Chronic ills seen as focal point to reform health care

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An estimated 133 million Americans - 45% of the population - have at least one chronic disease. And chronic diseases now account for roughly 75% of all health care spending.

To Kenneth Thorpe, focusing on the growing prevalence of chronic diseases and their cost could be the starting point in building bipartisan support for health care reform.

Thorpe, a professor at Emory University in Atlanta, saw that when he helped Vermont design a sweeping set of reforms enacted in 2006 under a Republican governor and a Democratic-controlled Legislature. Those reforms, known as Catamount Health and the Blueprint for Health, included expanded coverage for the uninsured as well as steps to improve the prevention and treatment of chronic diseases.

The lesson was that health care reform also must include initiatives to slow the rise in health care costs, and one way to do that is by focusing on chronic disease. "We are talking about truly lowering health care spending," Thorpe said.

His experience in Vermont led him to found the Partnership to Fight Chronic Disease, a national coalition of 110 organizations, including such dissimilar groups as the Service Employees International Union and the U.S. Chamber of Commerce.

Thorpe was in Wisconsin last week to launch the Wisconsin chapter of the organization. The chapter, the sixth in the country, includes roughly 30 groups ranging from the AFL-CIO of Wisconsin to Wisconsin Manufacturers & Commerce and from the YMCA of Greater Milwaukee to the Professional Firefighters of Wisconsin.

"Everybody is frustrated about our inability to do anything," Thorpe said. "And all these groups are looking for ways to collaborate in a less contentious way."
Group's goals

One of the group's goals is to ensure that the rise in chronic diseases will be part of the debate on health care reform in the coming presidential election.

"If you want to fix health care, you have to go where the money is, and the money is in chronic illness," said Tommy Thompson, former secretary of the U.S. Department of Health and Human Services and former governor of Wisconsin.

Thompson and his wife, Sue Ann Thompson, president and founder of the Wisconsin Women's Health Foundation, will co-chair the Wisconsin chapter of the Partnership to Fight Chronic Disease.

Chronic diseases include a wide range of conditions, from mental illness, cancer and HIV/AIDS to high blood pressure, diabetes and asthma. Many of them stem from lifestyle - primarily smoking, poor diets and lack of exercise.

More than one-third of the U.S. population is obese - roughly more than 30 pounds overweight - and two-thirds is obese or overweight. That is double the number 20 years ago.

Thorpe has noted that 15% to 30% of the increase in health care spending in the past two decades is attributable to the increase in obesity.

By one estimate, if the rate of obesity was the same as 20 years ago, health care spending would be 10% lower today. That would work out to roughly $240 billion in savings this year.

Some chronic diseases have reached epidemic proportions among certain ethnic groups. African-Americans are 40% more likely to die from heart disease than whites. And Latinos are almost twice as likely to die from diabetes as whites.
Reform failures

Thorpe has written extensively about the higher prevalence of treatable diseases and its role in the increase in health care spending.

He also has seen his share of failed attempts at health care reform. He was an adviser to the Clinton administration's effort in 1993. He has worked on health care reform in New York and New Jersey, and he is advising Illinois' efforts.

"There's a sort of usual formula," Thorpe said. "They lay out the options for covering the uninsured."

The options never change.

"In most states, you can't get a plurality for any of them," he said. "And most people's second option is the status quo."

Yet roughly 85% of the population has health insurance. Their key concern is the cost. Further, 96% of the people who voted in 2006 were insured.

"That's one of the ways to get politicians' attention," Thorpe said.

Yet slowing the rise in costs is an issue that crosses the political spectrum. Wisconsin Manufacturers & Commerce, the state's largest business lobby, and the Service Employees International Union agree that more must be done to prevent and manage chronic disease.

"It's got to be part of any solution," said Nathan Hoffmann, a spokesman for the SEIU Wisconsin State Council.

Fighting chronic disease is just one component in health care reform, Thorpe said. Health care reform also must include expanding coverage for low-wage workers and people with pre-existing medical conditions.

"It's not either/or - not at all," he said. "But this provides a starting point."

The reform proposals put forth by the leading presidential candidates all support putting more emphasis on the prevention and treatment of chronic diseases. Yet fighting chronic disease also would require changing the focus and incentives in the health care system.

"The whole idea is doing the preventive maintenance," Thorpe said.

The current system is oriented toward providing specialty and acute care. That can be seen in how health plans and government health programs pay doctors. Primary-care doctors make a fraction of what specialists make. Yet primary-care doctors oversee much of the care for most chronic disease.

Other reforms could include bundling payments to doctors and hospitals for treating chronic disease and adopting the computer systems needed for electronic health records.

There also needs to be more research on what programs work best in preventing and treating chronic disease, Thorpe said. That work is just beginning.

"A lot of the basic stuff that you would think has been done, hasn't been done," he said.

The Partnership to Fight Chronic Disease plans to present a series of legislative proposals next year. The goal is to focus people on the right issues and to help move health care reform forward.

Targeting the cost of chronic disease could do that.