I’ve discussed in several previous posts, such as here, reasons why preventive medicine will not result in sufficient cost savings to pay for expanding health care coverage. It takes many years to see any savings from preventive care and there are substantial costs associated with providing such care. The Congressional Budget Office has now released a report showing that preventive health care will raise rather than lower costs. It is a safe bet that conservatives will publicize this report, while they tended to ignore the recent report which showed that the proposed public plan would not lead to the destruction of private health insurance.
As with the earlier Congressional Budget Reports it is necessary to consider how they make their estimates. The costs of providing preventive care are concrete and will be included in their calculations. The benefits of preventive medicine cannot be easily measured and therefore will be underestimated by the procedures they use. In addition, many of the benefits of preventive medicine will not be seen for well over ten years and therefore will not be a factor in current cost/benefit calculations.
Providing preventive care will cost more than it will save in cases where the individual patient was not going to develop one of the diseases for which preventive care is being provided. In some cases successful preventive medicine might even increase costs further, such as if a person were to live many years longer and consume additional health care resources. In such cases preventive care provides a real benefit and should be paid for, but not because of cost savings.
There are other cases where preventive medicine will save money by reducing the need for expensive care. It is far more cost effective to treat diabetes and hypertension with regular follow up of these diseases than it is to pay for bypass surgery, dialysis, or post-stroke treatment. There is no way to accurately predict such savings and therefore they will be underestimated by the Congressional Budget Office.
Still the fact remains that expanding health care cannot be paid for with simple actions such as expanding preventive care or computerizing medical records. Preventive care, along with expanding health care to all, is of value and is something we should be paying for. It is unfortunate that we have an atmosphere in this country where politicians feel the need to downplay the costs of their programs because increasing taxes is no longer acceptable.
The Obama administration has downplayed the costs of their health care plans, but we saw the same under George Bush. In addition to having no plans for paying for his Medicare Part D program, Bush also threatened to fire experts from the Medicare program if they testified before Congress as to the actual cost. Nobody likes to pay taxes, but rather than having a knee jerk opposition to all taxes we must consider whether we are receiving value for what we are paying. Increasing preventive care will probably save some money in the long run, but the real benefit is being healthier and living longer. This is something worth paying for.