A new set of health challenges confronts the United States at the beginning of the twenty-first century. Chronic and preventable diseases now account for most of the deaths and costs in the system, despite relatively low-tech and low-cost services that could limit them.
The underuse of preventive services stems from lack of awareness, low perceived value of such services, and a fractured financing system unable to align incentives from sickness toward wellness. This cannot be fixed through private insurance mandates or the public health system alone. Instead, a new system for health promotion and disease prevention in the United States is needed, and one such model is proposed in this paper. It would carve preventive services out of the existing health insurance system and would finance those services through the Wellness Trust, a new agency under the Department of Health and Human Services. This Trust would set national priorities for prevention, employ innovative and effective systems for delivering them, and align payments with priorities. The Trust would be the primary provider of prevention priorities for all Americans, irrespective of insurance status, and would reconnect with the medical system through an electronic health record. While this proposal may not have immediate or, in some cases, overall budget savings, it has the potential to improve and extend lives.
This idea was originally sketched out as part of the Center for American Progress’s comprehensive health reform plan and was described in an opinion piece and a shorter paper (Lambrew et al. 2005, Lambrew and Podesta 2006a, Lambrew and Podesta 2006b). This paper describes the idea of a Wellness Trust in greater depth and includes a discussion of its cost implications.