For patients with heart disease, delays in treatment can be a death sentence. All too often in our health care system, red tape forces patients to wait to access lifesaving medications.

Cardiovascular disease is the leading cause of death worldwide, and for adults over the age of 70, CVD accounts for over 40% of total deaths.

Fortunately, researchers have made critical advancements in this space, decreasing mortality rates, slowing disease progression, and lowering risks of stroke and emergency hospitalizations. Yet for many, one lifesaving treatment remains out of reach.

Today, Medicare policy requires many patients with severe aortic stenosis, a common, deadly, age-related heart valve disease, to wait until symptoms appear before receiving transcatheter aortic valve replacement, despite clinical evidence showing earlier treatment can improve outcomes and reduce costs.

In May 2025, the U.S. Food and Drug Administration approved TAVR for asymptomatic patients on the basis of strong evidence for early treatment. As officials at the Centers for Medicare & Medicaid Services decide whether to update coverage for TAVR accordingly, they must preserve access to early intervention methods and timely treatment for seniors and other vulnerable groups. For hospitals and cardiology programs across the country, coverage policy determines whether this innovation reaches patients when it can do the most good. The evidence paints a clear picture: TAVR can save up to $36,000 per patient in the first year alone, while delaying treatment more than doubles mortality risk and increases costs.

This mismatch between evidence and coverage reflects a broader structural problem in American health care: our health care system excels at rescue but struggles to intervene early.

It is less consistently designed to identify risk before disease advances, to bring prevention into the communities where people live, or to ensure timely access to proven innovation that can slow or even halt disease progression.

As our population ages, that imbalance becomes increasingly costly, both in human and fiscal terms.

A single heart attack can cost over $20,000 per patient, and the cost of CVD is not limited to direct medical expenses. As the population ages and workforce shortages grow, keeping older adults healthy and independent becomes increasingly important for economic stability.

By 2050, productivity losses as a result of heart disease and premature mortality are expected to increase to $361 billion in the United States.

CMS officials can look to the engAGE with Heart model in nearby Baltimore, Maryland, to understand what modern preventive care looks like when designed for society as it is now and not the Medicare system created decades ago.

Working through trusted institutions such as African American churches, senior centers and community organizations, and partnering with the University of Maryland and Johns Hopkins, the program brings prevention directly into neighborhoods.

The message isn’t new — exercise, healthy food, screening, referrals — but the messenger is.

The model works through established community relationships that emphasize prevention before disease progresses. This is prevention delivered at the point of risk, before hospitalizations, before costly complications, and before Medicare bears the fiscal burden.

Preventing avoidable exacerbations is one of the most efficient interventions in an aging society and another reminder that earlier action saves both lives and money.

Consider the role of prevention in improving health outcomes through vaccination.

Respiratory and viral infections, including RSV, flu, COVID-19, pneumococcal pneumonia, and shingles worsen chronic disease, especially heart conditions. From 1974 to 2024, vaccinations against 14 pathogens averted 154 million deaths. That makes routine adult vaccination a straightforward tool for reducing hospitalizations, doctor visits and lost days of work. This is preventive policy using the innovations of 21st century adult vaccines that Congress and the rest of us can support today.

Prevention at this stage is not abstract public health — it is targeted risk management that reduces downstream hospitalizations and the long-term costs borne by Medicare, the broader health system and the economy.

The lesson is straightforward. Medicare should not require patients to become sicker before receiving effective treatment.

Ensuring that patients have access to timely treatment before decline and removing unnecessary barriers to care by aligning CMS coverage with the latest data is key.

That is what reform looks like in an aging America — and increasingly, in an aging world.