Short answers, national edition: yes, but not the way health insurers want it to be. As usual, detailed explanations are below the fold.
Short answers, local edition: Yes, most often in connection with land use planning. Should Pleasantville use its park & recreation department funds for more soccer fields or more open space? Should its traffic funds pay for a bike lane or a bike path? Further discussion another day.
We will, I hope, have some form of healthcare reform by the end of this year. Although my personal vote is for single payer (including abolition of for-profit health insurers, and most especially utter obliteration of the Evil Empire known as Anthem Blue Cross of California), all signs emanating from the Beltway show a much more incremental reform that assigns health insurers a large role.
And I don't like the ideas of America's Health Insurance Plans, the health insurers' trade group. Maybe I just don't trust them. However, to me, AHIP's comments on encouraging healthy lifestyles sound a lot like a variation on the theme of "privatizing the profits and socializing the losses" -- this twist being "socialize the prevention, we'll collect the profits until there are no more profits to be had."
According to AHIP, "the country" [does that mean the federal and state governments?] can support AHIP's objective of "driving higher value" [what kind of doublespeak is that?] by, among other things: "Conducting outreach to racially and ethnically diverse populations to help promote healthier lifestyles, timely preventive screenings, and appropriate medical care; and providing incentives for all patients to embrace healthy lifestyles [wait just a minute? who provides what incentive?] and to follow their recommended treatment regimens."
AHIP's position paper also states: "Our public health infrastructure needs to be better positioned to implement strategies that prevent or ameliorate health care concerns and promote well being and healthy lifestyles as part of health care reform. [Again, I believe this translates as: Government should handle prevention.] We need to focus attention and allocate sufficient resources — particularly at the community level — to address significant public health issues, such as
obesity and tobacco dependence that cause an increasing prevalence of chronic illness. We advocate a new, targeted national initiative [emphasis mine] to increase public awareness of the links between preventable conditions and chronic illness and to support new and existing prevention programs in our schools, worksites, and communities. Health plans are uniquely positioned to assist in this effort and are committed to working directly with communities to promote safe and healthy living and provide models for targeted investments in public health across the country." [I can't even translate that.] Source [pdf]
Notice that the insurers are not volunteering to do anything about prevention, awareness, or education themselves.
A Los Angeles Times columnist is more cynical:
Briefly, the industry wants the government to assume the cost of treating the sickest, and therefore most expensive, Americans. It wants the government to clamp down hard on doctors' and hospitals' fees. And it wants permission to offer stripped-down, low-benefit policies freed from pesky state regulations limiting their premiums.
The insurers think government intervention is fine if it applies to customers they don't want. The way they put it in their reform plan is that we need a system that "spreads costs for high-risk individuals across a broader base" -- the base consisting of all taxpayers, that is.
Who are these "high-risk" individuals, by the way? At an AHIP convention last year, I heard a prominent industry consultant describe the customers the industry is desperate to dump on taxpayers as those with multiple chronic diseases, like diabetes sufferers with asthma or cancer patients with heart problems. He called these people "clinical train wrecks." (Nice way for someone connected with the "caring professions" to talk, isn't it?)
So, for people struggling with obesity, the health insurers' plan is simple: The government will educate you about obesity, but you'll pay premiums to us. We'll clamp down hard on payments to your doctor. When you get too sick, we'll dump you back on the government.
What kind of prevention do the health insurers want the government to advocate? Tobacco education programs have made a difference, as generally the number of smokers has decreased. Diet and nutrition programs haven't. My
Magic Eight Ball intuition tells me that reply hazy, ask again later the next tack to take will be exercise.
Of course, education and prevention are very important, and I'm happy whenever people put down the remote and move their bodies. I just don't trust anything coming out of the mouth of AHIP. I also don't like the two extremist end-arguments: mandatory exercise and (more politically feasible) substantially higher premiums based on a "lack of personal responsibility."
Since obesity is generally perceived as a huge, preventable disease caused by poor choices in diet and exercise; since food choices are political (as orangeclouds and others have demonstrated so well); since governmental programs about diet have not stopped the obesity epidemic; and the stakes are high in health care reform, look for exercise to become political on a national level.