One of the benefits of a home office is I can watch television so I watched the six hour summit. I thought it was promising in that there is a wide area of agreement on goals albeit a cavernous gap in how to do it.

The basic gap seems be in several areas. Republicans feel the cost curve is not sent downward with either House or Senate bill. They also want more private sector free market solutions and less Federal mandates. A key area missing, say Republicans is tort reform and fraud reduction. Republicans would agree that we need more affordable insurance rates, more protection for pre-existing conditions, and more focus on prevention. Republicans want a step by step approach rather than a comprehensive system wide bill desired by Democrats.

The Democrats think they address these provisions at least partially. They say costs will come down because they establish a medical panel to evaluate what works, provide preventive care without co-pays, and are working on incentives for states to reduce lawsuits.

I think that if the Democrats included full tort reform and less mandates they can come to an agreement this year. The Republicans would need to agree to Federal standards on coverage mandates for insurance companies, although maybe they can be scaled down so costs can be less for consumers. What is striking is that the CBO says rates will rise more than 10% because the government mandates coverage levels higher than we get now.

The level of political theater was evident on both sides. I would say at least 50% of the comments were substantive and could lead to a bridge between the parties. I was disappointed that Reid, Pelosi and McCain and several Republican house members were highly political rather than cooperative. Leadership seems to be a problem on both sides as many junior members had better comments than senior members who seem so set in the blame game.

Obama was very good. He did not give his normal 10 minute answers and let members talk. He listened and minimized blame. He appeared to be genuinely trying to see what the common agreement was between the sides and tried to encourage positive discussion. On the other hand, it seemed that he was fairly set in his views that the Democratic plans do achieve the goals Republicans wanted since it has many of their ideas in it. If he wants a bi-partisan bill passed he will need to give a lot more. It seems up to Republicans to agree that the current bills have many of their ideas rather than have Democrats conclude that for them.

One of the best arguments came from Tom Coburn, a Republican who is a physician, said we must go much more aggressively after the estimated 15% fraud in Medicare. He suggested we use undercover patients who can reports fraud and Democratic Senator Chuck Schumer said that can be added. Coburn also admitted that he and his fellow doctors practice defensive medicine that is also raising costs greatly. We need, Coburn said, tort reform to allow doctors to prescribe only tests patients need and not for legal protection.

It is clear from the day long talks that Obama will need to mediate much more as the Congressional leaders are much more set to blame each other than compromise. What Obama needs to do is to give enough to Republicans that their moderates are satisfied. If he tries to pass this bill through reconciliation it will be a major political blunder. I believe the current bill is not the needed solution to our problems. No one convinced me that cost will be controlled under the current bills. All that will be achieved is more coverage at a huge cost to taxpayers. I think Republicans are correct that cost must be the primary focus. Obama says the bill is deficit positive but that is because we are all paying more taxes and premiums to fund it.

The First Lady this week has announced a new push to fight childhood obesity. Michelle Obama’s cause is the kind of push needed to lower the health care cost curve long-term. We, as a nation, are getting fatter year by year and clearly our obesity related diabetes and heart disease will on its current path eventually bankrupt our health care system. Thirty years ago the teen age obesity rate was 5%, and now it is almost 18%. That is a huge change in one generation and portends a huge increase in future diabetes and heart disease cases. There is no doubt that health care marketers will be playing a key role in the shift from disease treatment to disease prevention.

DTC, as it is largely done today, is about treating the disease once it is diagnosed. Very few DTC ads are designed to encourage prevention. Once could argue that cholesterol drugs do promote prevention of heart attacks among people with high cholesterol. Or that diabetes pills promote control which prevents serious complications later in life.

The majority of ads, however, target existing disease sufferers for treatment. Under pressure from DTC critics drug companies have increased campaigns to encourage early diagnoses and testing. Clearly though, spending is about 90% in the brand awareness building among current sufferers.

The future of health care cost control will depend on keeping us from getting chronic illness. Some of this will be the result of early diagnosis. Much will be targeted to keep us from getting disease. The problem we face as advertisers is convincing America that they must slim down, exercise, and eat better. If it was easy to succeed through simple public service ads, we would not be getting fatter and more sedentary.

Michelle Obama is doing a good thing urging American parents and their kids to exercise and eat right. The issue is how to change behavior which clearly has been trending in the wrong direction. Drug, OTC, diet, exercise and food companies have an enormous opportunity to develop products and services to address prevention. They are fighting an enormous counter marketing machine for tasty, cheap products that create obesity. Marketing disease prevention will take all the creative talent we can muster.

I expect that marketing disease prevention is a huge future industry once we recognize that we do not have the budget to effectively treat a nation of obese diabetes and heart disease sufferers. Ten people in good shape might be able support the one costly sedentary sufferer of diabetes and heart disease. The reality is that we may have one in shape person for every obese person. That math will not support generous treatment. Sounds like our social security dilemma where the numbers just do not add up for affordability long term.

Once we get healthcare reform we can expect prevention to be a huge part of its metrics for success. We need to incentivize good behavior and penalize bad behavior. We can no longer allow people with bad health habits to get a full government subsidy to maintain bad habits. Medicare and Medicaid do just that. One day I suspect cost pressures will force government to shift co-pays to those who fail to maintain healthy habits. The fast-food, couch potato, smoker crowd may resent that but that is the way it has to be. Prevention will be encouraged and good habits rewarded with lower premiums and co-pays. Otherwise we will all go broke treating preventable disease.

The latest data from FDA shows warning letters on drug promotion almost doubled in 2009 to 41 from 21 in 2008. That is not surprising given the changes in Washington. Clearly the Democrats are demanding more enforcement actions against drug companies, which they saw as lax under Bush.

FDA has indeed speeded up its process to issue warning letters. The new head of FDA Dr. Margaret Hamburg has pledged to step up enforcement. Most of the letters are for inadequate fair balance. Obviously, there is always a desire from drug companies and advertising agencies to stress the positive. No one wants ad space dedicated to stressing negative points. The law, however, requires balance and some drug ads were non-compliant.

No one can argue against a vigilant FDA. The public needs it and drug companies are better off if violators get caught. The more warnings issued the more likely Congress will realize that the FDA is vetting drug ads, thoroughly and quickly warning offenders to end their campaigns. Companies who fully comply expect FDA not to let their competitors get away with unfair balance.

What FDA needs to do is continue to issue guidances and educate drug companies with examples of acceptable and unacceptable treatments of fair balance. As long as FDA is consistent and clear in what is violative the drug companies will have no problem complying. It is clear that most new drugs are using DTC in their launch campaigns. Therefore the guidances on what is acceptable treatment of risk are critical to brand teams developing DTC. No drug company wants a warning letter and its possible consequences and I believe they do want to comply. In the past there have been inconsistent decisions as to what is a violation. I hope the FDA reviewers are huddling with each other to ensure standards for one category are the same as others.

So go to it FDA, and if warnings increase in 2010 from 41 to 81 so be it. All the industry can ask is for clear standards, fast pre-clearance and sensible negotiation over disagreements on what is fair balance. That requires continued quantitative studies as to what consumers take away from drug ads so we all know what is fair disclosure. It is not in the public interest to overwhelm consumers with information as studies have shown less can be more in terms of risks and warnings. Drug companies have a right to sell their products through DTC and it is in everyone’s interest to have a well staffed FDA overseeing it.