Benjamin Franklin's adage that an ounce of prevention is worth a pound of cure is worth remembering at this worrisome time for health care and the economy. The prevalence of chronic illnesses in the United States is projected to increase, from 133 million persons in 2005 to 171 million in 2030.1 Health care spending accounts for 16% of the gross domestic product and may reach 25% by 2025.2 Rising health care costs are eroding corporate profits and threaten Medicare solvency, state budgets, pensions, and the viability of employer-sponsored health insurance. Family medical bills, insurance premiums, and the number of uninsured persons are increasing. Policy makers have proposed solutions (eg, value-based purchasing, consumer-directed plans, information technology), but whether these are enough to alter the spending trajectory or can overcome the political challenges remains unclear.3
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