The Prevention Fallacy
by digby
There’s a liveblog happening over at HuffPo (in which yours truly is participating) that featured this observation by Jay Bhattacharya, M.D., Ph.D. Associate Professor of Medicine, Stanford University:
The unfortunate fact is that, according to the health economics literature, even if we expanded prevention substantially and according to the best available evidence, total health care expenditures would not decrease and in many cases would increase.
This is for two reasons. First, preventative interventions, by their very nature, needs to be applied to a broad population to be effective. Most of that population will derive little benefit from those interventions because they would never get the disease even in the absence of the interventions. Childhood vaccines are a good example of this. Of course, the extent to which is true depends on the particular intervention being considered, but the principle applies to all preventative activities. In order to prevent one person from getting sick, we need to apply the intervention to more than that one person. This fact greatly increases the costs of prevention.
Second, no matter how successful prevention is in reducing disease, no such intervention confers immortality. Everyone will eventually die of something. This obvious point has an important corollary, which is best illustrated with an example. Suppose we could find a way to prevent cancer entirely. Such an intervention would without a doubt increase the incidence of heart disease since more people would be alive to get heart attacks. This consideration is obviously most important for prevention applied to older people. In some simulation work that I have done, I have found that even if we found a way to prevent all cancers for free (and we are far from such an incredible technology), Medicare costs would fall by only a small amount.
None of this should be taken to mean that we shouldn’t expand prevention. It’s just that the benefits of such an expansion, which in some cases could be considerable, will not come for free.
Of course prevention is a good thing in its own right. Any less suffering or fewer early deaths is a good thing. But it won’t cut overall health care costs because everyone is going to die of something eventually.
This was Tom Coburn’s big cost saving idea (along with eliminating waste fraud and abuse.) But we should keep in mind that Dr Coburn believes that the answer for sick people who’ve been left to fend for themselves should beg their neighbors to help them because the government is never the solution.
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