Prevention has two major components. The first, early disease detection, is addressed in the new law with provisions requiring both private and public insurance plans to cover—with no payments required from patients—all screening methods rated A or B by the U.S. Preventive Services Task Force. This includes dozens of procedures ranging from blood pressure and lipid level monitoring to tests for colorectal cancer and sexually transmitted diseases. The reasoning is that if more people are screened and more cases of disease are detected earlier as a result, many people will live longer and with a better quality of life. While it is not clear that this saves money overall (since screening, subsequent treatments and longer lives add to the system’s costs, even as savings accrue from preventing or minimizing illness), it is widely agreed by people across the political spectrum that such a prevention-oriented policy is justified on moral grounds.

Lifestyle-Based Health Promotion

The second, and in the long run the most important aspect of prevention is lifestyle-based health promotion, primarily in the form of a healthy diet, regular exercise and stress management. The goal here is to stop disease before it starts, and if that fails, to reverse its course or at least minimize the damage. The most fundamental health question we as a society face in the coming years is whether enough of us are willing to change behaviors that are harmful to our health and replace these with health-affirming choices. These individual decisions are at the heart of what Mark McClellan, Director of the Food and Drug Administration and later the Centers for Medicare and Medicaid Services under President George W. Bush, calls “consumer side reform.”² If we aren’t willing to make such changes, neither reform nor regulation of the health insurance industry will save us from the consequences of our actions. But if enough of us are willing, we could be on the cusp of a great health renaissance.

Though the key choices ultimately rest with each individual, representative government can play an active and essential role as well, coordinating (in partnership with private and nonprofit sector health advocacy groups and associations of health professionals) a multifaceted, long-term campaign for the promotion of health. To some extent, this is nothing new. The Surgeon General, National Institutes of Health, Centers for Disease Control and Prevention, and many other federal and state agencies have a variety of programs in place (anti-smoking, anti-obesity, etc.) that pair noble aspirations with limited resources. Some of these programs, particularly on smoking cessation, have been very effective vehicles of change.

Confronting a Tidal Wave of Advertising

It is no secret that the positive messages from these prevention and health promotion initiatives have been drowned out for many decades by an ever-rising tidal wave of advertising from the manufacturers of junk food, alcohol, and prescription medications. Television programming in the United States is awash in ads for foods and beverages that promote illness and obesity, alongside ads for the pharmaceuticals used to treat the ailments these foods and beverages cause. The absence of any significant countervailing message urging viewers to seek out the vegetables, fruits and other whole foods known to be cornerstones of good health is more than a disgrace—it is a national tragedy. Most people believe what they are repeatedly told, especially when exposure to these expertly-crafted messages begins at an age when their capacity for critical thinking has not yet developed and matured.