How health care reform can improve public health

by Paula Hartman Cohen

Have we overlooked the public health aspect of health care reform?

In the health care reform debate, we’ve heard and read how health care reform will or will not work, what it will or will not cost, and how it will or will not impact each one of us as individuals.

We’ve also heard from those who have great faith in our current system, and sincerely believe we should leave it alone.

It may work well for some people, but, on the whole, our nation does not hold up well in international comparisons. In fact, we come in 37th on the World Health Report 2000 and, according to a London School of Hygiene and Tropical Medicine report, the U.S. has the highest rate of preventable deaths among 19 industrialized nations. Clearly, there’s room for improvement.

My question is, will health care reform improve public health, or not?

For answers, I turned to Howard K. Koh, M.D., assistant secretary of health for the U.S. Department of Health and Human Services (HHS). Koh is senior health adviser to the Secretary of HHS, and he oversees the Office of Public Health and Science, the Commissioned Corps of the U.S. Public Health Service, and the Office of the Surgeon General. Previously, he served as associate dean and director of the Division of Public Health Practice and the Center for Public Health Preparedness at Harvard School of Public Health. From 1997-2003, he was commissioner of public health for Massachusetts.

In a recent interview, Koh told me we can “absolutely” expect to overall public health to improve if we provide quality, affordable health care coverage for all Americans.

“Health insurance reform will link people to health care services and assure access to quality health care,” he said. “Reform will also protect people against unfair insurance practices so they won’t be denied coverage as a result of a job loss or a pre-existing condition.”

Right now, millions of Americans cannot get coverage and 14,000 more lose their insurance every day, Koh said. “When Americans go without health insurance, they suffer.”

That suffering isn’t limited to the uninsured. Many with insurance fear they will lose their benefits. According to Koh, one in six Americans who had employer-sponsored insurance coverage in 2006 lost that coverage by 2008. As a result, many children and adults went without preventive care, immunizations, basic dental services and prescription medicine. “When sick, [the uninsured] are more likely to experience poorer health outcomes” than the insured.

“We are the only advanced democracy that allows this hardship on millions of its people,” according to Koh.

So exactly how will health care reform impact public health in the US? Koh explained:

1. Reform will promote prevention.

“We’re developing a wellness care system that protects health, promotes healthy behaviors and strengthens community prevention…

“A national report recently found that 100,000 lives could be saved each year by investing in five basic preventive services that are available through a doctor’s office…[including] flu shots [for] adults and daily aspirin use counseling for men over 40 and women over 50.“

2. Reform will lead to better quality and continuity of care, in part through the expansion of health information technology.

“Expanding the use of electronic health records is fundamental to reforming health care and reducing preventable medical errors.”

3. Reform will help address chronic diseases.

“Right now, seven out of every 10 Americans who die each year die of a chronic disease. That’s 1.7 million people. And without health insurance reform and an emphasis on regular primary care and prevention, that number is only going to get bigger.”

4. Reform will end denial of coverage based on a person’s medical history, a practice that disproportionately hurts minority populations.

“Many minorities are discriminated against by health insurance companies when they try to get insurance, and we can’t continue to allow this.”

“We can’t eliminate all disease,” Koh said, “but …we can reduce chronic disease by ensuring Americans have the care they need to prevent and treat these diseases so that if they do get sick and need care, they have the best possible chance of getting better.”

In our current system, low-income Americans, including racial and ethnic minorities, are less likely to receive preventive care than others.

“The data are undisputed,” he said. “Minority groups have higher rates of disease, fewer treatment options, and reduced access to health care….this contributes to widening health disparities in our country.”

When it comes to closing the gap on health disparities, Koh said, “we should remember that this isn’t a partisan issue. It’s a moral issue.”

Paula Hartman Cohen is a freelance writer and blogs at birdsonawire.

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  • T Steadmon

    Health care reform will absolutely improve public health but there are 2 problems:

    The first is that recent versions of the bill have relaxed requirements that require all citizens to have health insurance. This caused the insurance companies to cry foul since they were willing to stop denying coverage for pre-existing conditions with the understanding that this expense would be off-set by everyone having insurance. Their fear is that the current version of the bill will allow people to wait until they get sick and then demand low priced health care coverage. Thus if people were allowed to buy coverage only when they got sick, the contributions of preventative medicine and routine care would not benefit overall public health as much in populations where this were common.

    Secondly, government being government, they have taken the substantial public health savings that will be realized and have overestimated the savings by about 30% compared to what even the most optimistic public health experts believe. Politicians are notorious for underestimating the costs of projects and overestimating the benefit they will provide. Even though substantial gains in public health will be seen, they will never be able to live up to the rosy projections forecasted by politicians trying to get this bill passed.

  • Doc99

    The CBO accepted Baucus’ claims that don’t withstand scrutiny.

  • Bladedeoc
  • Bladedeoc

    I’m sorry that was a complete HTML fail. The url is and it should read “begging the question after the word of.

    I’m a much better surgeon than a coder, really. :-)

  • CourtCourt

    We need to focus more on obesity and smoking.
    We need to make neighborhoods more walkable and invest in community centers that have gym equipment where people can afford a gym membership.
    We also need to try to make eating fruits and vegetables more affordable in this country. It’s ridiculous you can get a burger cheaper than you can a pound of broccoli or spinach.

    It would also be nice if the government paid the price of medical school for primary care physicians. We need more of them to help deal with chronic diseases and obesity.

  • Nuclear Fire

    I laugh at comparisons of our medical system to others because of the complete lack of intellectual honesty in the comparison. The fallacies usually involve two forms. The first is the country X (Spain) has the same Y (life expectancy) as the US but spends 20 percent less, overlooking the obvious facts that country X has half the obesity rate as the US. Maybe that’s a public health failure, maybe is a personal failure multiplied by a million but as far as I’m concerned that’s a win for doctors/pharma. The headline should read “Heroic Doctors keep lard-buts alive in spite of their deliberate attempts to die by lifestyle choice.”

    The second is the comparison of published expenditures vs what is actually the standard of practice. When is the last time you gave your doctor a large some of cash under the table in addition to the insurance payment? Never, right? The idea is preposterous. Unless you live in Japan or several other countries I’ve heard of (some even mentioned in the comments of this blog recently). My father in law gave 3 million yen (ca. 30K USD) to his thoracic surgeon for lung ca surgery. Coincidentally his surgery went from “sometime in the next six months” to the next week. I remember sitting in a public health class in medical school where the salaries of physicians in Japan was actually compared to that in the US and the point was the US docs make too much money. Official statistics are about as accurate as Homan’s sign.

  • Classof65

    I have a competent, caring primary care physician. I do not expect the level of healthcare I already receive to change. However, the knowledge that some people will receive primary care for the FIRST time is mind-blowing to me! That children will receive innoculations they would not otherwise have gotten makes the entire reform worthwhile.

    Yes, I expect the cost to exceed what the politicians have estimated. No one seemed to care when Bush’s wars cost millions more than he projected, but now we’re supposed to worry about every nickel? It’s in everyone’s best interest to watch the pennies and the dollars — Bush’s people lost an entire pallet of American dollars in Iraq and no one blinked an eye…

  • dana

    Government run health care – the so-called “public option” – presents serious challenges for us. The private sector and competitive market forces are the best means to meeting health care needs. Watch this video from the U.S. Chamber

  • ninguem

    Japan has better neonatal outcome than we have.

    But normal obstetrics is not a covered service in Japanese health financing.

  • ninguem

    Nuclear Fire – “…..The first is the country X (Spain) has the same Y (life expectancy) as the US but spends 20 percent less, overlooking the obvious facts that country X has half the obesity rate as the US……”

    Indeed. Africans have a shorter lifespan than whites. Japanese have longer lifespan. The lifespan numbers march through if that Japanese or that African moves to America or to England. When they see the discrepancies in other countries it’s due to socioeconomic conditions or genetics. The same discrepancies in the USA are due to our evil capitalistic healthcare system.

  • Carl Strohmeyer

    As Americans, our generally excellent health care system does close the gap as compared to the UK when you factor in life expectancy after age 60, this tends to show why a government takeover is NOT the answer; HOWEVER doing nothing is also not the answer either.
    Losing a job should not mean inability to seek medical care or being self employed should not mean going bankrupt with a major medical condition occurs.

    Reference: Heath Care Reform, Period/ Interim Life Expectancy

  • Wellescent Health

    Unfortunately, I am not convinced that reform will promote that much prevention, unless significant ongoing funding is directly ear marked for that purpose. Many other countries promote prevention and only see a little success. Prevention requires ongoing outreach efforts and constant education campaigns to convince people to take action and convincing people to do anything is often a hard sell. Like many other aspects of modern life, people remain unengaged so this first step is a challenge.

    For those people who do decide to take action, many will have to work with their doctors and make lifestyle choices. Given the failures in quitting smoking or losing weight, changes that cannot take place rapidly and easily will also be difficult to maintain.

    While I would like to see more prevention, this will take funding that is too often insufficient and too little in comparison to treating people once they have developed a condition.

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