Healthful behavior is a key to health care system

By J. Scott Applewhite, AP

Rep. Paul Ryan, R-Wis., has proposed capping Medicare and turning Medicaid over to the states.

EnlargeCloseBy J. Scott Applewhite, AP

Rep. Paul Ryan, R-Wis., has proposed capping Medicare and turning Medicaid over to the states.

"Behavior is central to health care," said Bob Nease, chief scientist at Express Scripts, which manages health benefits for more than 50 million people. "The health care system's been barking up the wrong tree."

Costs will continue to rise, he said, as one-fourth of the population contends with health problems related to behavior: Overeating, lack of exercise, smoking and not managing chronic diseases, such as diabetes or Alzheimer's, leading to expensive hospital visits.

STORY: Congress passes 2011 spending planTHE OVAL: White House launches tax calculatorThis week, the House plans to vote on Ryan's budget proposal today. He also proposed turning Medicaid over to the states and cutting it by $750 billion over the next 10 years.

On Wednesday, the House voted to repeal the Prevention and Public Health Fund, part of the new health care law, which provides $750 million to prevent tobacco use, heart disease, stroke and cancer. Proponents of the repeal argued that the money could be used for any health initiative without congressional approval, and, according to a support letter from Americans for Tax Reform and the Center for Fiscal Accountability, amounts to "little more than a taxpayer-funded exercise in social engineering."

But health experts gathered for the Atlantic Health Care Forum last week in Washington, D.C., reacted less than glowingly to Ryan's plan, including Chet Burrell, president of Blue Cross/Blue Shield, who said the gap between the money provided for Medicaid and Medicare and actual health costs would continue to grow without a push for behavioral change. In the District of Columbia region, health care costs have average increases of between 8% and 12% a year, he said.

"This is not cheap stuff, doing this kind of intervention," said Francis Collins, director of the National Institutes of Health. "But we all know just how ineffective this is without support."

As an example, he said his agency conducted a study of 3,234 people who were pre-diabetic, or those with a family history of diabetes, live a sedentary lifestyle or are overweight. About one-third, at a cost of $2,780 each for a three-year period, went through a behavior-modification program with exercise training and life coaches. About 58% of those patients avoided full-blown diabetes. One in 4 Americans older than 20 were considered pre-diabetic in 2007.

"In the long run, it will be cheaper," Collins said. According to the Centers for Disease Control and Prevention, it cost $299 billion to treat diabetes in 2010.

But in a second study that reduced complications in patients with diabetes by 90%, the behaviors encouraged by daily phone calls disappeared when the program ended, said Myrl Weinberg, president of the National Health Council, which represents people with chronic diseases and disabilities that lobbies for health care for all. "We believe that people absolutely want to change their behaviors," she said. "They need that social support."

It may be more important that employers provide wellness programs, such as gym memberships or smoking-cessation classes, than provide more money for health insurance, said Harvey Fineberg, president of the Institute of Medicine. And that social support will be necessary for behaviors to change.

Nease said such campaigns have worked in the past, when health groups and the government encouraged seat-belt use for children, and created anti-smoking advertisements. At the same time, marketers began to "supersize" products.

"We made smoking socially unacceptable," Nease said. "We have done the exact opposite with being overweight."

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