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Words of wisdom on preventive care
No one really knows whether preventive medicine will save money in the long run, let alone free up the billions of dollars a year needed to help pay for universal health insurance. In fact, studies have shown that preventive care — be it cancer screening, smoking cessation or plain old checkups — usually ends up costing money. It makes people healthier, but it’s not free.
“It’s a nice thing to think, and it seems like it should be true, but I don’t know of any evidence that preventive care actually saves money,” said Jonathan Gruber, an M.I.T. economist who helped design the universal-coverage plan in Massachusetts.
Here is the article by David Leonhardt.
Posted by Tyler Cowen on August 8, 2007 at 10:07 AM in Medicine | Permalink
Comments
Shouldn't preventive care be directed primarily towards ailments that are costly and degrade quality of life but are not instant killers? For example, diabetes, which causes lots of smaller ailments over a long period, but takes a while to kill? Meanwhile, let people smoke and eat red meat, since heart attacks are quick killers.
Posted by: ah at Aug 8, 2007 10:56:34 AM
The types of preventative "care" that would actually cut down on the resources devoted to healthcare are things like smoking cessation and better diet/weight control. However, these are things that every adult already knows how to do, but chooses not to- in other words they have bad habits. I fail to see how universal care is going to address these issues. I mean, really, do you need a doctor to tell you to lose weight and stop smoking? Or am I wrong to assume that most of the smokers and overweight people already have doctors telling them these things?
Posted by: Yancey Ward at Aug 8, 2007 11:13:18 AM
This is an excellent article, especially the end, but alas it will be ignored.
Posted by: Robin Hanson at Aug 8, 2007 11:31:53 AM
Interesting. So, in the end, the question is whether there's a metric that determines the 'good' of the issue more than price. Price, in this case, is not a good reason (in fact is an anti-reason). Would price factor in the (assumedly) longer/healthier lives that preventatively-cared-for people would lead?
Posted by: shawn at Aug 8, 2007 11:46:36 AM
The article repeatedly ignores the time value of money. I'll trust that Gruber doesn't, but this is definitely not "an excellent article."
Posted by: Douglas Knight at Aug 8, 2007 12:11:25 PM
Is it really true that there is no evidence that preventive care saves money? That's quite a sweeping statement. it seems like a no-brainer to me that prenatal care, the older vaccines, and dental hygiene for children are money savers (although we may have already achieved most of those savings). What exactly do the studies cover, and do they consider the other economic costs of lost days of school and work or the other utility benefits of being healthier?
I agree that it's silly to use highly paid doctors to tell people to lose weight and not to smoke, and that preventive care won't do much for the Medicare age group, but I'm not sure why the same conclusions should apply to all preventive care for all age groups.
Posted by: DK at Aug 8, 2007 12:13:08 PM
DK has hit the nail on the head. It is not true to say that "preventative care doesn't cut costs". It MAY be true to to say that "marginal increases in preventative care won't cut costs".
Posted by: RobbL at Aug 8, 2007 1:17:26 PM
Why health itself is pennyless? It should find its way into the balance feet as intangible asset.
Posted by: xu at Aug 8, 2007 2:40:38 PM
The answer here is that **today** most people who are going to get really sick and demand expensive care will do so regardless of the timeliness of the diagnosis. This may change in the future and change the equation quite a bit.
Posted by: JPC at Aug 8, 2007 10:40:00 PM
libertarians freely attack the positions of teacher unions (which is good).
So why aren't libertarians attacking the positions of health care workers, who we are giving a blank check to???
there's defenitly societal pressure to give doctors and nurses unlimited support. it all pisses me off.
Posted by: thehova at Aug 9, 2007 12:03:20 AM
Preventive care can be justified even if it doesn't save money as long as people prefer
to stay healthy than to get cured after having been sick.
Posted by: vic at Aug 9, 2007 3:37:15 AM
thehova: "there's defenitly societal pressure to give doctors and nurses unlimited support. it all pisses me off."
Please explain what unlimited support is given to nurses. By support, do you mean that they shouldn't be required to have a medical education before performing such tasks as administering narcotics, drawing blood, injecting fluids into veins, cleaning wounds, ensuring sterility of operating rooms, etc? Or is it the licensing that states undertake on behalf of its citizens that "pisses you off"?
Posted by: John Dewey at Aug 9, 2007 9:50:58 AM
Dk: "preventive care won't do much for the Medicare age group"
Why do you believe that? Half of those age 65 can expect to live more than 15 years. As life expectancy will be increasing, it's likely that the median remaining life of a 65-year-old will soon be 20 years. Are you saying that they can't do any more in those 20 years to either improve or wreck their health?
Posted by: John Dewey at Aug 9, 2007 9:56:02 AM
yeah, JohnDewey, i went on a rant last night that didn't make any sense.
but it bothers me when i hear medical practitioners complain that not enough money is going into health care (both for patients and to the employees themselves). even the maintenance workers at hospitals are compensated at a much higher rate than a private business would give. and nurses and doctors are well compensated for their education levels. yet, there's a lot of complaining.
we need health care to be truly managed. instead, right now, we just have spineless hospital administrators and insurance companies whose purpose is to keep doctors and nurses happy.
Posted by: thehova at Aug 9, 2007 1:22:33 PM
thehova: "nurses and doctors are well compensated for their education levels."
Do you feel the salaries of nurses should be determined by the amount of education they have? Or should we allow their pay to be determined by the market clearing price? If the health care industry has thousands of nursing openings, how should they attract workers from other fields? or entice young people to endure the long and hard training required?
Nursing salaries are determined in a free and functioning market. What alternative would you propose?
Please do not lump together physicians and nurses in your criticism. Physicians and the AMA can strongly influence politicians to limit their supply. Nurses have no such strength.
Posted by: John Dewey at Aug 9, 2007 2:19:49 PM
"Please do not lump together physicians and nurses in your criticism. Physicians and the AMA can strongly influence politicians to limit their supply. Nurses have no such strength."
good point. yeah, and probably nurses should have more authority and decision making roles but the AMA gets in the way. yeah, i'm down on the AMA.
Posted by: thehova at Aug 9, 2007 2:52:25 PM
"yeah, i'm down on the AMA."
Well, that's OK with me. I'm not anti-AMA, but I'm not defending them, either.
On the other hand, I sleep with a nurse every night, and that bias my opinion a little.
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