An Ounce of Government Funded Prevention May Not Be Worth the Cost

Peter Suderman | July 1, 2009

In an online health-care townhall this afternoon, President Obama said that "we need to invest in prevention and wellness."  And indeed, according to CNN, Obama has already allocated about $2 billion for primary care health centers, much of which will be spent on preventive care. The reason for this, he says, is clear-cut: "We know this saves money." But the truth isn't quite so simple.

The same CNN article quotes Dartmouth professor of medicine Dr. H. Gilbert Welch as saying just the opposite: "I think it almost always costs more money." Welch goes on to argue that "the problem with early detection strategies is it identifies so many well people as having abnormalities that may be worrisome for disease. But it turns out most of them will never become a problem."

The CBO is a little more careful in its estimation of preventive care's cost savings, but doesn't come close to Obama's sweeping certainty. A post on the director's blog notes the following:

For example, many health reform proposals include expanded support for preventive care and wellness services, as well as greater emphasis on primary care. Such policies have the potential to improve health outcomes and enhance the quality of patients’ lives. To the extent that policies avert diseases or lead to more effective medical care, they also might reduce health spending on balance. However, some policies of this sort might actually raise health spending, because additional preventive or primary care generally costs money, not every aspect of preventive or primary care is effective at averting disease, and people who avoid certain diseases may fall victim to other diseases instead.

Elsewhere, the CBO has written that preventive services "would have clearer positive effects on health than on the federal budget balance." A study last year in the New England Journal of Medicine cautioned that although "some evidence does suggest that there are opportunities to save money and improve health through prevention," it's also true that "sweeping statements about the cost-saving potential of prevention... are overreaching." In other words, it depends, and we should be wary of politicians like Obama who want to sell us a bundle of expensive prevention using overly broad claims about its cost savings.

Comments

|7.1.09 @ 4:11PM|#

If that dumb son of a bitch would STFU for twenty four hours, I'm sure it would have a beneficial effect on my blood pressure.

|7.1.09 @ 4:28PM|#

P Brooks -

I too am weary of the 24/7/365 campaign. I'm convinced that overexposure will bite him in the ass, probably by November 2010.

|7.1.09 @ 4:29PM|#

Count me out of a society that is constantly told they are probably sick and need to be tested constantly to make sure they get lifesaving treatment before the big C wipes them out.

Paul|7.1.09 @ 4:42PM|#

It has almost become a point of religious conviction, that if you have a doctor looking up your ass all the time, they're going to increase the chances of early detection, overall wellness and health outcomes.

Unfortunately, to have that doctor staring at you 24x7, it costs money. Lots of money. That's why you don't have your mechanic sitting in your driveway to look under the hood everytime you come home.

You could argue that the preventative medicine in my analogy for the car would be regular oil changes and tuneups. Except most people don't need such maintenance, but it still costs for the visit. Imagine going to your mechanic, him not changing your oil, not changing your sparkplugs, but still charging you $140 per hour to 'look over' the vehicle. This is what a lot of preventative medicine is going to be like. Now imagine 300,000,000 people getting this regular maintenance. The costs are going to explode. My guess is what is saved by early dectection, while good for the individual, will not be good on the group.

|7.1.09 @ 5:43PM|#

It seems to me that prevenetive care will also result in the early detection of life-threatening illnesses that cost a lot of $ to stabilize/cure -- illnesses that may have otherwise resulted in earlier deaths and resulting cost savings.

This is a good thing, but don't tell me it will save money.

creech|7.1.09 @ 5:56PM|#

How about taking a simple first step: end the sugar subsidy, end farm subsidies. And, if we are going to have government schools, teach the kids about healthy life choices. Maybe 2 or 3 per class will listen.
We are becoming a nation of hypocondriacs.

IceTrey|7.1.09 @ 7:04PM|#

Of course preventative care costs more in the long run because the longer you live the more you cost. Someone who dies at 50 from smoking related lung cancer (even if they receive treatment) costs less than someone who lives to 85.

Ebeneezer Scrooge|7.2.09 @ 1:27AM|#

Yes but they already have that covered, you see. If health care costs go out of control they can use cap and trade to kill off the economy. With more people living in poverty, life spans will drop and then so will the costs.

They don't give a shit how "we the people" live, so long as they are the ones who get to rule over us.

|7.3.09 @ 11:16AM|#

"To the extent that policies avert diseases or lead to more effective medical care, they also might reduce health spending on balance. However, some policies of this sort might actually raise health spending, because additional preventive or primary care generally costs money, not every aspect of preventive or primary care is effective at averting disease, and people who avoid certain diseases may fall victim to other diseases instead."

So, basically we're screwed either way. Awesome.