It’s almost time for the Senate to take up health care reform again. The sticking point in early August was over how to finance it, well, after whether or not Republicans would back a public health care option at all. In the end, though, the over $1 trillion dollar price tag on some of the proposed healthcare reform is high in general and even higher sounding in the time of economic crisis.

A new study published by the Health Affairs journal says that the Congressional Budget Office may be missing possible savings in some of the health care reform proposals because they are not looking at its preventative care components- like those efforts to prevent chronic conditions like diabetes and heart disease.

A crucial point made. I hesitate to think that Congress hasn’t considered these options though- the cynical view would say that there isn’t any money in preventative health care. Healthy people don’t need health care. While I agree that any reform package should really involve a high focus on preventative care, I also am not sure that that is any kind of close to the reality of what will be put out there. Whether Republicans or Democrats are going to pass a bill, somebody is going to make money.

Obama and other Democrats, though, have argued that initially costly primary care visits will lower costs over time- a step in the right direction. The Congressional Budget Office, though, doesn’t look at preventative measures as part of its 10 year forecast. The report recommends that the CBO change its methods. Again, the cynical view would say that there certainly isn’t enough time for any committee to redo its methods, go back and redo its study, and come out with a revised projection analysis that incorporates something as subjective and wide reaching as preventative care.

But they should.

And there are other methods that look at 25 or more years rather than 10. Why weren’t those used? A 10 year model to look at health care can’t take into account how peoples’ health changes over time. Long-term care diseases like diabetes and heart disease require different eyes and different models.

"Although this would not be necessary for the vast majority of cost estimates produced by the CBO, it would improve the information available when Congress considers health legislation with implications for the treatment of a relatively small number of costly chronic illnesses," said the report.

Basically nothing can be done in the short-term- there isn’t going to be a major change in the CBO’s report and they aren’t going to change how Congress looks at the healthcare reform bills as they stand now- but as healthcare reform continues to be an issue (and it will certainly be an issue long after the current debates and possible bill fade to memory), it is a powerful tool to see either how things are doing or how they can improve.

It would be in Congress’ best interest to adopt longer-term models to assess its options in the future- both for the health of its debates and for the health of the citizens it serves.
While such methods would need to be adjusted as treatments change, it could provide the CBO a starting point to look more long term, they said.