Health Care Question: Does Preventive Care Mean Big, Big Savings?

One of the mantras of health care reform advocates is that if we pay a little more now for preventive care, we'll have big, big savings on the back end—variously defined as anywhere from next Tuesday to 25 years from next Tuesday. Here's the Wash Post on a new study that says fuggedaboutit:

Using data from long-standing clinical trials, researchers projected the cost of caring for people with Type 2 diabetes as they progress from diagnosis to various complications and death. Enrolling federally-insured patients in a simple but aggressive program to control the disease would cost the government $1,024 per person per year—money that largely would be recovered after 25 years through lower spending on dialysis, kidney transplants, amputations and other forms of treatment, the study found.

However, except for the youngest diabetics, the additional services would add to overall health spending, not decrease it, the study shows….

For diabetes patients, only about two-thirds of that cost would be recovered in the first decade, when fewer complications materialize, and more than three-quarters would be recovered over 25 years, the study found. Only for the youngest patients, those aged 24 to 30, would spending on preventive care wind up producing a net savings: the study calculates that $21 billion spent on younger patients would cut overall spending on their health care by $6 billion over 25 years.

Whole story here.

Without meaning to, I think this story perfectly illustrates what happens when health care becomes a focus of public financing. Among other things, you start doing cost-benefit analyses for entire classes of people (and however well-intentioned and even necessary such studies are, they are at best wild guesses of future costs and technologies). That's creepy enough on the face of it, but it's especially the case when it comes to medical situations whose solutions might end up being dictated by the state. "Society" might look at the numbers and make one decision, but I suspect individuals and families faced with particular situations will make very different calculations. Or, more correctly, more personal decisions.

The study above underscores that cost savings are almost certainly not going to come from any sort of health care reform that pushes the idea that if only we get everyone to the doctor twice a year for checkups, everything will be peachy-keen, or even cheaper. What it reminds us is that one of the ways we are living longer and better lives is precisely because we're spending more on health care. Spending more on health care over the years is, by itself, no more an indication of dysfunction than spending more on prepared food or tattoos. A huge chunk of it simply reflects the fact that there's more stuff worth buying out there, and that we're willing to shell out. 

Health care costs can and should be cut or, same thing, made more efficient, through market competition, technological innovation, and lifestyle shifts that each person needs to run through their own preference-meter. These are not things that should be subject to overall caps on medical costs imposed by someone other than the person living with the body that will eventually fail them.

Update: My colleague Peter Suderman, who knows the ins and outs of this stuff like nobody's business, points out:

There's actually a fairly large body of work saying preventive care doesn't save money.

The CBO says it: http://blogs.abcnews.com/politicalpunch/2009/08/congressional-budget-expert-says-preventive-care-will-raise-not-cut-costs.html So does the New England Journal of Medicine: http://content.nejm.org/cgi/content/full/358/7/661

More interestingly, a new study of consumer-driven health care, in which people have high deductible insurance, an HSA, and pay for a lot of routine care out of their own dollars, found that people in these sorts of plans are, contra conventional wisdom, more likely to seek preventive care than those on standard insurance plans: http://www.marginalrevolution.com/marginalrevolution/2009/08/consumer-drive-health-care-plans.html

Comments

[John]

The idea of preventative care goes hand and glove with the modern liberal obsession with the idea that bad things need never happen. If preventative care doesn't save any money, then maybe perhaps, smoking, drinking, and eating decent food aren't as bad for us as nanny obsessed liberals say they are. If you honestly believe that all the worlds problems relate to people doing unapproved things, it makes perfect sense that the key to healthcare costs is preventative care.

[John teebone]

That actually seems pretty reasonable when you think about it!

RT
http://www.online-privacy.es.tc

[sage]

Maybe John teebone should have worn a helmet as a child. All the time. And he should have had a diet consisting of something other than paint chips. Will preventive care help poor mr teebone?

[kinnath]

Preventive care means improved quality of life. It almost never translates to reduced expenses.

[T]

Preventive care means improved quality of life. It almost never translates to reduced expenses.

To be slightly tacky, preventive care always seemed like a way to keep people alive until they get the really expensive diseases. Instead of dying of a heart attack at 50, we keep you alive until 70 when you get colon cancer. I'm sure the individual in question thinks it's a fair trade, but it does cost more money.

[I, Kahn O\'Clast]

The "liberal" counter to this post would be that the preventive steps would have kept these patients from becoming diabetics to begin with. I am not saying I agree, but that would surely be the argument: we get people to the doctor early, modify their diet and exercise behavior and save all the treatment costs.

[short, fat bastard]

. . . . but that would surely be the argument: we get people to the doctor early, modify their diet and exercise behavior and save all the treatment costs.

Please explain how the state will modify my behavior without violating my constitutional rights.

[John]

"The "liberal" counter to this post would be that the preventive steps would have kept these patients from becoming diabetics to begin with. I am not saying I agree, but that would surely be the argument: we get people to the doctor early, modify their diet and exercise behavior and save all the treatment costs."

1. Lots of people don't follow their doctors advice, so it wouldn't save any money for those people.

2. For every person who do preventative care and are diabetic there will be lots who are not and would have been fine without the care. That money is wasted and reduces the savings of the program even further.

[MayorOmalleySuxs]

SFB, I don't think IKO was stating that the state forcing modified diet and exercise behavior. Rather, I think he/she was stating that the state forcing these changes will be the liberals argument. I agree with that opinion. If the state wins even more control on health care, the new-age Puritanism that is inherent in the liberal's statist positions will attempt to force many changes on all of us, especially us that are not members of politically favored groups.

[MayorOmalleySuxs]

Must use preview and proof read!!!!

SFB, I don't think IKO was stating that the state forcing modified diet and exercise behavior was a good idea.

[hurlybuerhle]

@T: Ding ding ding! You are winner! We will all die someday from something, and the health problems that arise from simple old age are far more costly to treat than those that arise from lifestyle.

[P Brooks]

We should be handing out government-subsidized cigarettes in every high school, if we really want to lower overall health care costs.

[alice bowie]

I have to agree that "Lots of people don't follow the doctors advise".

Look at all of the warnings about Cigarettes, drugs, liquior, Burger King, skiing, etc.

Companies are now starting to fire fat people and people that smoke. So, I wouldn't be suprised if 'Society' started following suite and finding some sort of blame for people's diseases.

I'm against a public plan, but I don't see how a private plan won't do the same.

[Enough About Palin]

Man up and die, people. Man up and die.

[creech]

Wasn't an early argument for taxpayer funded government schools that the population would learn all the healthy measures they needed to take to be good citizens. After a hundred years of classes in "health," etc. how is that working out?

[I, Kahn O\'Clast]

Indeed I was not saying that I agreed that the government forcing changes in behavior was a good idea, I was saying that that was essentially a portion (if not the main part) of the "liberal" argument. Even if they refuse to admit it to themselves.

[alice bowie]

I'm beginning to wonder. What does 'Lowering Healthcare Cost' mean?

- Should Doctors, Nurses, Drug Companies take pay cuts?

[R C Dean]

How short our memories are. Back in the day, HMOs were sold as the way to deliver preventive care. They had first-dollar coverage for the preventive stuff now being touted, they forced everyone to have (in the modern parlance) a "medical home" as is now being discussed, etc.

The result? Many, many years of rising health care costs.

Indeed, most of the cost control measures now being touted are nothing more than a revival, in new trade dress, of the HMO. This is not a new idea. It has been tried. As a cost control measure, it failed. Not to mention, people hated it.

[alice bowie]

After a hundred years of classes in "health," etc. how is that working out?

I guess some people listen...and others don't care. I use to love McDonalds Sausage McGriddles. NYC recently passed a law requiring food companies to report the nutritional information. I've stopped eating all of that stuff. It was simply too expensive as far as cholesterol/fat/calories. One would argue that this is a LIBERAL MOVE. And, the fact is that I could have looked up the nutritional information. But, once it was on the actual package that I had to unravel, I stopped eating it.

[Pro Libertate]

I suddenly have had an insight. It's not "healthcare reform." It's "wealthcare reform."

[shunray eanl mack]

man i really dont care about this because im just a little kid and i shouldnt be worried about no health care questions or none else like it and thats all she wrote folks......lol smiley face

[The Angry Optimist]

Nick Gillespie:

Health care costs can and should be cut

Um, why? If Americans want to spend an average of 15% of their income on health, instead of 10, who are we to say that costs need cutting?

[T]

I use to love McDonalds Sausage McGriddles. NYC recently passed a law requiring food companies to report the nutritional information. I've stopped eating all of that stuff. It was simply too expensive as far as cholesterol/fat/calories.

What did you think the nutritional content of a Sausage Mcgriddle was? It's sausage and egg between syrup soaked pancakes. How could that possibly be anything other than a gut bomb?

It is not the government's job to protect you from yourself.

[kilroy]

Not sure if this has been posted here before or not but this is a great treatment of many of the universal health care myths:

Health Care Mythology (PDF)

[@]

Question: Does Preventive Care Mean Big, Big Savings?

Answer: Sometimes.

[Johnny Longtorso]

I use to love McDonalds Sausage McGriddles. NYC recently passed a law requiring food companies to report the nutritional information. I've stopped eating all of that stuff. It was simply too expensive as far as cholesterol/fat/calories.

I used to eat nothing but pure lard and refined sugar, washed down by Thunderbird, until The State educated me otherwise. Thank you, State, because it was only due to your tireless efforts that anyone would know that was unhealthy.

[aelhues]

I personally am moderately supportive of providing information to citizens through laws such as required nutrition information. However, I am vehemently opposed to government trying to influence my choices through biased taxation, or regulation. They put together a committee that decides that sugar is bad for me, and then adds a sugar tax, then companies start replacing sugar with some chemical sweetener that I don't like, or want. Then government raises taxes on the chemical substitutes, because they decide I shouldn't have those. Then, companies....and so on. Regardless, I despise the government trying to modify my behavior through any coercive methods, which certainly includes taxation.

[John G]

So, now that you all have posted some stupid, point missing things, let me add something to this argument as someone who has had Type 1 Diabetes for over 25 years now. Just to point out, Type 1 has no known preventative measures before it occurs, and has no relation to weight, diet, etc. It is an autoimmune disease, and the root cause isn't know.

I actively spend time every day trying to prevent complications, and this does cost money. My insurance has not always covered what is needed to keep me alive, let alone prevent complications. And when not covered, thanks, I do pay for the test strips, etc, myself.

The complications that could occur are covered, of course. These would be amputations of hands, feet, etc. In addition to heart attacks, loss of vision, loss of kidney function.

So, thanks for claiming that by trying to modify the incentive for insurance carriers so they will cover ongoing treatments they are trying to change my behavior. Because that is what the preventative measures being talked about here are, not whether you want to go eat McDonalds.

[short, fat bastard]

Dear I, Kahn O'Clast; sorry for the sloppy post.

Will the proponents of Obamacare, who intend to reap the benefits of preventive care, please explain . . . . .

[T]

So, John, you're saying you require certain services to stay alive and you would like someone else to pay for those services.

That's not insurance. You can call it insurance if you want, but that won't make it so.

[Kant feel Pietzsche]

I used to eat nothing but pure lard and refined sugar, washed down by Thunderbird, until The State educated me otherwise.

If you add a couple of pounds of foie gras to that mix and throw the whole thing into a blender, it makes a GREAT smoothie

[alice bowie]

I'm glad you all think I'm an idiot because I didn't specifically know how high the cholesterol is in a sausage and cheese sandwich. I know that the were high.

What I'm saying is that the LABEL did stop me from eating it. Even though I knew what the components are. I'm also saying that many americans are probably not as dumb as me...but may look at these labels and it may sink in for some people.

I know libertarians don't like government intervenion...and prefer that the govenment not pass any laws at all concerning food. But, I happy that we have the nutritional and ingredient label. I know it's unamerican of me...but it helps dump people like me...at least some of us.

[John Thacker]

How short our memories are. Back in the day, HMOs were sold as the way to deliver preventive care. They had first-dollar coverage for the preventive stuff now being touted, they forced everyone to have (in the modern parlance) a "medical home" as is now being discussed, etc.

The result? Many, many years of rising health care costs.

No, you have that quite wrong. The result was several years of health care costs rising not at all, followed by a patient revolt against not being able to choose your own doctor and having your choices limited, and all that about rationing, followed by rising health care costs once HMOs stopped trying to control costs.

Indeed, most of the cost control measures now being touted are nothing more than a revival, in new trade dress, of the HMO. This is not a new idea. It has been tried. As a cost control measure, it failed. Not to mention, people hated it.

Incorrect. As a cost control measure, it succeeded enormously. But people hated it, and got the HMOs to stop trying it.

See studies here among others.

Of course, if Peter Suderman thinks that CDHP and HSAs are so good, then he should at least acknowledge that that's one decent health reform that the Republican Congress did, giving HSAs the same type of tax benefits as traditional employer-provided plans. Hopefully they're entrenched enough now that the new Congress won't quash them in the current bill, but some versions of the bill have basically outlawed high deductible plans.

[John Thacker]

If you want "irony," RC Dean, you can note that the Democrats are now proposing the same sorts of things that they led the political charge against when HMOs were doing them. Indeed, a combination of both political effort and just patient hatred for HMO cost controlling strategies are why they were abandoned. For controlling costs, they worked fine.

You can see this study from the Kaiser Foundation. Note that from 1994 to 1997 or so, health care costs did not rise rapidly. But then the consumer revolt against HMOs caused them to abandoned their restrictive policies, and we've had the double-digit increases, far faster than other inflation, since.

[SugarFree]

John G,

None of what you have listed are what is meant by preventative care. Insulin, needles, test strips, etc. are how you manage the symptoms of your disease, not means by which you are keeping yourself from getting sick. You are already sick.

Cutting back on food-based cholesterol = Preventive
Insulin after developing diabetes = Treatment

[R C Dean]

Thanks, John T. A quick scan didn't really get to my perception that, over a multi-year time span, the HMO's did not succeed in controlling costs.

I'm sure its out there. Of course, one advantage that a government plan would have is that (a) it is immune to bargaining pressure from providers and (b) it is immune to consumer rejection, both factors in the failure of the HMO model. But of course, we knew all along that government could just cram down cost controls, damn the torpedos.

My recollection is that, as a model that generated cost savings more or less organically, HMOs failed.

[Joe M]

Um, why? If Americans want to spend an average of 15% of their income on health, instead of 10, who are we to say that costs need cutting?

I think you're taking about expenditures, while Nick is talking about expense. That is, outlays versus cost per unit of health care.

[alice bowie]

My recollection is that, as a model that generated cost savings more or less organically, HMOs failed.

Amonst other things, I didn't like the fact that you had to take off a day to see the primary doctor and then take another day off to see the specialist.

[alice bowie]

I don't think that was a cost savings technique...I just think it was a silly policy. Unless the cost-savings effort is to deter me from even bothering going to the doctor at all.

[John Thacker]

My recollection is that, as a model that generated cost savings more or less organically, HMOs failed.

Well, right, I basically agree. Don't get me wrong, the fact that it failed because consumers wouldn't go along with it makes it still a failure from my perspective, and almost certainly yours as well.

However, from the perspective of, say, Director Orzsag, what the data shows is that HMOs would have worked if only it were the government mandating the insurance coverage so that patients couldn't "cheat" by demanding more permissive health care. After all, the HMO experience shows that we could reduce health care costs in the US via a rationing method, but that people wouldn't stand for it.

Orzsag and others may believe that people will swallow it if it's the government controlling it, but I tend to believe that over the long term the American people will vote in favor of no cost controls, despite what he thinks.

CDHP and HSAs do, OTOH, seem to be working as intended. That argues that the libertarian/Arnold Kling critique has a lot to it.

[Highway]

And to expand on SugarFree's point there, people already KNOW what they're supposed to do to 'prevent' problems. Don't want to be diabetic? Then you should lose 40 pounds and eat better. Don't want to get heart disease? Then you should stop eating hamburgers.

The more I think about it, the more I realize there really isn't 'preventative' care. There isn't anything like changing your transmission fluid to prevent having to rebuild the whole transmission later. All preventative care for your body basically boils down to doing what *everyone* already knows you should do: Stay fit, eat healthy. Getting a whole bunch of tests to see if you're still healthy doesn't make a difference.

[John G]

Sugarfree, you said:
"None of what you have listed are what is meant by preventative care. Insulin, needles, test strips, etc. are how you manage the symptoms of your disease, not means by which you are keeping yourself from getting sick. You are already sick. "

However, if you read what the study is about, insulin, test strips, etc are what the aggresive treament routines are.

And that is what seems to be missing in the whole discussion. The costs of these treatments add up. Our current system is willing to pay in full for me to have my limbs cut off if I don't choose to treat myself. It won't allow me to choose to use that money up front to prevent the complications.

Of course, you can argue, as T does, that none of this should be paid for. But you should be up front about that.

And, yes, the cost of treating diabetes adds up to where the break even point doesn't make sense to pay for treatment for people over a certain age. But no one is arguing this point that I hear.

Everyone seems to be arguing that a system designed by government tax policies should be retained, despite doing a poor job and being an inefficient waste of money.

[John G]

Highway, you said:

"And to expand on SugarFree's point there, people already KNOW what they're supposed to do to 'prevent' problems. Don't want to be diabetic? Then you should lose 40 pounds and eat better. Don't want to get heart disease? Then you should stop eating hamburgers."

You missed my first sentence, where I said I had no choice about being diabetic. I was not overweight, and am not overweight. That has nothing to do with Type 1 Diabetes. There is nothing that I could have done to prevent my body from deciding to destroy the beta cells, and causing my diabetes.

And yes, I realize the study is about Type 2 Diabetics, who are frequently overweight. And the first part of the treamnet is to lose weight.

[R C Dean]

Our current system is willing to pay in full for me to have my limbs cut off if I don't choose to treat myself. It won't allow me to choose to use that money up front to prevent the complications.

Nobody is stopping you from paying out of pocket for anything you want.

[R C Dean]

Orzsag and others may believe that people will swallow it if it's the government controlling it, but I tend to believe that over the long term the American people will vote in favor of no cost controls, despite what he thinks.

I suspect that, in this Brave New World, the expressed preferences of the American people count for less all the time, particularly in light of their apparent revealed preference for government-funded (and thus controlled) everything.

[Invisible Finger]

Preventive care = get 'em started on the perpetual healthcare-system usage cycle ASAP; we gotta increase billings, dammit!

Sounds an awful lot like "Buy now or be priced out forever."

[Invisible Finger]

we get people to the doctor early, modify their diet and exercise behavior and save all the treatment costs.

LOL!!

In the 60's the education system became infatuated with the food pyramid and shoving every kid into gym class every day. End result - obesity epidemic.

Same "opposite of intended" results for the War On Drugs, Officer Friendly, D.A.R.E., etc.

History shows time and time again that Organization Man is a complete fuck up.

[Enough About Palin]

@John G

Man up, John G. Man up.

[The Gobbler]

"but it helps dump people like me..."

You live in a dump?

[Keith Richards]

"There isn't anything like changing your transmission fluid to prevent having to rebuild the whole transmission later."

I respectfully disagree.

[Russ 2000]

I'm just waiting for a final solution to the health care crisis.

[Dr, Strangelove]

Most health problems are due to genetics, not behavior (most broken bones and torn ligaments excepted).

To really be preventive what we need is a better gene pool.

I have a plan!

[T]

Everyone seems to be arguing that a system designed by government tax policies should be retained, despite doing a poor job and being an inefficient waste of money.

No. Criticism of a proposal is not the same as acceptance of the status quo. There are a number of ideas that get thrown out here, and elsewhere, which would be far better than the current proposed idiocy.

Additionally, I don't think you'll find too many people here in favor of the current tax treatment of health care insurance.

[John Thacker]

Everyone seems to be arguing that a system designed by government tax policies should be retained, despite doing a poor job and being an inefficient waste of money.

No, I'm certainly not arguing that. Neither was Whole Foods CEO John Mackey in the Wall Street Journal. However, proposals to get rid of the inefficient government tax policies tend to get shouted down, and also seem unpopular with the broader electorate. (Such as McCain's, or as with the hysterical reaction to Mackey's op-ed.)

[MikeP]

Everyone seems to be arguing that a system designed by government tax policies should be retained, despite doing a poor job and being an inefficient waste of money.

Any legislation that looks like what Congress is discussing today would create a health care environment that is unambiguously worse than today's.

There are many dimensions of health care in the US. The proposals bouncing around Congress take almost every one of those dimensions directly away from where they should be going. As unpleasant as the current situation is, it is better than what Obama, Pelosi, and Reid are trying to achieve.

[alice bowie]

Hey MikeP,

After arguing w/u 4 weeks....U've convinced me. The public plan just simply won't work. Insurance makes about 3% profit. Yea, the government won't charge the 3%...but I'm willing 2 bet that the government waste would probably by 30%.

[MikeP]

Glad to hear that, alice.

Just to reiterate, a couple things that Congress could do right away that would be unambiguous improvements are:

1. Allow employers to issue employees pre-tax health insurance vouchers that the employee can use to purchase insurance from anyone, not just from the employer's chosen insurers.

2. Allow interstate purchase of health insurance, so state insurance regulations cannot trap their residents in 51 different local minimums.

[Damonestro]

So the study concluded that for type 2 diabetics... preventative care would be worth it for folks 30 and under....

So preventative care is worth it for type 2 diabetics under 30....

So preventative care is worh it for some, and not for others, and the younger the person is, the more it's worth it...

And this challenges the prevailing belief on preventative medicine.... *how*?

[MikeP]

And this challenges the prevailing belief on preventative medicine.... *how*?

Because it takes an extremely cherry picked population...

The new study looks at a more narrow population -- people already diagnosed with diabetes -- and projects the cost of providing them with a very specific regimen of frequent checkups and diagnostic tests that has produced predictable results in clinical trials.

...and finds that, for a small subset of that population, there is a positive rate of return somewhat less than what you would get if you put the money into a bank.

[joshua corning]

Just to reiterate, a couple things that Congress could do right away that would be unambiguous improvements are:

1. Allow employers to issue employees pre-tax health insurance vouchers that the employee can use to purchase insurance from anyone, not just from the employer's chosen insurers.

2. Allow interstate purchase of health insurance, so state insurance regulations cannot trap their residents in 51 different local minimums.

3. Tort reform

[joshua corning]

Hey MikeP,

After arguing w/u 4 weeks....U've convinced me. The public plan just simply won't work. Insurance makes about 3% profit. Yea, the government won't charge the 3%...but I'm willing 2 bet that the government waste would probably by 30%.

Not just waste government would create perverse incentives to consume more of a limited resource and drive up costs.

Sure Insurance companies would make 3% but eliminating them would remove incentives for people not to go to doctors for skinned knees.

Also i fail to see how government would be better at getting people to use preventative care then the incentives built into a fee market....if you don;t keep yourself healthy it will cost you money seems more persuasive then government paying billions on "don't drink soda pop" ads but if you do drink pop the government will socialize the risk and pay for your health care later in life.

[alice bowie]

joshua corning,

Tort Reform will do NOTHING.

I have many Doctor Friends. And, if they stop paying their Malpractice Insurance ($150,000+ in some cases), they are NOT going to lower their consultation fees.

One would have to pass LAWS to make Doctors lower their fees...and that's just not Mr. Freedman's game of cricket.

[Medic001]

Want the hard nosed truth.

We stop paying for Type 2 diabetics care. Make them pay out of their own pocket.
Maybe if people were forced with the harsh financial reality of their care they might take better care of themselves.

You want to know how to avoid becoming a diabetic II? (In no particular order)

1. Stop eating crap food.
2. Stop eating crap food with MSG
3. Stop drinking soda.
4. Exercise (more than 2 times a week for more than 30 Mins)
5. Stop eating crap food....
6. Take your vitamins.
7. Drink plenty of water.
8. Stop eating crap food.
9. Exercise.
10. Stop eating crap foods.

You too can prevent type two diabities!

[Medic001]

One more thing.

I see" get them to the Doctor early!"--

Well first you need more primary care physicians first. Right now Family Care practice has the fastest decline in Doctors. Why?

As a PCP you might make a nice 100,000$-100,500$ a year. As a specialist your looking at up to and over 300,000$

That's double what they make to looks solely at assholes and elbows.

Insurance companies pay less; doctors get less, so they leave the areas that pay less.

Family Care.

Early preventive care is great in theory.

But you have to start educating good health from the start.

Not when people are 18 and signing up for "life".

You know how may 20 something's I meet that can't cook for them selves? And they wonder why they are 200 lbs at 65 inches.

Start early, loose the crutch.

The government is not going to fix it, we as individuals must change the life styles through education. Not nanny state set ups like New York and their fat soda, or the missing lung photos of smokers.

- My 2 cents

[robc]

if they stop paying their Malpractice Insurance ($150,000+ in some cases), they are NOT going to lower their consultation fees.

Just like oil companies wouldnt lower prices when the price of a barrel went back down.

I dont know about you, but Im still paying $4.50 a gallon.

Yeah, they lowered it slower than the raised it. But the market eventually pushed prices back down.

[alice bowie]

Want the hard nosed truth.

We stop paying for Type 2 diabetics care. Make them pay out of their own pocket.

And when they run out of money...they end up on Medicaid.

[John Thacker]

I have many Doctor Friends. And, if they stop paying their Malpractice Insurance ($150,000+ in some cases), they are NOT going to lower their consultation fees.

Ah, so you must equally believe that if their Malpractice Insurance rates go up, they are NOT going to raise their consultation fees. Because one direction implies the other.

[Rimfax]

See McAllen, Texas

[Damonestro]

The study cited in this article says that preventative health care would save money for diabetics under 30... and that savings would literally be in the billions...

That Gillespie cites this study as some kind of argument against a federal insurance policy shows how far down the rabbit hole of dogma he is...

This study says that for diabetics under 30, not only does it make moral sense to give them preventative care, it also makes financial sense, SIGN THEM UP!!!!!!!

For diabetics over 30, it's a moral issue of whether any life improvement is worth cost, but that can be debated while all the 30 and unders are being signed up.

[Medic001]

McAllen TX! Is a GREAT example of Health care cost and over spending!

thank you RIMFAX!

No Alice. We stop paying for ALL of their health care.

You got money for a Big Mac, or for Cigarettes, you've got money to pay your own bills.

I say if you can't make good healthy choices. F**K you-
I'm not paying for your problems.

No one is paying my bills.
No one does my work for me.
No one eats for me, changes me, wipes my ass.

Why should I for people competent enough to get dressed in the morning?

That's right, because I'm not supposed to!
I am sooo tired of people getting shit for free because of their social economic status.

And this crap about?ohh the poor. They can't help it, they don't know how to eat right, they don't have the resources?

For people in REAL life poverty, I'm talking is actively trying to figure out where the next meal is rolling from?i.e. trash can or hand out? THAT is entirely different.

What I'm talking about are the slack jawed lazy yokels at Wal-Mart that ride in hover rounds because their stubby legs can't hold up that fat ass.

We have a guy who comes into my clinic?he is diabetic and weights 425 lbs!!!!

He has gained 100 lbs since I've been in this clinic. Every time?" oh I'll go to the gym tomorrow?" As I see him cross the street and pick up a Mac and a Latte.

No shame, no sympathy!

[alice bowie]

You sound pretty mad there Medic001

You are actually the 1st person i've heard that wants to eliminate Medicaid (The Public Plan solely sponsered by the Tax Payers).

You may have a good argument.

I think that if you really wanna lower the cost of healthcare (Along with the standard of living of Millions of medical providers), go ahead and eliminate Medicaid and Medicare and only service the people that are sick and can pay.

[alice bowie]

The more and more I chat on these blogs, the more i believe that we should have Apartheid in America. Not by race, but by people that are willing to fund (via taxes of the working people) medical treatment, social security, education, etc.

Perhaps u can move us liberals to NY, NJ, and California. We'll work, pay high taxes, and take our chances with the evils of the welfare state. The rest of you guys can have the rest of the country. We won't tax any of you guys. We'll eliminate FICA, Federal Taxes, Medicaid, Medicare for all of you guys...and you can let your free market run wild.

Me, I think i wanna live with the Pincos and limo-liberals here in NYC.

We can make it like they did in 'ESCAPE FROM NY'

[MikeP]

This study says that for diabetics under 30, not only does it make moral sense to give them preventative care, it also makes financial sense, SIGN THEM UP!!!!!!!

The study says that spending $21 billion on this cherry-picked group yields $6 billion in 25 years.

That's the equivalent of putting the money in equal annual parts into a bank account earning a measly 2%.

Put it into an account earning 4% and the return is $9 billion greater.

So what this study demonstrates is that, at typical discount rates between 3% and 7%, even this carefully selected preventative care simply isn't cheaper than the alternative.

[alice bowie]

MikeP,

Do u suggest that Private Insurance should not offer preventative care? Or, that public insurance payers such as medicare/medicaid shout not?

[MikeP]

I suggest that individual insurers should offer whatever preventative care their customers prefer, hopefully based on some useful medical reasoning.

I also suggest that anyone -- such as President Obama -- who imagined that there is a big pot of undiscovered gold at the end of the preventative care rainbow is and has always been flat out wrong.

[Medic001]

MikeP- I agree with you.
Alice- You are100 correct. I am as pissed off as a wet bee!

I will always help the "helpless", I swore an oath to help the sick, the injured, to care for my patients: To up hold my care with the highest dignity and respect.

But how can i do this when half the people I take care of, don't even respect themselves?

at 31 I'm as cynical, sarcastic, and curt as an 85 year old out of blue hair dye.

And it comes from experience. I'm a young dog, but I've out grown my floppy feet. And I know what I know.

There is no simple answer, but I'll tell you, standing over the edge pissing on a raging inferno isn't going to help us.

Mike made a great point.
"Individual insurers should offer whatever preventative care their customers prefer, hopefully based on some useful medical reasoning."

I don't need 15,000$ worth of preventive care a year. I'm a healthy and have minor health issues (I'd like to thank our fine USN for my reactive air way...thanks!)

I see an ND once a month to treat my "asthma".
It cost me about 60$. And I don't have to take any medication.

Perhaps these insurers should look into "alternative" medicine which has a lower cost and in my opinion more effective health care.

Reward the Physicians, ND, PA, RNNP etc take on preventative care through nutrition classes, natural practices ( ie acupuncture, massage, etc..Herbs..Etc) and healthy exercise.

I think (there I go again) that insurers should offer healthy eating and exercising classes. And once you've completed them, and show that you can maintain a healthy life, you get a cheaper deal. Or put that extra savings into a health account.

So every year you aren't going to the Dr. For some bullshit head cold (that if you had stayed home and took it easy, you would have gotten rid of it three days sooner)

Put that 100$ (or what ever) towards your...oh shit...this sucks... can't believe my leg is broken in three places insurance.

But well. That would be in an enlightened world, where people took responsibility for their own actions, and acted upon their "good intentions."

- Cynical medic001

>:)

[AC]

Um, the nations with universal health care pay less than half what we do per capita, live longer than we do, and have lower infant mortality.

You are a lying corporate whore.

[alice bowie]

Look Ac

As much as I'm for free enterprise and Free Markets. I know that we can cut cost by simply paying for people's medical expense.

We can ONLY pay for people that present a Social Secuirty Card.

The level of service in America would be questionable. I just don't know how it would go.

But, the truth is, even though I'm against the public plan and Single Payer...It must be cheaper to have a Single Payer.

[alice bowie]

If we didn't have the eligibility crap, the judication process, the check to see if claims are paid process, and the 50 other people that touch your insurance claim...I know it would be cheaper. It must be.

But this is not wanted here in America. Period. People just don't want it.

[MikeP]

Um, the nations with universal health care pay less than half what we do per capita, live longer than we do, and have lower infant mortality.

Surely you are aware that the US has extremely different demographics from other countries. In particular, low birth-weight babies born to young mothers (e.g., a teenage birthrate seven times Sweden's) plays a big part in infant mortality.

However, you may not know that when you account for early death due to fatal injury -- accidents, homicides, suicides -- the US has the highest life expectancy in the world.

And of course it is worth realizing that, while the level of US per capita spending is much higher than other countries, attempts to reduce growth in that spending by mimicking those countries is fraught with failure since those countries are currently experiencing the same growth rates as the US.

Aside from those inconveniences, your sophomoric understanding of comparative health regimes is spot on.

[alice bowie]

MikeP,

Would u believe that the infant mortality rate amonst teen girls is actually low?

[MikeP]

No, I wouldn't.

In 1980, there were 562,330 babies born in the United States to teenage mothers (19 years of age or younger). The offspring of teenage mothers have long been known to be at increased risk of infant mortality, largely because of their high prevalence of low birth weight (less than 2,500 grams). We used data from the National Infant Mortality Surveillance (NIMS) project to examine the effect of young maternal age and low birth weight on infant mortality among infants born in 1980 to U.S. residents. This analysis was restricted to single-delivery babies who were either black or white, who were born to mothers ages 10-29 years, and who were born in one of 48 States or the District of Columbia. Included were 2,527,813 births and 28,499 deaths (data from Maine and Texas were excluded for technical reasons). Direct standardization was used to calculate the relative risks, adjusted for birth weight, of neonatal mortality (less than 28 days of life) and postneonatal mortality (28 days to less than 1 year of life) by race and maternal age. There was a strong association between young maternal age and high infant mortality and between young maternal age and a high prevalence of low birth weight. Neonatal mortality declined steadily with increasing maternal age. After adjusting for birth weight, the race-specific relative risks for babies born to mothers less than 16 years of age were still elevated from 11 to 40 percent, compared with babies born to mothers 25-29 years of age.

[Damonestro]

"Put it into an account earning 4% and the return is $9 billion greater."

MikeP the options the study looks at are

1) Preventative care
2) Interventional care

I didn't realize that you support option

3) No care at all and instead putting the money into a savings account.

[MikeP]

The option implicit in my discounting argument is not no care at all. It is interventional care as required while putting the advance money that would have gone for preventative care into a savings account.

If the savings account pays much more than 2%, you'll have the $6 billion needed for the extra interventional care as well as some left over.

I am not saying that the preventative care is better than the alternative. Including quality of life issues, it probably is.

What I am saying is that this isn't a cost-saving measure. If this were a federal program tasked to save money, the government would save more by using the $1024 per person per year to pay down the federal debt rather than to supply even this highly selected preventative care.