Over the past few weeks, the health reform debate has moved beyond platitudes and begun to engage some of the hard issues that will need to be resolved to enact reform. In the Senate, higher-than-expected cost estimates of the Senate Finance Committee's reform proposal, concerns that reform might not be bipartisan, and differing viewpoints about creation of a "public" health plan have dominated the recent debate. By comparison, other aspects of reform are much less controversial, including provisions related to public health. It is too early to predict the final framework of reform—most in Washington do not expect the Senate to meet its original goal of considering a health reform bill before the August 2009 recess—but work produced by the Senate Health, Education, Labor and Pensions (HELP) Committee and the Senate Finance Committee offers clues about the provisions it is likely to include. The following are some of the policy provisions related to public health proposed by each committee.
Senate HELP Committee 1
- Provide uninsured individuals with immediate access to preventive care and treatment for identified chronic conditions.
- Develop a national prevention and health promotion strategy that sets specific goals for improving health.
- Provide grants to establish community health teams to support medical homes, implement medication management services, and design and implement regional emergency care and trauma systems.
- Develop a national strategy to improve the delivery of health care services, patient health outcomes, and population health that includes publication of an annual national health care quality report card.
- Establish a National Health Care Workforce Commission to make recommendations and disseminate information on health workforce priorities, goals, and policies.
- Increase the number of community health centers and school-based health centers.
Senate Finance Committee 2
- Improve prevention by covering only proven preventive services in Medicare and Medicaid and providing incentives to Medicare and Medicaid beneficiaries to complete behavior modification programs.
- Strengthen primary care and chronic care management by providing bonus payments to certain primary care providers.
- Set national priorities for comparative clinical effectiveness research.
- Create a Chronic Care Management Innovation Center within CMS.
- Provide grants to states to implement innovative approaches to promoting integration of health care services to improve health and wellness outcomes.
- Improve prevention by covering only proven preventive services in Medicare and Medicaid and providing incentives to Medicare and Medicaid beneficiaries to complete behavior modification programs.
Frieden Appointed to Head CDC
On May 15, 2009, President Barack Obama appointed Thomas Frieden, M.D., as director of the Centers for Disease Control and Prevention (CDC).3 Frieden had been commissioner of the New York City Health Department, one of the nation's largest public health agencies, since January 2002. In New York, he led efforts that require restaurants to publish calorie counts on menus and menu boards, banned the use of trans fats in restaurants, cut teen smoking in half, increased cancer screening, and implemented the largest community electronic health records project in the country (see Figure 4 in Feature). In the 1990s, along with then New York City Health Commissioner and current nominee to head the Food and Drug Administration, Margaret Hamburg, M.D., Frieden led the effort that stopped the spread of drug-resistant tuberculosis.
CDC is the lead agency to help state and local health authorities detect and control chronic disease and infectious disease threats. As the nation's lead prevention agency, it will play a key role in establishing a health care system that is more accessible, cost-effective, and accountable.
1. Senate HELP Committee Draft, "Affordable Health Choices Act," (June 9, 2009).
2. Senate Finance Committee Description of Policy Options.
3. The White House Briefing Room, "President Obama appoints Dr. Thomas Frieden as CDC Director," (May 15, 2009).
