Disease prevention and the military rank side by side as national priorities, at least on paper. Federal obligations for public health, as part of promoting "the general welfare," and providing for "the common defense" originate in the same two sentences of the Constitution.
But while the military grabs more than $600 billion in federal spending, the Centers for Disease Control and Prevention (CDC) get only about 1 percent of that. It’s time we narrowed the disparity. Doing so will create jobs, reduce avoidable costs to taxpayers, and save lives.
The Supreme Court's ruling to uphold the Affordable Care Act is an unmistakable signal that health care will remain a top federal priority for years to come. Politicians on the right, like Mitt Romney, often denounce the 17 percent of the federal budget that goes to health care. But leaders of all parties tend to overlook the jobs it generates. And outside the Obama administration itself, many are dropping the ball on realizing the new jobs that come with improvements in care and the efforts to reduce expense and misery through disease prevention that are interwoven in healthcare reform.
Investment in health care, including in public health, is a major catalyst for employment. Several independent analyses estimate the nation's three-year increase in healthcare positions from 250,000 to more than a million. A report this May by the Bay Area Council Economic Institute looks just at California, a state hard-hit by the recession and the nation's single largest economy, estimates that 99,000 jobs will be created statewide by the federal health reform law. And that is in just the first year of the law's implementation.
Will our priorities in public investment match the healthcare marketplace and the needs of the American people? Last month brought news from the Association of American Medical Colleges that the country is 63,000 doctors shy of meeting the nation's demands.
Such reports and the recent high court ruling should embolden elected officials and candidates at all levels to champion investment in
health care. This includes education pipelines into health-care professions and research, reporting, and prevention efforts targeting diseases acquired in the course of receiving health care.
100,000 Die From Hospital-Contracted Diseases
These diseases hit 1 in 20 hospitalized Americans each year and kill 100,000 people, according to estimates by the Department of Health and Human Services. Clostridium difficile (C. diff) infections are among the most common and the most lethal. In addition to the anguish they inflict, these diseases add about $30 billion in avoidable costs to the health-care tab picked up by taxpayers.
When it comes to improving public health by curbing and finding cures for such infections, government is key to the solution. Only the federal government can provide the financial incentives for research at public and private institutions, open and accountable evaluation of results and best practices, and sustained leadership needed to meet the challenge.
The Obama administration has shown responsibility in this area. The administration did not miss a beat in acting on a 2008 report from the Government Accountability Office calling for data-gathering, consistent reporting standards, surveillance, and prevention of health-care associated infections (HAIs). The 2009 federal stimulus act required action plans by states and funding for pilot projects at healthcare providers to measure, report, and prevent C. diff. cases.
The Affordable Care Act of 2010 takes aim at C. diff. and other HAIs by hinging federal payments to providers on measurable progress in reducing their infection rates. Gone are the days when a hospital could perversely bill a patient, or the taxpayers, for treating a condition they may have a role in transmitting.
When it comes to such fiscal discipline, what's not to love? True fiscal conservatives should hold up the reform law in celebration, not hold up its implementation. It takes a data-driven, common-sense approach to stewarding federal health-care funds and making its recipients accountable. Millions of Americans will benefit from the law's full effects, including the reduction of HAI exposure, and faster response to the most common symptoms of the most dangerous maladies.
Foremost is C. diff. Often associated with the use of antibiotics and, increasingly, proton pump inhibitors, the disease stems from an imbalance of harmful bacteria in the colon. Left unchecked, they shut down the digestive system and can kill a patient. My mom, a classroom teacher, died from C. diff. in just six days. When it comes to the 30 percent reduction goal for C. diff. cases set by the federal health department for 2013, we are falling short. And C. diff. was actually among the least ambitious goals on the punch list of five-year federal HAI prevention targets.
Congress Wants to Cut Funding for Vital Research
The imperatives on progress against disease and high-skilled healthcare jobs in America seem lost on some in Congress. On July 18, House Republicans sought to eliminate funding for the Agency for Healthcare Research and Quality, which provides incentive grants for public-health improvements at hospitals nationwide. According to an analysis by BusinessWeek, reductions is costs to taxpayers driven by the agency's work save more than $400 million each year, exceeding the agency's annual budget. Axing it may seem penny-wise, but is actually pound-foolish in the extreme.
Federal health reform is a big step in the right direction, albeit just one step. And the Supreme Court ruling to uphold it, instead of triggering resistance, should goad Congress to find ways to work with the administration to continue sound investments in public health. It should also guide academe, private enterprise, labor, and management to speak up about the good jobs that hang in the balance. Frontline caregivers and their unions, consumer advocates, hospitals, and community health centers all need to stand up for the jobs our communities stand to gain.
Now is the time to press forward on public health. Never has the federal government been this intensely focused on promoting this collective good, with such a range of expertise convened or such data at its disposal indicating where the investment of dollars can make the most difference in the lives and health-care outcomes of Americans. It's time we brought our overly militarized federal budget toward integrity with our Constitutional duty to promote the general welfare. Investing in public health saves lives, reduces avoidable expense, and creates sustainable jobs crucial to a strong economy.