Prevention First: Tom Brier’s Innovative Plan to Fix our Healthcare System
Guest Post by Patrick Ioffreda
Over the course of the Democratic primary election, few issues have been discussed as often or in as much detail as healthcare. By and large, the discussions center primarily on the question of coverage — that is, which payment model is best suited to provide Americans with affordable healthcare? Some candidates, like Bernie Sanders and Elizabeth Warren, support eliminating private insurance altogether and replacing it with a single-payer, government-run program. Others, like Joe Biden and Amy Klobuchar, would like to improve the Affordable Care Act and create a public option as an alternative to, rather than a replacement for, private insurance.
Lost in these discussions, however, is perhaps the most important question of all: How can we prevent Americans from getting sick in the first place?
When it comes to healthcare spending, the United States stands alone. A 2017 analysis by the Centers for Medicare and Medicaid Services found that healthcare costs in the United States account for 17.9% of our Gross Domestic Product, with the average American spending more than $10,000 per year on healthcare costs. Overall, the U.S. spends $3.5 trillion annually on healthcare — a figure that is expected to nearly double by 2027.
Despite outpacing the rest of the world in healthcare spending, however, the United States ranks just 37th when it comes to overall healthcare efficiency. Why? According to the National Institute of Health, a major reason is because the U.S. allocates a disproportionately small amount of funding toward preventative medicine. Indeed, while 90 percent of health expenditures in the United States are for treating chronic conditions like obesity, heart disease, and diabetes, less than 10 percent of funds are allocated toward preventative care. In other words, Americans tend to overlook the fact that the best way to cure a disease is to prevent it from happening in the first place.
To drive down healthcare costs and increase overall efficiency, our elected officials should adopt legislation that uses the tools of preventative medicine—including regular check-ups, a nutritional diet, and frequent exercise — to promote communities of healthy living. As described by former Rhode Island state health department director, Dr. Michael Fine, healthy living “is about being able to participate in family life and work and community; it’s about good relationships, promoting healthy choices, and the right to have what you and your family need for your well-being.”
Democratic candidate for Congress in Pennsylvania’s Tenth District, Tom Brier, has provided us with a legislative starting point. As Tom explained in a recent interview, he would like to see the federal government create “Community Health Centers” (CHCs) across the country that would provide Americans with the resources they need to maintain healthy lifestyles, including, for example, nutrition plans, exercise programs, budget planning classes, and preventative treatment options. By partnering with the private sector, Brier’s hope is that the federal government, over time, would be able to expand CHCs to include on-site health clinics, fitness facilities, pre-K child care, and after-school programs — all of which would improve our country’s collective health and increase civic participation.
Under Brier’s proposal, CHCs would be built, at least initially, in neighborhoods suffering from diseases of poverty, a contingent that is predominantly Hispanic and African American. According to the Pennsylvania Department of Health (PDH), the total age-adjusted death rate is 25 percent higher for blacks than whites, a disparity due in large part to the fact that blacks are significantly more likely than whites to die from a chronic illness like heart disease and cancer. Indeed, PDH found that, compared to whites, African Americans are 22 percent more likely to smoke cigarettes; 11 percent less likely to engage in physical activity; and 16 percent more likely to be obese. Moreover, black adults are 44 percent more likely to report being unable to see a doctor because of cost and 15 percent less likely to have a personal doctor or healthcare provider.
Hispanics don’t fare much better. Twenty-seven percent of Hispanic adults don’t have a personal healthcare provider and 16 percent have no insurance whatsoever. A significant portion of Hispanics lack the funding necessary to eat balanced meals and, according to PDH, many “usually do not have enough money left over to make ends meet at the end of the month.”
Thus, by focusing specifically on the neighborhoods most affected by inequality, Brier’s CHC proposal would help to close this racial, ethnic, and moral imbalance.
As it happens, a smaller version of the CHC concept already exists here in Harrisburg. Since 1994, the Community Check-up Center in Hall Manor has been providing family planning services and pediatric care to Harrisburg residents irrespective of their ability to pay. Opened initially by mothers who wanted to improve the health of their children, the center is now open to all members of the Harrisburg community, proving that neighborhood-based initiatives can indeed have monumental impacts on our communities. As one worker told Tom and me when we visited their facility in November 2019, “our patients wouldn’t make it without us.”
The problems plaguing America’s healthcare system cannot be cured overnight. Nor can they be addressed by a single, cure-all solution. Unsustainable premiums, exorbitant pharmaceutical drug costs, lack of transparency, needlessly complex billing requirements — all of these issues must be addressed if we are are to fix America’s enormously complex healthcare system.
That said, little progress can be made unless and until we adopt a new understanding of what it means to be healthy. Health is not merely being free from illness or disease; health means exercising regularly, eating well, working with dignity, caring for children, enjoying time with friends, and having hope in the future. And because a community is only as healthy as its resources, Tom Brier’s CHC proposal may very well reverse our nation’s course on healthcare.
Patrick Ioffreda is a 2019 graduate of Cornell University, where he earned his degree in communications. He is currently working as a research assistant for the Penn State Health Milton S. Hershey Medical Center and plans to enroll in medical school in the fall of 2021.