An argument for a better Affordable Care Act to restore America’s health

The U.S. spends more on healthcare than any other nation worldwide, a dazzling $3.2 trillion, but these investments do not translate into optimal health.  Compared to other high-income countries, Americans have the lowest life expectancy and the highest rates of remediable chronic diseases that drive healthcare costs including heart disease, hypertension and stroke, diabetes, cancer, and overweight and obesity.  Currently, 117 million adult Americans suffer from one or more chronic health problems known to benefit from healthy lifestyle behaviors.  Rates of overweight and obesity have peaked at a 30-year high and affect two-thirds of adults and one in three children. 

Even healthy adults have high rates of reversible metabolic risks, elevated blood pressure, excess abdominal fat, and higher blood glucose or cholesterol levels.  For the first time, many experts believe that a generation of children has higher rates of preventable obesity-related conditions like diabetes that may claim the lives of many before their parents’.  We cannot let these crippling trends continue. 

{mosads}Regrettably, the ongoing caustic debate on repeal and replacement of the Affordable Care Act (ACA) has offered few real solutions.  It fails to address our nation’s serious health problems and, as a consequence, risks bankrupting our healthcare system.  

The National Academy of Medicine (NAM) and many other expert groups have called for redirecting health care away from its primary focus on diagnostics and treatment and towards prevention.  What does a new approach look like?  It emphasizes high-quality, compassionate care focused on attaining and preserving health across the population.  

Personalized prevention is placed squarely into the clinical mix.  Healthcare services are customized to effectively meet the individual’s biological needs, personal goals and preferences, and targeted to achieve optimal health outcomes.  Clinicians working in multidisciplinary teams empower their patients to achieve healthy lifestyle behaviors known to prevent disease and restore and protect health. 

Effective lifestyle-focused counseling services are made widely available and integrate the ‘pillars of prevention’, optimal nutrition, physical activity, smoking abstinence, and alcohol moderation. The individual’s achievement of positive health outcomes is monitored as a key metric of healthcare quality.  Community-based public-private partnerships are expanded to create ‘cultures of health’ that make it easier to sustain healthy lifestyles in settings where Americans learn, work and seek recreation. 

Healthcare benefits are realigned to incentivize services that achieve personal lifestyle changes and improve health outcomes at individual and population levels.  The revitalized ACA framework is financed by shifting healthcare priorities, curbing excess system costs and inefficiencies, tying investments and reimbursement to prevention and health improvement, and in the longer term, the savings realized by achieving better health outcomes.  Can we attain these goals?   

Some might argue that the science supporting prevention is weak and that such legislative realignments would be premature.  Make no mistake.  The science has never been stronger and now commands immediate action.  The  American College of Cardiology (ACC), the American Heart Association (AHA), the American Diabetes Association (ADA), The Obesity Society (TOS), the American Academy of Pediatrics and the Academy of Nutrition and Dietetics have all defined evidence-based clinical practice guidelines consistent with NAM’s recommendations that integrate the fundamentals of personalized prevention and lifestyle-focused, improved disease management.  Can we effectively revitalize the ACA?

Our nation’s current nutrition and health policy directive, the 2015-2020 Dietary Guidelines for Americans (DGAs), offers a road map that aligns with current clinical guidelines.  The DGAs are based on the recommendations of the 2015 Dietary Guidelines Advisory Committee (DGAC), a 14-member, federally-appointed expert advisory group, that reviewed the science on ‘what works’ to improve nutrition and lifestyle behaviors, promote health, and reduce disease at individual and population levels. 

The DGAs model three new dietary patterns, the Healthy American-style,  Mediterranean-style, and Vegetarian-style dietary patterns to combine with other beneficial lifestyle behaviors and achieve better health outcomes across the lifespan. Each is designed for differing personal tastes and preferences and has a food and nutrient profile known to reduce disease risk and improve health and well-being, particularly when part of an overall healthy lifestyle.  Importantly, there is no ‘one size fits all’ formula.  Healthy diet and lifestyle behaviors can be customized to the needs of the individual or an entire community.  ‘Best practice’ strategies for effectively achieving individual and community health are carefully laid out.  These are real innovations and sound solutions based on prevention strategies experts recommend. 

We know ‘what works’ to prevent major chronic diseases, reduce their metabolic complications, and stem the tide of our epidemics of overweight and obesity.  Health professional teams can empower individuals and their families with effective personalized, lifestyle-focused prevention. 

Public-private partnerships can strategically guide our schools, adult and child daycare centers, workplaces, and other community settings to improve population and individual health.  Evidence-based web, mobile and telephonic technologies and digital platforms can reach millions of Americans with cost-effective, customized services and programs. 

Americans want affordable healthcare that meets their personal needs and promotes their health and well-being effectively.  It is time to reshape the ACA by incentivizing and promoting personalized prevention and improved disease management through sound lifestyle change strategies.  We must transform our healthcare and public health systems into the effective frameworks for individual and population health that Americans want and deserve.   

Dr. Barbara E. Millen is currently the founder and president of Millennium Prevention, Inc. She was appointed chair of the 2015 U.S. Dietary Guidelines Advisory Committee.                                                             

The views expressed by this author are their own and are not the views of The Hill.