An ounce of prevention is no cost-saving cure

In the debate over health care reform, preventive medicine has become almost everyone’s panacea. During recent campaign-style town hall meetings in New Hampshire, Colorado and Montana, President Barack Obama never missed an opportunity to claim that preventive care and wellness programs would save money and lives.

Yet there are some inconvenient truths facing would-be reformers who tout prevention as if it were a bottle of “Dr. Feel-Good’s Incredible Health-Promoting, Cost-Saving Elixir.” The facts suggest that Americans have plenty of reason to be reluctant to swallow what politicians are trying to sell.

The most recent warning came from the Congressional Budget Office. The nonpartisan agency has issued a study that debunks the claim that preventive care for all Americans would translate into substantial savings for the federal government.

To the contrary, the CBO noted, “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 could this be true? Can’t just about everyone recite Benjamin Franklin’s adage that “an ounce of prevention is worth a pound of cure?” Wouldn’t it make sense to increase cancer and cholesterol screenings, vaccinations, anti-smoking programs, food content labeling and the like so that we focus on health care instead of disease care?

Obama made this case during his recent town hall meeting in Montana: “Are we better off waiting until somebody gets diabetes and then paying a surgeon for a foot amputation, or are we better off having somebody explain to a person who’s obese and at risk of diabetes to change their diet, and if they contract diabetes to stay on their medications?”

Democratic congressional leaders echo the same refrain. “Reform will mean higher-quality care by promoting preventive care so health problems can be addressed before they become crises. This, too, will save money,” argued House Speaker Nancy Pelosi, D-Calif., and Majority Leader Steny Hoyer, D-Md., in USA Today.

“We’ll be a much healthier country if all patients can receive regular checkups and tests, such as mammograms and diabetes exams, without paying a dime out-of-pocket,” they said.

Republicans have also been eager to embrace preventive medicine. Sen. John McCain, R-Ariz., regularly insists that “the best care is preventive care.” Former Republican presidential contender Mike Huckabee of Arkansas has claimed that wellness campaigns to reduce smoking and encourage diet and exercise could save “billions of dollars.”

The number crunchers at the CBO aren’t buying it. As the agency explained in an August letter, “for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.”

The CBO isn’t alone in its assessment. According to Alan Garber, the director of the Center for Health Policy at Stanford University, “the few studies that have compared preventive care to treatment have shown that either form of care can be cost-effective — or not — depending on how it’s used. There’s no magic to the idea of prevention, except that it sounds good.”

In a report published last year in the New England Journal of Medicine, researchers analyzed some 600 studies done since 2000 assessing the value of preventive care. They concluded that although about 20 percent of preventive measures — including flu shots and colorectal cancer screenings — did save money, “the vast majority reviewed in the health economics literature do not.”

One reason why? Prevention programs spend a lot of money targeting people who are perfectly healthy. Say, for example, that in screening 500,000 people, health workers find one person whose ailment can be pre-empted before it develops into a costly, life-threatening condition.

They might save, say, $50,000 on late-stage treatment for that patient. But they will have spent much more than that to test the other 499,999 people who were just fine.

Here’s another example from a study published last year in the journal Circulation. Suppose we enact several highly recommended measures to control cardiovascular disease and diabetes. Among other ends, the programs would improve blood pressure monitoring, increase access to medication and reduce cholesterol levels in high-risk patients.

Suppose that these prevention measures were 100 percent successful. The estimated cost of treating at-risk patients over the next 30 years would drop by about a trillion dollars. The preventive measures themselves, though, would cost $8.5 trillion — offsetting the savings by a factor of almost 10.

As for the net value of wellness programs, the CBO has determined that there’s not enough evidence to demonstrate that government efforts to discourage certain bad health habits would actually result in cost savings.

Fifteen years ago, the federal government began requiring food manufacturers to post nutrition and calorie information on food labels. Since then, Americans have had access to a barrage of data on every Snickers bar and bag of Cheez Doodles.

But the labeling hasn’t made us healthier. In fact, we’re actually fatter — since the advent of nutrition labels, the percentage of obese Americans has increased by two-thirds. With smoking cessation programs, the story is similar.

The reason is simple. Extending longevity tends to increase overall health spending. Illnesses like Alzheimer’s, osteoarthritis, osteoporosis and prostate cancer make the final years of life incredibly expensive. The average nonsmoker who lives to age 84 will require about $100,000 more in medical expenses than the average smoker who dies seven years sooner because of his bad habit.

A few preventive measures do indeed save money. Others may impose a net cost but nonetheless are worth it because they improve our well-being. Preventive and wellness efforts may reduce pain and suffering and increase quality of life — which may be justification enough.

But that’s not the justification Washington is offering. Instead, lawmakers are trying to sell us on the seductive — but ultimately false — idea that taxpayer dollars spent on prevention can yield long-term savings.

We face a staggering federal deficit and increased taxes for all Americans if Obama’s health care reform ideas are enacted. We need honest information about what proposed reforms will cost. And so it’s time for politicians to swear off “Dr. Feel-Good’s Incredible Health-Promoting, Cost-Saving Elixir.”

Sally C. Pipes is president and chief executive officer of the Pacific Research Institute. Her latest book is “The Top Ten Myths of American Health Care.”

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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