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

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.