A major driver of health costs over the last couple of decades is chronic illness such as diabetes and heart disease. It’s time to add another chronic ailment to the list: “preventionitis.” Because much chronic disease is associated with bad lifestyle choices, many succumb to the utopian delusion that investment in “prevention” – eating better, exercising more, and so on – will cut society’s health bill.
Exercise and a healthy diet are of course good ideas. The “investment” that preventionistas advocate, however, is not a personal commitment to oneself, a family member, or a friend. On the contrary, it is massive government intervention to change society’s habits, paid for by tax hikes.
The latest symptom is a report funded by three weighty non-profit groups: the Trust for America’s Health, the California Endowment, and the Prevention Institute. They conclude that investing 10 dollars per person annually in “prevention” in California would result in savings 4.8 times greater than the costs, starting five years out. Overall, they claim that annual savings would be $1.7 billion, measured in 2004 dollars.
Statewide health spending in 2004 was $166 billion, so we are looking at annual savings of one percent. Ten years from now the annual savings would go up to $1.9 billion (2004 dollars), which would be much less than one percent of overall costs, because health costs will be much higher in 2014 than they were in 2004, even after adjusting for inflation. Even so, such estimates are fantastically over-precise. Politicians interpret these exercises in crystal-ball gazing as proof that they can never impose too much government control over people for their own good.
Governor Schwarzenegger, for example, recently signed a silly law that requires chain restaurants (a.k.a. fast-food joints) to post calorie-counts of their burgers, fries, and shakes on their menu-boards. To drum up support for this law, two scholars at UC Berkeley put on their rose-colored glasses, reviewed 84 studies of prevention, and concluded that the measure could cause California to avoid 50 million pounds of extra weight a year! That best-case scenario includes people who eat fast food seven times a week losing 5.4 pounds each. The study assumes that those who chow down at Wendy’s seven times a week will pay strict attention to state-mandated calorie counts.
The authors’ prescriptions include more jogging paths, more farmers’ markets, and cuts in the advertising of unhealthy foods to kids. Remarkably, the authors are aware that most scholarly research concludes that “prevention” does not actually cut health costs, if only because it makes us live longer and healthier and then we get sick and die anyway. This phenomenon is called the “compression of morbidity” in health policy circles.
Even those who accept the authors’ claims face some tough questions. Can the federal, state, and local governments collaborate to supply California with the right incentives to improve our lifestyles? Or would complexity overwhelm the incentives, resulting in growth of government bureaucracy and fewer resources left to people and their communities to improve their own health?
We need look no further than California’s state-run health programs to realize that bureaucratic growth and fewer resources is the inevitable outcome. Medi-Cal (for poor people) has cut back and slowed down payments to providers for months. Healthy Families (for children) is going to stop enrolling kids in order to save money.
Reducing the burden of chronic disease will not be easy, but Californians don’t need another burden as well. Preventionitis is easily avoided by reducing government’s power to tax and spend in pursuit of absolute control over our lifestyle choices.