Healthcare overhaul law shifts focus to preventing illness and keeping people fit

The new healthcare reform law covers a lot of ground -- at about 2,400 pages, it’s roughly twice as long as “War and Peace.”

Much attention this week has focused on big-ticket provisions such as a national mandate for buying insurance and an end to excluding people with preexisting medical conditions.

But scattered throughout the law are also a number of provisions that focus on prevention of illnesses and keeping people fit. And, some healthcare experts say, this is where the real action will be in years ahead.

“This is the great, unsung aspect of the law,” said Daniel Zingale, senior vice president of the California Endowment, a nonpartisan health foundation. “There’s a great deal there.”

Not least among those provisions, the law creates a $15-billion fund that will funnel cash to a variety of programs designed to emphasize more healthful lifestyles, including efforts to battle the obesity epidemic and help people manage chronic diseases.

A National Prevention, Health Promotion and Public Health Council will coordinate federal efforts to promote healthful living -- an approach that’s the complete opposite of our current system of waiting until people become sick and then prescribing costly treatments.

“If you had to name one thing that’s wrong with our current system, it’s the overemphasis on care and treatment after the fact, rather than preventing problems in the first place,” Zingale said. “For the first time, we’re looking at healthcare as something that extends beyond the doctor’s office and into our lives.”

The new law makes a number of changes to Medicare and Medicaid to encourage wellness, such as elimination of copays for more preventive services. It also provides additional resources for kids, pregnant women and people trying to stop smoking.

Significantly, the law increases the reimbursement rate for doctors who offer certain preventive services, creating a financial incentive for healthcare practitioners to keep patients in the pink.

It includes grants to small businesses that want to establish wellness programs for workers and provides incentives for employers to offer as much as 50% off insurance premiums to people who participate in such programs.

Finally, chain restaurants nationwide, as well as vending machines, will be required to disclose nutrition information about food and drink. This is a crucial element for helping people make informed decisions about what they eat.

For example, a Big Mac and a large order of fries at McDonald’s together contain more than 1,000 calories. A 32-ounce Triple Thick shake adds another 1,000 calories to the mix.

That’s the entire recommended allotment of calories for a whole day in a single meal. Is it any wonder we’re so fat?

Studies have shown that when people know all the details of what’s on the menu, they’ll make more healthful choices. And if they have the means, they’ll make a greater effort to stay fit.

The healthcare law helps us do that. Like Vice President Joe Biden said, it’s a big flipping deal. Or words to that effect.

Fuss about the bus

Tuesday’s column on public transportation drew plenty of reaction from readers, mostly simpatico with my sentiment that Southern California’s bus and rail network needs to be a whole lot more user-friendly.

But I also heard from a smattering of folk who think that bus drivers need to know their place.

Specifically, some people take issue with buses that hit the freeway during rush hour and clog up “fast lanes” (I use the term loosely) rather than stay to the right and out of the way of smaller, quicker vehicles.

The California Driver Handbook, issued by the state Department of Motor Vehicles, appears to support that idea. It says that bus drivers “must drive in the right-hand lane or in a lane specially marked for slower vehicles.”

“If no lanes are marked and there are four lanes or more in your direction, you may only drive in either of the two lanes closest to the right edge of the road,” it says.

But Sgt. Mark Garrett, a spokesman for the California Highway Patrol, said that’s just plain wrong.

“The handbook is erroneous,” he said. “There are many exemptions that apply to buses.”

So many exemptions, in fact, that the only buses that are actually required to stay in the right-hand lanes are school buses, and only when they have children on board. All other buses, including school buses without kids, can travel in any lane they please.

Armando Botello, a spokesman for the DMV, acknowledged that there are many exemptions that apply to buses on the freeway. But he said this is hard to make clear because of “limited space in the handbook.” I don’t know about that. Seems to me all you have to do is say that the right-hand rule applies not to “buses” but “school buses carrying kids.”

Botello said he’d pass along the suggestion to those who write the driver handbook.

David Lazarus’ column runs Tuesdays and Fridays. He can also be seen daily on KTLA-TV Channel 5. Send your tips or feedback to david.lazarus@latimes.com