Washington, DC — With the Senate health committee convening daily to craft a comprehensive health reform bill, the basic outline of this landmark legislation is now clear. 

Yes, it will ensure access to affordable, quality care for every American.  But, just as important, it will hold down health care costs by creating a sharp new emphasis on disease prevention and public health.

As the lead Senator in drafting the Prevention and Public Health section of the bill, I view this legislation as our opportunity to recreate America as a genuine wellness society – a society that is focused on prevention, good nutrition, fitness, and public health.

The fact is, we currently do not have a health care system in the United States; we have a sick care system.  If you’re sick, you get care, whether through insurance, Medicare, Medicaid, SCHIP, community health centers, emergency rooms, or charity.  The problem is that this is all about patching things up after people develop serious illnesses and chronic conditions.

We spend a staggering $2.3 trillion annually on health care – 16.5 percent of our GDP and far more than any other country spends on health care – yet the World Health Organization ranks U.S. health care only 37th among nations, on par with Serbia.

We spend twice as much per capita on health care as European countries, but we are twice as sick with chronic disease.

How can this be so?  The problem is that we have systematically neglected wellness and disease prevention.  Currently in the United States, 95 percent of every health care dollar is spent on treating illnesses and conditions after they occur.  But we spend peanuts on prevention. 

The good news in these dismal statistics is that, by reforming our system and focusing on fighting and preventing chronic disease, we have a huge opportunity.  We can not only save hundreds of billions of dollars; we can also dramatically improve the health of the American people.

Consider this:  Right now, some 75 percent of health care costs are accounted for by heart disease, diabetes, prostate cancer, breast cancer, and obesity.  What these five diseases and conditions have in common is that they are largely preventable and even reversible by changes in nutrition, physical activity, and lifestyle.

Listen to what Dr. Dean Ornish told our Senate health committee: “Studies have shown that changing lifestyle could prevent at least 90 percent of all heart disease.  Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle.”

It’s not enough to talk about how to extend insurance coverage and how to pay for health care – as important as those things are.  It makes no sense just to figure out a better way to pay the bills for a system that is dysfunctional, ineffective, and broken.  We also have to change the health care system itself, beginning with a sharp new emphasis on prevention and public health.

We also have to realize that wellness and prevention must be truly comprehensive.  It is not only about what goes on in a doctor’s office.  It encompasses workplace wellness programs, community-wide wellness programs, building bike paths and walking trails, getting junk food out of our schools, making school breakfasts and lunches more nutritious, increasing the amount of physical activity our children get, and so much more.

I am heartened by the fact that the major players in this endeavor – Democrats and Republicans alike – all “get it” when it comes to prevention and public health.  We all agree that it must be at the heart of reform legislation. 

As President Obama said in his speech to Congress earlier this year: “[It is time] to make the largest investment ever in preventive care, because that's one of the best ways to keep our people healthy and our costs under control.”

No question, comprehensive health reform is an extraordinarily ambitious undertaking.  But what makes me optimistic is that all the major groups are playing a constructive role, including those that opposed the 1993-94 heath reform effort.  Everyone agrees that the current system is broken.

Winston Churchill famously said that “Americans always do the right thing – after they’ve tried everything else.”  Well, we’ve tried everything else, and it has led us to bad health and the brink of bankruptcy.

Comprehensive health reform legislation is our opportunity to change the paradigm.  We are going to extend health insurance to every American.  And we are going to give our citizens access to a 21st century health care system – one that is focused on helping us to live healthy, active, happy lives.

Sen. Tom Harkin (D-Iowa) is a senior member of the Senate Health, Education, Labor and Pensions Committee and chairs the Senate panel that funds medical research and health care..

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