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Long-Term Thinking About Budgets and Preventative Health

April 26, 2018

When you examine the long-term prospects of the U.S. budget, you are also seeing a doctor’s report on the health of the American people.

As chronic diseases like diabetes, cancer, and heart disease affect more and more Americans, costs are sure to increase for Medicare and Medicaid spending. The good news is that many of these diseases are preventable by good habits of diet, physical activity, and avoiding tobacco and excessive drinking.

Preventive health care efforts can be key to managing America’s burgeoning health care costs, as well as saving lives. Lawmakers on both sides of the aisle are realizing that for a relatively small investment upfront, massive savings can occur decades down the line.

Efforts to measure the impact of proposed preventive health programs are, however, often hamstrung by Congress’ inability to effectively gauge the full impact of those measures over time. In order to ensure that Congress is passing the most effective and cost-efficient measures, our lawmakers must have access to accurate and nonpartisan projections.

Unlike other types of health care, preventive care’s full effect only becomes apparent after examining its likely impact over the span of decades.

At present, the Congressional Budget Office (CBO) only makes projections on savings in health preventative programs within a 10-year budget window. This leaves Congress with an incomplete picture of the impact of proposed programs. The benefit of prevention often stretches beyond a decade. For example, a colonoscopy at age 50 can catch polyps that, if not removed, could develop into cancer much later.

As a physician, I do not believe that the impact of every program can be accurately predicted half a lifetime into the future. There are simply too many variables. Sometimes though, the stars align and we have the data to make accurate predictions across large populations.

Making the most of the best data is increasingly a priority for budget-oriented members of Congress. A consistent voice for long-term thinking is my former colleague, and fellow OB/GYN, Rep. Michael Burgess (R-Tex.), who is offering a bill that would require the CBO to predict savings on preventive health measures up to 30 years in the future. Despite attracting 41 co-sponsors from both parties, the bill has progressed no further.

Rep. John Yarmuth (D-Ky.), a ranking member of the House Budget Committee, has also called for the CBO to look beyond the 10-year window to assess the budgetary and health impacts of proposed prevention programs.

Bipartisan agreement on health care is rare. There is, however, growing recognition that the long view of investment in prevention is good both for the budget and human health.