WASHINGTON — While calls for universal health care are beginning to be heard in the 2008 presidential campaign, some prominent medical experts and their supporters are trying to focus attention on what they say is the real source of runaway health spending — chronic diseases.
They're making some headway with leading Democrats and even with a couple of Republican candidates who oppose government-run universal health care, and curbing chronic diseases is emerging as a new issue in health care politics.
Long-term chronic ailments such as diabetes, heart disease, obesity and cancer account for 75 percent of U.S. health care expenditures and seven of 10 deaths. Yet chronic-disease sufferers get only 56 percent of the recommended preventative care they need. And many of their ailments are preventable.
If these patients were treated in a more proactive fashion, experts say, the country could save $100 billion to $125 billion a year in health-care spending — enough to cover many of the 46 million uninsured.
For years, Kenneth Thorpe, a noted health economist, has tried with varied success to make policymakers understand that logic.
A deputy assistant secretary for health policy in the Clinton administration, he said that most politicians are clueless about the connection between chronic disease and medical spending. Two-thirds of rising health-care spending is linked to adults with chronic conditions, and the doubling of the adult obesity rate since 1980 accounts for 30 percent of that spending growth, Thorpe said.
He's having better luck of late after teaming with former U.S. Surgeon General Dr. Richard Carmona and former Medicare administrator Mark McClellan to launch the Partnership to Fight Chronic Disease.
The bipartisan partnership, a national coalition of health, business and civic interest groups, is working in the early primary and caucus states of South Carolina, New Hampshire and Iowa to ensure that presidential candidates feature chronic-disease prevention and management in their health care platforms.
Thorpe, the group's executive director, said that health care changes should focus on making coverage less expensive and covering the uninsured. Candidates in the last two presidential elections focused only on the latter, he said.
"We're trying to jump-start the debate about health care reform in a more productive way that doesn't just initially go into the political bickering over how to pay for it," said Thorpe, who chairs the Department of Health Policy at Emory University in Atlanta.
"If you can reduce the share of adults that have chronic conditions and better manage those with chronic conditions to keep them out of hospitals and out of doctors' offices, you can reduce spending and make coverage more affordable."
Thorpe has consulted with the staffs of the three leading Democratic candidates, and all appear to have heeded his message.
Sen. Barack Obama, D-Ill., told supporters on July 20 in Hampton, N.H., that better preventative care, such as reimbursements for wellness programs, coupled with better management of chronic diseases, could help save up to $125 billion a year.
"We can take that money and use it to make sure every single American has high-quality health care by the end of my first term as president," Obama said.
Sen. Hillary Clinton's health care modernization strategy draws liberally from the partnership's themes and targets unmanaged chronic illnesses as a major driver of health costs. Clinton would require all insurers participating in federal programs to cover preventative services and provide incentives for participation in chronic-care management programs.
Former Sen. John Edwards' health proposal also calls for investments in preventive care and improved treatment of chronic diseases.
Republican candidates Tommy Thompson and Mike Huckabee, who oppose government-run universal coverage, have stressed the importance of better chronic care.
"We don't need universal health care mandated by federal edict or funding through ever-higher taxes," Huckabee says in a video on his campaign Web site. "But what we do need to get serious about is preventative health care instead of just chasing more and more dollars to treat chronic disease that's often avoidable."
Because the partnership's nonpartisan message has resonated with Republicans and Democrats, the group has been able to build state-level support across the political spectrum.
"I've been fighting the health care battle in Iowa for a number of years, and I never imagined I'd be partnering with people in the Republican Party. But if you can find common ground with unusual partners on an issue as important as wellness and prevention of chronic illness, how great is that?" said Sarah Swisher, the vice chair of the Iowa Democratic Party. She's the co-chair with former Republican Gov. Terry Branstad of the Iowa Partnership to Fight Chronic Disease.
Group members have shadowed visiting candidates and pressed them to address their concerns. They're also encouraging interested groups and voters to join their call for new approaches to chronic diseases. The group has bought newspaper and radio ads and plans more extensive media use as the race heats up.
The partnership's work was on display Monday night in the Democratic presidential debate in Charleston, S.C., when 30-year-old Charity Woods posed a poignant online question to the candidates.
After explaining that both of her grandmothers were diabetics who died of massive heart attacks, Woods, a partnership volunteer, said that her mother also has diabetes and has already suffered a heart attack.
"What I'd like to know is, how do each of you plan on addressing chronic disease and preventive health in your health care plans?" Woods asked. "I'd like my mother to be around to see her grandchildren."
ON THE WEB
For more information about the Partnership to Fight Chronic Disease, go to www.fightchronicdisease.org