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“Fortunately, we now have an ideal opportunity to implement reforms. The new health insurance exchanges created under the Affordable Care Act can establish effective care coordination strategies to identify and treat chronic conditions earlier, addressing not just the immediate conditions but the underlying ones as well,” the op-ed piece asserts.
Thompson and Thorpe argue Medicare can adopt the strategies, and the “benefits for both patients and taxpayers will be substantial.”
Proponents of government intervention into a chronic condition now classified as a disease by the American Medical Association, say federal investments – whatever they may be – will pay off multi-fold over time.
Perhaps these prevention crusaders would be well served to dust off a 2009Congressional Budget Office report which shows preventative medicine – at least the kind the federal government likes to doctor – is rarely cost-effective.
Pound of prevention
How much would the Treat and Reduce Obesity Act, or TROA, cost taxpayers? Nobody seems to know. Kind’s office did not have cost projections. An official from the Congressional Budget Office on Thursday told Wisconsin Reporter there won’t be a fiscal estimate until the bill is reported out of committee.
In an August 2009 letter to the House’s Subcommittee on Health, the Congressional Budget Office broke down its analysis titled, “The Budgetary Effects of Expanding Governmental Support for Preventive Care and Wellness Services.”
In short, “expanded governmental support for preventive medical care would probably improve people’s health but would not generally reduce total spending on health care.”
The problem, according to the CBO report, is that even when the unit cost of a particular preventative service is low, costs can accumulate quickly when a large number of patients are treated preventively. Such is the case in Wisconsin, where 28 percent of the population is obese, in a nation with a 26.2 percent obesity rate.
Thorpe argues institutional changes could save the United States $200 billion in obesity-related health-care costs.
The CBO report, however, notes that researchers who have examined the effects of preventive care “generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illnesses.”
A research paper in the New England Journal of Medicine, after reviewing hundreds of previous studies on how preventive care affects costs, concludes that less than 20 percent of the services that were examined save money, while the rest add to costs.
A study by researchers from the American Diabetes Association, the American Heart Association and the American Cancer Society found use of highly recommended preventive measures aimed at cardiovascular disease would substantially reduce the projected number of heart attacks and strokes that occurred but would also increase total spending on medical care because the “ultimate savings would offset only about 10 percent of the costs of the preventive services on average.”
Of course, as the CBO analysis points out, just because a preventive service adds to total spending doesn’t mean it is a bad investment. Saving a life, improving someone’s quality of life, most would agree, are inherently good things. But those who argue they do not come with a cost, or that the cost benefits eventually outweigh the initial taxpayer outlays, are ignoring critical research over time.
The CBO also notes the overlap often associated in services under federally mandated preventive programs.