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An Ounce of Prevention

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  • 1. A Gaping Omission in The Deficit Commission Report: An Ounce of Prevention to Lower the Deficit and Benefit SocietyOne sensible strategy has been virtually absent from recent proposals to reduce the federaldeficit, including the most important, the Simpson-Bowles deficit commission. We need toprevent the problems in the first place that are eating up federal revenues. We could reduce theneed to just "raise taxes/cut programs" if we invested in preventing problems like illness andcrime before they happen. There already exist well-tested “evidence-based programs” thataddress social problems and typically start saving money within three to ten years.If we sufficiently fund programs to cut the high school drop-out rate by 50 percent, we could add$30 billion in federal revenues annually. Fewer drop outs mean higher employment rates (hencemore tax revenue) and less teenage pregnancy, drug use, poverty, and crime. Prisonerrehabilitation programs are proven to lower recidivism rates and criminal justice expenses, whichcan cut into the cost of crime’s aftermath that currently exceeds $1 trillion annually. Similarly, itis far cheaper to prevent substance abuse than to pay for its consequences, which cost $360billion annually. Funding early childhood programs for vulnerable populations would result, by2050, in an estimated federal and state budget savings of $61 billion annually, an increase of$107 billion in the gross domestic product, and crime-related savings of $155 billion (in 2004dollars).Pollution control, waste control, and energy conservation save money. Every dollar spent indisaster prevention, including reinforcing infrastructure, saves $7, on average, when calamitystrikes—in addition to boosting jobs and the economy. Armed conflicts can sometimes beforestalled at a small fraction of the expense of war by using "preventive defense," "preventivediplomacy,” or conflict management techniques.Finally, widespread initiation of good practices in childhood rearing, wellness, exercise,nutrition, and public health campaigns can dramatically save in budget-busting health care costs.One analysis found that interventions like “end-of-life” discussions, nurse follow-ups, anddiabetes prevention instruction could save $50 billion annually, mostly in federal dollars. If wecan prevent obesity from rising above 2008 levels by using behavioral, medical, and legalinterventions, federal and state governments could save an estimated $100 billion annually inhealth care costs by 2018. This does not include gains in worker productivity.Given sufficient initial investment in and widespread implementation of prevention programs,the annual impact on the federal budget would increase over time, reaching hundreds of billionsof dollars in savings and added revenues. This is a considerable sum in relation to the estimatedsavings from the Commissions proposals. Savings will be maximized if all government agenciesexplore these possibilities and new research is funded to identify additional areas for savings. We
  • 2. can start small, given current concerns about new spending: invest $5 billion annually for fouryears in various preventive programs. If subsequent evaluation finds a good cost-savingtrajectory, then significantly more funds can be allotted. One exciting new possibility for fundingprevention efforts are “social impact bonds,” which enable the private sector to invest ingovernmental social service programs and reap part of the savings.The Commission did recommend investing in education and infrastructure to promote economicgrowth. It also proposed a new “Cut-and-Invest Committee" to identify outdated, ineffectiveprograms and recommend others for high-value investment. The Commission additionally notedtwo projects involving primary health care that have generated savings. These could be the seedsof a prevention model, which should have been given far more prominence in its deliberations.In fact, a letter promoting prevention was sent to the Commission by a sixteen member group,including the NEA, American Public Health Association, National Council of WomensOrganizations, and American Human Development Project of the Social Science ResearchCouncil.President Obama, along with Commission members and Budget Committee heads in the newCongress--Rep. Ryan and Sen. Conrad--intend to consult the Commission report as they beginwork on budgetary matters. They should add prevention possibilities to the mix. Perhaps someRepublican-supported program cuts might be accepted by Democrats if they anticipate atrajectory of investment in programs that promote social and medical welfare as well as savemoney—with Republicans amenable to some cost-saving investment. Everyone wants economicgrowth, which prevention investment can promote.Tax increases and program cuts are bitter pills; prevention leads to greater well-being. Surely it ispreferable to prevent a disease than treat it; to avoid an oil spill than to clean it up; to avoidprison or war. To benefit society while saving money is a hard combination to beat.Neil Wollman, Ph. D. is Senior Fellow, Bentley Alliance for Ethics and Social Responsibility;Bentley University;NWollman@...u; Abigail A. Fuller, Ph. D. is Associate Professor of Sociology, Manchester College, NorthManchester, Indiana.

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