Preventive Care And Saving Money

During the last presidential campaign I criticized both Hillary Clinton (back in 2007 when she appeared to be the inevitable Democratic nominee) and Barck Obama (when it was clear that he really would be the nominee) for claiming that savings from preventive care would help finance their health care plans. The question of savings from preventive care and life style changes came up in the blogosphere in an exchange between Paul Campos, Matthew Yglesias, and Ezra Klein.

The main argument from Campos is that improving health does not save money because people will live longer. If someone does not die of cigarette smoking they will live longer and consume greater health care costs. This very well could be true but there are problems with this line of thought.

Not all health care expenses are equal. Chronic diseases such as diabetes and complications of tobacco use can be very expensive to treat. While success is questionable, if Americans could really be convinced to lead healthier life styles this could reduce the incidence of diabetes. People can live a far longer time without diabetes and require less health care costs than someone receiving treatment for diabetes for thirty or more years. If life styles could not be changed to prevent diabetes, then changes once someone is diagnosed with diabetes can still greatly affect health care costs. Intensive treatment of diabetes to achieve good control costs far less than renal dialysis or coronary artery bypass surgery.

I don’t think it is possible to answer the question of whether life style changes and preventive medicine will lead to greater or lesser costs in the long run. There are just too many variables. Different types of preventive medicine and life style changes will vary tremendously in both cost and efficacy. If looking purely at the cost, then the ultimate fate of the person saved from dying of complications of cigarette smoking can lead to different outcomes. Treatment of heart disease, lung disease, and cancer from tobacco use can be expensive, especially if this leads to bypass surgery or if the patient winds up on a ventilator several times (which often happens with COPD).  If someone is kept from smoking they might live longer, but they could also wind up consuming a lot less in health care costs despite a longer life. The right preventive programs will probably save money in the long run, but this is not the main reason for such treatment.

The more important point here is that if measures lead to a longer life span, especially in which people are healthier during this time, this is a major benefit in itself even if we do not save money. As Ezra concluded, “If the end point of health reform is not that we spend fewer dollars, but that we get a lot more health for the dollars we do spend, that’ll be a good outcome.”

While  it is not possible to answer with certainty whether encouraging healthier life styles and practicing preventive medicine will save money in the long run, one thing is certain. This will cost more in the short run. It costs money to provide preventive care and it can take many years to see the benefits. While we should concentrate a larger share of our health care dollars on preventive care, this cannot be done with the expectation that we will save money in the short run or will help pay for health care reform.

Update: I have thought of a good example in this post in which preventive care is clearly not cost effective, but we should still spend the money.

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5 Comments

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