Preventive Medical Care

[Fern]

Many lefties supporting UHC have long argued that preventative medicine will save us money and help to pay for insuring the uninsured. Looks to be the exact opposite

Link to CBO letter in pdf

New England Journey of Medicine, American Diabetes Association, American Heart Association, and the American Cancer Society all had studies showing the same thing - increases in preventative medical care would cost more money in the long (and short) run.

Here's some of the language from the CBO letter to Congress explaining why it costs more:

Preventive Medical Care

Preventive medical care includes services such as cancer screening, cholesterol management, and vaccines. In making its estimates of the budgetary effects of expanded governmental support for preventive care, CBO takes into account any
estimated savings that would result from greater use of such care as well as the estimated costs of that additional care. Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive
services, expanded utilization leads to higher, not lower, medical spending overall.

That result may seem counterintuitive. For example, many observers point to cases in which a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has
progressed. In such cases, an ounce of prevention improves health and reduces
spending?for that individual. But when analyzing the effects of preventive care
on total spending for health care, it is important to recognize that doctors do not
know beforehand which patients are going to develop costly illnesses. To avert
one case of acute illness, it is usually necessary to provide preventive care to
many patients, most of whom would not have suffered that illness anyway. Even when the unit cost of a particular preventive service is low, costs can accumulate
quickly when a large number of patients are treated preventively. Judging the
overall effect on medical spending requires analysts to calculate not just the
savings from the relatively few individuals who would avoid more expensive
treatment later, but also the costs for the many who would make greater use of
preventive care.2 As a result, preventive care can have the largest benefits relative
to costs when it is targeted at people who are most likely to suffer from a
particular medical problem; however, such targeting can be difficult because
preventive services are generally provided to patients who have the potential to
contract a given disease but have not yet shown symptoms of having it.

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 illness. An article published last year in the New England
Journal of Medicine provides a good summary of the available evidence on how
preventive care affects costs.3 After reviewing hundreds of previous studies of
preventive care, the authors report that slightly fewer than 20 percent of the
services that were examined save money, while the rest add to costs. Providing a
specific example of the benefits and costs of preventive care, another recent study
conducted by researchers from the American Diabetes Association, the American
Heart Association, and the American Cancer Society estimated the effects of
achieving widespread use of several highly recommended preventive measures
aimed at cardiovascular disease?such as monitoring blood pressure levels for
diabetics and cholesterol levels for individuals at high risk of heart disease and
using medications to reduce those levels.4 The researchers found that those steps
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 particular note, that study sought to capture both the
costs and benefits of providing preventive care over a 30-year period.

Here's an article on it by Charles Krauthamer. I know many of you on the left don't like him, so just stick with the original letter from the CBO if you're so inclined:

By Charles Krauthammer

In the 48 hours of June 15-16, President Obama lost the health-care debate. First, a letter from the Congressional Budget Office to Sen. Edward Kennedy reported that his health committee's reform bill would add $1 trillion in debt over the next decade. Then the CBO reported that the other Senate bill, being written by the Finance Committee, would add $1.6 trillion.

The central contradiction of Obamacare was fatally exposed: From his first address to Congress, Obama insisted on the dire need for restructuring the health-care system because out-of-control costs were bankrupting the Treasury and wrecking the U.S. economy - yet the Democrats' plans would make the problem worse.

Accordingly, Democrats have trotted out various tax proposals to close the gap. Obama's idea of limits on charitable and mortgage-interest deductions went nowhere, as did the House's income-tax surcharge on millionaires. And Obama dares not tax employer-provided health insurance because of his campaign pledge of no middle-class tax hikes.

Desperation time. What do you do? Sprinkle fairy dust on every health-care plan, and present your deus ex machina: prevention.

Free mammograms and diabetes tests and checkups for all, promise Democratic leaders Nancy Pelosi and Steny Hoyer, writing in USA Today. Prevention, they assure us, will not just make us healthier; it also "will save money."

Obama followed suit in his New Hampshire town hall meeting last week, touting prevention as amazingly dual-purpose: "It saves lives. It also saves money."

Reform proponents repeat this like a mantra. Because it seems so intuitive, it has become conventional wisdom. But like most conventional wisdom, it is wrong. Overall, preventive care increases medical costs.

This inconvenient truth comes, once again, from the CBO. In an Aug. 7 letter to Rep. Nathan Deal, CBO director Doug Elmendorf wrote: "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 illness."

How can that be? If you prevent somebody from getting a heart attack, aren't you necessarily saving money? The fallacy here is confusing the individual with society.

For the individual, catching something early generally reduces later spending for that condition. But, explained Elmendorf, we don't know in advance which patients are going to develop costly illnesses. To avert one case, "it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway." And this costs society money that would not have been spent otherwise.

Think of it this way: Assume that a screening test for disease X costs $500, and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.

That's a hypothetical case. What's the actuality in the United States today? A study in the journal Circulation found that for cardiovascular diseases and diabetes, "if all the recommended prevention activities were applied with 100 percent success," the prevention would cost almost 10 times as much as the savings, increasing the country's total medical bill by 162 percent.

Elmendorf also cited a definitive assessment in the New England Journal of Medicine that reviewed hundreds of studies on preventive care and found that more than 80 percent of preventive measures added to medical costs.

This doesn't mean we shouldn't be preventing illness. Of course we should. But in medicine, as in life, there is no free lunch. The idea that prevention is somehow intrinsically economically different from treatment - that treatment increases costs and prevention lowers them - is simply nonsense.

Prevention is a wondrous good, but in the aggregate, it costs society money. Nothing wrong with that. That's the whole premise of medicine: Treating a heart attack or setting a broken leg also costs society. But we do it because it alleviates human suffering. Preventing a heart attack with statins, or breast cancer with mammograms, is costly. But we do it because it reduces human suffering.

However, prevention is not, as so widely advertised, healing on the cheap. It is not the magic bullet for health-care costs.

You will hear some variation of that claim a hundred times in the coming health-care debate. Whenever you do, remember: It's nonsense - empirically demonstrable and CBO-certified.

Another (of many) good reasons to slow down on this. It takes time to seperate the wheat (truth) from the chaff (BS, and/or lies). I think we're still clealry in the process of sorting which is which.

How did Obama and the Dems get this so wrong given all the above reputable medical organizations finding to the contrary? Did those drafting the UHC proposal simply ignore it because it didn't fit their agenda and hope we'd never find out? Or, are they just incompetent? (Both?)

Fern

 

[fallout man]

Working hard to get my fill,
Everybody wants a thrill
Payin anything to roll the dice,
Just one more time
Some will win, some will lose
Some were born to sing the blues
Oh, the movie never ends
It goes on and on and on and on



Furthermore,

A further consideration affecting the budgetary impact of proposals is that some
types of preventive care may increase longevity. Of course, that effect reinforces
the desirability of such care, but it also could add to federal spending in the long
run: Social Security outlays rise when people live longer, and Medicare outlays
may rise because, even if a preventive service lowers a beneficiary?s risk of one
illness, a longer lifespan allows for more time to incur other health care expenses
associated with age.

This CBO report is GODLESS, SOCIALIST GARBAGE. That sounds like a DEATH PANEL to me!!!

The CBO suggests that pulling the PLUG on GRANDMA is cost effective. Why don't we just prevent the old from going to the doctor at all?! (!!!1) They'll expire faster if they can't get their preventative care--SAVINGS!

 

[BoberFett]

Somehow I don't know that I buy this one. Admittedly I haven't read all the details, but it seems to be a logical conclusion that if you can catch some diseases in their early stages then it's easier to operate on a small area than a large. It has to be easier to remove a small tumor than it is a huge one that has tentacled out around surrounding tissue.


Edit: And falldown boy is still not funny. You have a worse sense of humor than Republicans, and that takes a lot.

 

[ZeGermans]

I support universal health care because it works and is used in every other first world country, we're just so horribly afraid of our poors getting remotely similar care to the middle class that we have to make all sorts of bogeymen

 

[Fern]

Originally posted by: BoberFett
Somehow I don't know that I buy this one. Admittedly I haven't read all the details, but it seems to be a logical conclusion that if you can catch some diseases in their early stages then it's easier to operate on a small area than a large. It has to be easier to remove a small tumor than it is a huge one that has tentacled out around surrounding tissue.

For any individual case that is correct.

Preventative care does have costs. What the studies found is that a whole bunch of cheaper preventative care only actually uncovers a few caes where serious care is needed. I.e., the aggregate costs of the preventative care exceeds the savings obtained in a few serious cases.

I'll copy some of the CBP report that explains it above in my original post.

Fern

 

[dainthomas]

The report is flawed in one respect. Sure, if you pay for EVERY SINGLE POSSIBLE preventative treatment, then yes it will cost more. Things like well-baby care and regular checkups for healthy adults will easily pay for themselves though. Catching a gradual upward trend in bp, cholesterol, or blood sugar when they can be treated for free through diet/exercise will be FAR cheaper than waiting until someone has a stroke and has to be stuck in a nursing facility for the rest of their life.

 

[Fern]

Originally posted by: ZeGermans
I support universal health care because it works and is used in every other first world country, we're just so horribly afraid of our poors getting remotely similar care to the middle class that we have to make all sorts of bogeymen

Our poor have great medical care. It's free too.

It's called Medicaid.

Often, when the middle class gets something serious requiring major medical they end up on Medicaid too. (After they're bankrupt because of annual or lifetime limits on benefits).

Fern

 

[BoberFett]

Originally posted by: ZeGermans
I support universal health care because it works and is used in every other first world country, we're just so horribly afraid of our poors getting remotely similar care to the middle class that we have to make all sorts of bogeymen

I thought the "everybody else is doing it" defense stopped working at about age 8?

 

[fallout man]

Originally posted by: BoberFett

Edit: And falldown boy is still not funny. You have a worse sense of humor than Republicans, and that takes a lot.

Boom-tsk!

Actually, Michael Steele and I trade notes. He really helped me reach out to the ethnic audience.

Back on topic:

Originally posted by: BoberFett

Originally posted by: ZeGermans
I support universal health care because it works and is used in every other first world country, we're just so horribly afraid of our poors getting remotely similar care to the middle class that we have to make all sorts of bogeymen

I thought the "everybody else is doing it" defense stopped working at about age 8?

"Everybody else" is sort of doing something right--they're able to get a higher quality of life and somehow pay less for it.

Are you one of those fellers who showers with their underwear on, because the French like to get naked a lot?

 

[ZeGermans]

Originally posted by: Fern

Often, when the middle class gets something serious requiring major medical they end up on Medicaid too. (After they're bankrupt because of annual or lifetime limits on benefits).

Fern

....don't you see a problem with this?

 

[First]

Preventative medical care is more of a sensible, moral issue of quality of life than it is a cost saving measure. Hard for wingnuts to wrap their head around, but true nonetheless.

 

[DrPizza]

wtf? How are mammograms and other screenings considered "preventive care" rather than "early diagnosis"?

Preventive care: encouraging patients to eat healthier, exercise more, stop smoking cigarettes.

And back to their cost analysis - I don't see any indication that they've included the loss of productivity as a cost - they're only considering the direct costs associated with the medical treatment. For every working 50 year old, making 80k or more salary, that dies a premature death from heart disease, or is on extended disability for heart disease - how much less are they paying in taxes? How much less are they contributing to the nations GDP?

 

[Gonad the Barbarian]

Of course it's cheaper. All care is aimed ultimately to be preventative of death, which is obviously the cheapest solution. So just let everyone die and all our healthcare problems are solved.

 

[her209]

Originally posted by: ZeGermans

Originally posted by: Fern
Often, when the middle class gets something serious requiring major medical they end up on Medicaid too. (After they're bankrupt because of annual or lifetime limits on benefits).

Fern

....don't you see a problem with this?

Do people get to go on disability after they have their foot amputated due to diabetes?

 

[Harvey]

Originally posted by: DrPizza

wtf? How are mammograms and other screenings considered "preventive care" rather than "early diagnosis"?

Preventive care: encouraging patients to eat healthier, exercise more, stop smoking cigarettes.

And back to their cost analysis - I don't see any indication that they've included the loss of productivity as a cost - they're only considering the direct costs associated with the medical treatment. For every working 50 year old, making 80k or more salary, that dies a premature death from heart disease, or is on extended disability for heart disease - how much less are they paying in taxes? How much less are they contributing to the nations GDP?

+1

Regardless of the source, "counterintuitive" doesn't begin to say how full of shit I find this article. As an engineer, it makes absolutely no sense, whatsoever. Add to that the fact that prevention and early detection result in less suffering and debilitation for those who become ill.

 

[jdjbuffalo]

The direction we are going likely won't fix our issues. We need comprehensive healthcare reform. We need something modeled after those who have already done it. We shouldn't just pick a version like the German or French version and vote for it. There will need to be some changes to accommodate our country but most of the people who have the money/power now (Health Insurance and Pharma companies) don't want to give it up regardless of how good or bad it is for the country. As long as we let them steer the debate, we'll never get what we need.

Your article is heavily biased and I doubt a lot of the information provided.

We pay the most in the world for healthcare but we have far from the best system. For comparable healthcare coverage we pay 2 - 4 times as much. These are simple facts compared to the rest of the world.

We don't take care of people in the right places. In poor or heavily immigrant areas, people go to the ER because they can't be turned down for medical coverage and they can't go to a GP. This clogs our ERs and raises the costs of providing medical care to several times what it should be. We need to be helping these people in GPs.

A lot of poor people and even some with crappy healthcare coverage will wait until an issue becomes an emergency before they will do anything about it because they tell themselves that they can't afford to go in an have it fixed. Something that costs a few hundred dollars in medicine can turn into a $50,000 hospital bill.

These are the areas where preventable medicine can make a huge difference. We're already paying for these people anyways, the difference is that we can pay 10 times less.

The last important part of prevention is that we live a healthier life. That means exercising and eating better. I have to admit that this one is probably the hardest for the country and one most people will avoid...

 

[fallout man]

Originally posted by: Evan
Preventative medical care is more of a sensible, moral issue of quality of life than it is a cost saving measure. Hard for wingnuts to wrap their head around, but true nonetheless.

It's indeed a warped world view when expensive, pre-emptive warfare is A-OK, but pre-emptive healthcare is considered something that will bring down God's wrath.

 

[Superrock]

Saying preventative care will not save money in the long run is like saying diagnosing diseases will cost us money. It's such a broad statement that its easily oversimplified. The polio vaccine is a preventative measure that saved millions of people from polio. Breast cancer exams, on the other hand, may not be necessary for those ethnicities who are not at risk.

 

[zinfamous]

Originally posted by: Fern

Originally posted by: BoberFett
Somehow I don't know that I buy this one. Admittedly I haven't read all the details, but it seems to be a logical conclusion that if you can catch some diseases in their early stages then it's easier to operate on a small area than a large. It has to be easier to remove a small tumor than it is a huge one that has tentacled out around surrounding tissue.

For any individual case that is correct.

Preventative care does have costs. What the studies found is that a whole bunch of cheaper preventative care only actually uncovers a few caes where serious care is needed. I.e., the aggregate costs of the preventative care exceeds the savings obtained in a few serious cases.

I'll copy some of the CBP report that explains it above in my original post.

Fern

depends on the type of preventive care that you are getting. Some counties spend vastly more per patient during individual appointments, which has been long touted as a major flaw with our privately-owned healthcare industry. Costs are way up, and lifespan/general health is not only negligible compared to the cheapest healthcare counties, but also can detract from overall quality of life.

catching a disease early is always the best option, and is certainly cheaper--assuming the diagnostics ordered per visit are reasonable. Some US systems do it right, some do it horribly wrong. when you're ordering 10 tests per routine visit, and call this preventive care, and make this the standard for an entire population, then yes--that is ridiculously expensive.

This is why getting the insurance companies out of the picture needs to be the primary goal. Salaried physicians > pay-per-test system.

 

[Zedtom]

Is the health care industry interested in anything besides the bottom line? The message seems to be that any changes to the current health care model as practiced by the HMO's and the insurance carriers are going to be costly. That is obvious. We need to look at every facet of the industry to try to find ways to cut costs. If we decide to let the industry scare us into doing nothing to reform their way of doing business, then we will bankrupt the country.

 

[Specop 007]

Originally posted by: BoberFett

Originally posted by: ZeGermans
I support universal health care because it works and is used in every other first world country, we're just so horribly afraid of our poors getting remotely similar care to the middle class that we have to make all sorts of bogeymen

I thought the "everybody else is doing it" defense stopped working at about age 8?

"Free" medical care is a "right", didnt you know. Everyone DESERVES free medical care. After that will come cars and entertainment. I for one cannot wait for my government provided 80" plasma. After all, entertainment is a right I say!

 

[MovingTarget]

An ounce of prevention is worth a pound of cure.

Identifying/Nipping a problem in the bud before it becomes a real issue also saves a lot of $$ too.

We as a society mostly agree that we should care for our sick/elderly, which costs money.
----------------------------------------------------------------------------------------------------------------------

Healthcare reform with this in mind will not be cheap, but it is still necessary. YMMV as to how much... The CBO report misses the point...

 

[shira]

Making the point that that preventive care doesn't save money is kind of silly. Health care itself doesn't "save money."

We could save a lot of money by never doing diagnostic tests, never doing surgery, never taking medication. We pay for these things because they make us healthier.

Preventive care makes us even healthier. So why is it surprising that it costs even more money?

Now, it's certainly reasonable to ask which specific preventive care is or is not worth the money. If an anti-alzheimers pill is invented that reduces the incidence of the disease by 50%, but the cost is TWICE that of taking care of the alzheimers patients that would otherwise exist, is that a cost worth paying? Stay tuned for this and many other excruciating health-care dilemmas in the decades ahead.

 

[fallout man]

Originally posted by: Specop 007

Originally posted by: BoberFett

Originally posted by: ZeGermans
I support universal health care because it works and is used in every other first world country, we're just so horribly afraid of our poors getting remotely similar care to the middle class that we have to make all sorts of bogeymen

I thought the "everybody else is doing it" defense stopped working at about age 8?

"Free" medical care is a "right", didnt you know. Everyone DESERVES free medical care. After that will come cars and entertainment. I for one cannot wait for my government provided 80" plasma. After all, entertainment is a right I say!

You are so fucking high.

 

[MovingTarget]

Originally posted by: Specop 007

Originally posted by: BoberFett

Originally posted by: ZeGermans
I support universal health care because it works and is used in every other first world country, we're just so horribly afraid of our poors getting remotely similar care to the middle class that we have to make all sorts of bogeymen

I thought the "everybody else is doing it" defense stopped working at about age 8?

"Free" medical care is a "right", didnt you know. Everyone DESERVES free medical care. After that will come cars and entertainment. I for one cannot wait for my government provided 80" plasma. After all, entertainment is a right I say!

/taps sarcasm meter...

Not having medical care can and will kill you. Not having and sitting in front of a plasma screen will probably extend your lifespan...