Summary: Certain voices in the US Senate have been talking about the need for a paradigm shift in health reform, toward policy which helps us move to a “wellness society.” Wayne Jonas, MD, and his coalition through the Samueli Institute have been promoting an ambitious Wellness Initiative for the Nation. Here the Integrator interviews Brian Thiel, Samueli Institute’s vice president charged with government relations for an update on how the effort is faring. There is good news here for the advancement of a whole system vision of what a wellness society will require. And there is a long legislative road ahead.
Samueli Institute on the Advance of Whole System Wellness in US Senate Health Reform Legislation
“For those who have been working years to promote wellness, our time has come.” These are the words of U.S. Senator Tom Harkin (D-IO) in late February of 2009 at the National Summit on Integrative Medicine and the Health of the Public quoted in the cover story by Eric Goldman in the Summer 2009 Holistic Primary Care.
So how is wellness faring in the heat of the current Congressional jockeying over health reform? The Integrator turned to Brian Thiel, vice president for strategic partnerships and advancement at the Samueli Institute (see Invitation from Wayne Jonas/Samueli to Daschle Discussion of a Wellness Initiative for the Nation, December 23, 2008.) The Samueli Institute-backed Wellness Initiative for the Nation (WIN), led Samueli Institute’s CEO Wayne Jonas, MD, the former director of the NIH Office of Alternative Medicine director, is the most ambitious, whole system policy agenda for wellness that is out there. Are Harkin and the US Senate buying it?
The short story is that all of what WIN is promoting has not yet shown up in the targeted bill. Yet key provisions have, and Thiel is pleased with the headway: “We have a phased approach with WIN.”
Office on Wellness emerges as a Council
A key recommendation in WIN was the establishment of a White House Office on Wellness. Thiel points to Section 301 on page 346 of the Affordable Health Choices Act, as of the June 26, 2009 draft status of this Kennedy-HELP health reform bill. The section, if passed into law, would establish the National Prevention, Health Promotion and Public Health Council. While the Council idea would not seem to have the clout of a White House Office, Thiel indicated that the Obama administration “didn’t want another office in the White House.”
However, the Council approach maintains much of the whole-system concept of wellness that the Samueli Institute and its supporters, including the Integrated Healthcare Policy Consortium, is promoting through WIN. The membership of the proposed body would include heads of agencies ranging from education and energy to agriculture, transportation, defense, as well as Veteran’s Administration and Health and Human Services (pages 346-347). The council is not located in or necessarily chaired by anyone at HHS. The president would appoint the chair. WIN’s expanded vision of the inputs to health and wellness appears to be taking hold.
Wellness advisory team from stakeholders not in, but a potential opening exists
Another provision in the WIN proposal is the establishment of a formal advisory body from the community to make sure the august Council had significant ongoing “inputs from the field” and a “sanity check,” as Thiel put it. A diverse group of historic players in the wellness community would be called upon for ongoing assistance. Leaders in integrative practice were eyeing the potential of landing positions of influence there.
However, the draft legislation, as of late June, did not include establishment of such a team. Thiel points to language (page 348, line 3) which mandates input from “relevant stakeholders.” He states: “This is as close as we got to what we were promoting.”
Budget for an ambitious agenda?
For the Council to have clout, it needs funding. Thiel notes that “no funds were specifically provided for the execution of the Council’s responsibilities.” Then how will this keep from being mere window dressing, like the Council on Fitness, rolled out now and again but certainly not an engine of change such as the WIN proposal recommended?
The mere filing of annual reports on the nation’s wellness, prevention and health promotion efforts, which the Council would be charged to do, could easily be dismissed or forgotten unless significant funding is associated with the Council’s recommendations.
While there is no funding in Section 301, there is funding nearby. Thiel indicated that the Institute plans to discuss with the Committee the possibility of linking Section 301, setting up the Council, with Section 302, which establishes the Prevention and Public Health Investment Fund. In the current legislation, $10-billion each
year, from 2010 to 2019, would be appropriated to “provide for expanded
and sustained national investment in prevention and public health
programs to improve health and help restrain the rate of growth in
private and public sector health care costs.” Thiel notes that the Council’s work would be enhanced if it had a strong influence on, or purview over, setting the spending agenda of the Investment Fund.
While there may be reason for hope, the clarity that the Council will be linked to the Fund, says Thiel, “is not something we have discussed.”
How will this fare with competing bills?
Of course, inclusion of such language in one draft bill among a handful in the US Senate, with others emerging from the US House of Representatives, has no guarantees. At the time of the interview, three bills were emerging in the House. Said Thiel: “We have not yet been all that aggressive in making House recommendations.”
Thiel notes that these House bills include nods to “prevention and wellness” and a “prevention and wellness trust.” But none embodies the holistic view in the Kennedy-HELP bill on which the Samueli Institute has focused its impact. Concludes Thiel: “We are appreciative of the consideration the Senate gave to wellness. There is a lot of work left to do.”
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