Prevention's part in the health-care debate

WASHINGTON — As Congress struggles to decide how America should take care of its sick, another controversy is simmering: whether health-care legislation should include billions of dollars aimed at keeping people well.

A draft Senate bill would provide up to $10 billion annually for a "prevention and public health investment fund" — a portion of which could be used for projects such as bike paths, sidewalks, farmers markets and other community interventions meant to curb chronic and costly conditions like obesity.

But while some lawmakers believe these initiatives could trim American waistlines and cut costs in the long run, others consider them wasteful spending.

One critic, Sen. Mike Enzi of Wyoming — an accountant who is the top-ranking Republican on the Health, Education, Labor and Pensions Committee — called the provisions "an $80 billion slush fund for additional pork-barrel projects."

"The [Health Committee] bill will pave sidewalks, build jungle gyms and open grocery stores," Enzi said, "but it won't bring down health-care costs or make quality coverage more affordable."

But advocates say preventive efforts will bring down costs.

"We know these programs work," said Richard Hamburg, director of government relations for the Trust for America's Health, a nonpartisan organization that works to make disease prevention a national priority. "In and of itself, prevention makes sense," Hamburg said.

Trust for America's Health joined more than 300 organizations in urging lawmakers to include public health and prevention money in the bill. The group also issued a 2008 report suggesting that an investment of $10 per person per year in "proven community-based programs" — access to fresh produce through farmers markets, for example — could save the U.S. more than $16 billion annually within five years in lower health care costs.

Hamburg acknowledged Republican objections. But, he said, "Frankly, building healthy parks and making them easier to access is a good thing."