings in general and more specifically as it relates to health reform.

The CBO is a valuable resource for elected officials for measuring the economic value of specific legislation. But what we are realizing is that doesn't mean that it automatically scores what we as Americans value, especially as it relates to our health.

Americans want to live longer, healthier and happier lives. In order to do so they and we make investments in our health, education and well-being that are intended to pay dividends throughout our lives. However, the CBO scoring is limited to only measuring those that pay off in the short term, within 10 years.

This means that while common sense tells us that investing in educating our children, staying healthy, getting checkups to find and treat disease early etc, are invaluable to us as individuals and to the country as a whole, the CBO finds no "economic value" because of its limitations in scoring.

It's as if your car dealer came out and told you there is no value in keeping oil in your car, or getting regular oil changes -- their mechanics are great and will do the repairs when the car breaks down.

In the last month, many organizations have weighed in on the topic and are calling on our leaders to look beyond the narrow focus of the 10-year horizon. Members of organizations such as American Public Health Association, the American Cancer Society, American Association of Diabetes Educators, the YMCA, National Changing Diabetes Program, National Commission on Prevention Priorities, Trust for America's Health, Nurse-Family Partnership, Partnership for Prevention, U.S. Preventive Medicine, and others have voiced an interest in reevaluating CBO's current mandate as it relates to health and healthcare legislation.

Now comes a new study from the University of Chicago that has just been published by Health Affairs. The research presents results that combine the economic approach with epidemiologically-based data to project federal costs for diabetes under alternative policies.

The research's authors developed a model that incorporates critical findings from major clinical trials, illustrating that an investment in early, aggressive treatment for diabetes has payoffs in reduced complications that increase over time, with a significant amount of the health and hence economic value accruing after the usual 10-year CBO window. The model, based on published clinical trial data, captures the expenses of diabetes prevention and management along with cost reductions over 10-year and 25-year periods. This is critical information for Congress to have when considering Health Care Reform proposals.

So why is this new research so valuable?
  • First, their paper shows that this kind of long-term analysis can be done and done well. The data exists and can be compiled in a meaningful, credible way.
  • Second that doing the analysis matters...a lot. Their analysis shows that a short-term view like CBO takes can make the net costs seem much greater than they actually are. And the good health outcomes seem much less than they really are.
  • Third and finally, their analysis uses one of the most serious, common and costly of diseases, diabetes, and shows us that hundreds of thousands of people could have serious disability like blindness, amputations and kidney failure needing lifelong dialysis prevented or delayed for many years if our medical care system was better designed. This is huge. It doesn't get better than this.

Diabetes is one of those conditions where the science has progressed light years since the CBO was formed. And this paper shows us what the fruits of that science could be. But this same approach could be applied equally well to a growing number of preventative health investments where we have reliable data that shows us the effects of investment and the implications of disease progression.

In this paper the authors show how we can combine epidemiological science with economic analysis to better see the true costs and where we get the best value over the longer term. We need to do this more, not just in health and medical care, but for investments in our children as well.

As Congress resumes its discussions around health care, I hope they are not unduly distracted by the loud catcalls given so much media attention during their recess. But rather I hope that they turn their ear to a more deliberate and fruitful dialogue among the medical and health community that is pointing the way towards improving the health and health care of all Americans.

Dr. James Marks is currently the Senior Vice-President, Director of the Health Group at the Robert Wood Johnson Foundation and is former Assistant Surgeon General, Director of the Centers for Disease Control's National Center for Chronic Disease Prevention and Health Promotion.