Monday, August 17, 2009

More health care myths exposed

Charles Krauthammer has a good op-ed piece debunking the myth that preventative medicine "saves" any money. From the article (emphasis mine):
This inconvenient truth comes, once again, from the CBO. In an Aug. 7 letter to Rep. Nathan Deal, CBO Director Doug Elmendorf writes: "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, explains 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 real-life actuality? In Obamaworld, as explained by the president in his Tuesday town hall, if we pour money into primary care for diabetics instead of giving surgeons "$30,000, $40,000, $50,000" for a later amputation — a whopper that misrepresents the surgeon's fee by a factor of at least 30 — "that will save us money." Back on Earth, a rigorous 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. That's because prevention applied to large populations is very expensive, as shown by another report Elmendorf cites, a definitive review in the New England Journal of Medicine of hundreds of studies that found that more than 80 percent of preventive measures added to medical costs.

If this is not clear, think of it this way. There are thousands of diseases that you may develop and thousands of tests that can tell if you have one of them. There are tons of activities which can prevent all those potential diseases. Unfortunately, the costs of all those tests and preventative activities are far greater than the costs of any one of those diseases.

Another thing I am surprised he didn't mention is that development of disease is highly correlated with age. The reality is that at some point in our lives we will all get a major disease and die. Preventative measures cannot stop this, they can only delay it. Those end of life diseases, which account for 80% of medical care, will always happen. Until we can figure out that Highlander trick and become immortal, I wouldn't hold my breath for any "savings".


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