Chronic illness is often identified as a culprit responsible for high health costs. By chronic illness, we usually mean diabetes, heart disease, etc. It’s time to add another chronic ailment to the list: “preventionitis”. This is the utopian delusion that investment in “prevention” – eating better, exercising more, quitting smoking, etc., will cut America’s health bill.
That’s not to say that I shouldn’t get off my backside and go for a long walk to buy some fruit and vegetables, instead of sitting here blogging with a bag of pork rinds by my side. Of course I should.
However, the “investment” that the preventionistas advocate is not a personal commitment to yourself, a family member, or a friend, to improve one person’s lifestyle. It’s massive government action to change society’s habits, paid for by tax hikes.
The latest exhibit is a report from the Trust for America’s Health, California Endowment, and Prevention Institute, which concludes that investing ten dollars per year in “prevention” in California would result in savings 4.8 times greater than the costs, starting five years out. Overall, the annual savings would be $1.7 billion dollars (measured in 2004 dollars). (We’ve recently seen another example of this overly precise approach to estimation, with respect to regulating fast food.)
Impressive? Maybe not: statewide health spending in 2004 was $166 billion dollars, so we are looking at annual savings of one percent. After ten years, 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.
To achieve these very small savings, the government would have to get a lot of things right. The authors reviewed 84 studies of “prevention” (and they did a very thorough job of it, too, lest anyone accuse me of criticizing their hard work). They include building more jogging paths, opening more farmers’ markets, and cutting out advertising unhealthy foods to kids.
I’m not going to dwell on the quality of the literature review, but the authors do allude to criticism that “prevention” does not actually cut health costs, because it makes us live longer and healthier and then we get sick and die anyway! (This is the “compression of morbidity”.) I lean towards that view, as I discussed in a study of California’s tobacco tax. It’s also discussed in Sally Pipes’ new book and a recent article by Maureen Hazel and Nadeem Esmail.
On the contrary, let’s accept everything that the authors claim about the benefits of prevention. Do you really think that the federal, state, and local governments could collaborate to carpet-bomb California with the right incentives to improve our lifestyles? Or do you think that the complexity would overwhelm them, resulting in growth of government bureaucracy and less resources left to people and their communities to improve their own health?
We need look no further than Medi-Cal and Medicaid to realize that the latter is the inevitable outcome.