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What next?

By Dr. Kohar Jones

The presidential election has passed.
After spending $6 billion dollars on the federal elections-the most expensive election in history--everything in Washington D.C. remains exactly the same as before election.  Almost.
President Obama remains the president.
The House remains Republican.
The Senate remains Democrat.
The Supreme Court of the United States remains SCOTUS.

There is one difference.  A major one.

We know now that health reform will move forward.
States will scramble to catch up with preparing for the health insurance exchanges, which WILL move forward.  States will decide whether, and how, to expand Medicaid coverage. Hospitals will continue to figure out how to optimize handoffs of patients to the doctors outside their hospital doors--to prevent the quick bounceback, the unnecessary (and soon to be unpaid for) return within a month to the same hospital for the same condition, when meds are not bought and follow-up doctors not seen. Every American citizen will be expected to have health insurance by January 1, 2014.

Between here and then, we have a fiscal cliff to deal with.  As a society, we desperately need to slow down our health care spending, a shocking 17.5% of our federal budget.

In the 1970s, spending on health care and education were on par. Not so today.  "Compare the physical conditions of schools and hospitals,” medical historian and sociologist Paul Starr asked a group of medical educators last week in San Francisco. "How much further can we let this go? The resources are coming out of other things."

The be all and end all of health reform cannot be ensuring access to Americans to the highest level of care for the diseases that plague American society today.  70% of our $2.7 trillion healthcare spending is on diseases of lifestyle.  It is estimated that by the year 2020, a full 20% of federal spending will be on diseases of lifestyle.  If our health plans only focus on ensuring every American has access to gastric surgery, we will all get fat and sick before spending lots of money to get better.

Instead, to save America money, we need to change our lifestyles.

More walking. More fruits and vegetables. Less soda.

An important part of healthcare reform is funding for prevention and public health measures.  Right now in America, only 4% of our healthcare spending goes to public health.  We spend $250 to keep people healthy in comparison to over $8500 for direct medical care on average for each American.

We need to shift our spending from a sickcare system to a healthcare system that begins by creating a built environment that promotes healthy habits where we live, work and play.  Then every American can be healthy, and our federal budget balanced.

Now that we know healthcare reform is moving forward, we need to make sure healthcare reform moves in the right direction--away from a disease-oriented pay-for-procedures system, and towards a health-oriented system that pays for wellness.

Best wishes for the next 4 years, Mr. President! Be well, and help us to be well too.

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