Above and beyond the point about generics made here, I refer you to a column by Charles Krauthammer on the myth of the savings claimed for preventive care. Again, on its face, the claim sounds good: Prevention, TGL proclaimed at his town hall, “saves lives. It also saves money.”
So what’s the problem this time? Enter Dr. K:
Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.
For scoffers, the good doctor provides real-life stats from the medical journal Circulation demonstrating that “‘if all the recommended prevention activities [for cardiovascular diseases and diabetes] were applied with 100 percent success,’ the prevention would cost almost 10 times as much as the savings, increasing the country’s total medical bill by 162 percent.”
Whhhoooops!
Comments 17
The costly treatment is more like $45,000 for the initial procedure and hospital stay and at least grand annually thereafter for testing and meds if all goes well.
August 14th, 2009 at 12:28 pm
????
August 14th, 2009 at 1:03 pm
Surgical treatments for cardiovascular problems start at $25,000 for angiospasty, $50,000 for single-bypass, $75,000 for double-bypass.
Unchecked diabetes is also a big-ticket problem. it’s going to involve multiple amputations, vision failure (single greatest cause of blindness in the US) and dialysis. We ain’t talking $10,000 here.
August 14th, 2009 at 1:45 pm
fuster, thank you for that schedule of charges, but I’m not planning on having any of those procedures. I still don’t understand your reason for your comment.
August 14th, 2009 at 1:52 pm
I think, if I’m not as usual, misunderstanding, that I’m trying to suggest that Dr. K’s figures ain’t no good.
The monetary figures are way off and the figures in the screening aren’t any good either. Universal screening isn’t recommended and if correct screeens are in place, we’re likely to catch a lot more than 1 in 100.
Diabetes occurs in nearly 9% of the population, and about 2.5% of the total population are undiagnosed, and therefore untreated.
August 14th, 2009 at 2:07 pm
Nope, as usual, you are misunderstanding. The money figures and percentages given in the blocked quote by Krauthammer are (as he states in the column) purely hypothetical. They are there to explain the flaw in Obama’s reasoning. That is why I add “For scoffers, the good doctor provides real-life stats from the medical journal Circulation” and then go on to tell what he said.
You should really try reading the post carefully and even consult the sources before doing such a grand job of looking stupid.
August 14th, 2009 at 2:18 pm
Thanks as always for the quality of your advice. I, of course, did read your post fairly carefully and followed the link to Krauthammer.
The figures offered remain dumb and there are no links to the source articles where I might have been able to find some enlightenment.
August 14th, 2009 at 2:54 pm
fuster, to declare the figures dumb and/or inaccurate, you need to be able to provide alternatives of your own. Can you?
Where, e.g., did you read that “we’re likely to catch a lot more than 1 in 100″? Or that “Diabetes occurs in nearly 9% of the population, and about 2.5% of the total population are undiagnosed, and therefore untreated”?
Inquiring minds want to know.
August 14th, 2009 at 2:58 pm
Inquiring minds can go to the website for the American Diabetes Association.
http://www.diabetes.org/home.jsp
They have figures slightly lower than the ones I’m using, but not greatly different.
August 14th, 2009 at 3:33 pm
I wasn’t asking specifically about that statistic. I was asking in general how you know that Krauthammer is wrong and that, more generally, prevention is cheaper than care after the fact. That was your point, was it not?
Also, for the record, I don’t think K is saying that prevention is not good or important. I think he would agree that healthful behaviors and avoidance of unhealthful practices is good general “medicine” for anyone. He is referring to costly screening.
Anyway, what is your proof that is wrong?
August 14th, 2009 at 3:50 pm
My point was not to say definitively that prevention is cheaper, because I think that it’s unprovable either way. What I was trying to do was show that Krauthammer wasn’t giving you solid information. I didn’t want you or us folks here to rely on it.
My overall opinion is that prevention is unlikely to result in greatly reduced costs when considered only in terms of health care spending.
I am fairly confident that we will agree that if we merely break even with prevention, we’re coming out way ahead overall.
August 14th, 2009 at 4:03 pm
I don’t think it’s unprovable either way, and you still haven’t backed up any of your claims. If you say “Krauthammer wasn’t giving you solid information,” then you need to be able to back it up. Likewise your statement that with prevention we’ll come out ahead.
Please don’t take this the wrong way, fuster, but Krauthammer is an M.D. and IMHO a pretty smart guy. And you’re — well — fuster. That’s not to say I won’t take your word over his but that you need to convince me. So far, you haven’t done that.
August 14th, 2009 at 4:14 pm
fuster, I did a very quick search and came up with this. The author, like Krauthammer, is a doctor. In the fourth graph, he speaks of the two types of prevention I alluded to and then offers this:
In essence, he not only agrees with Krauthammer but raises other problems with the notion of screening. Find me at the very least an M.D. who makes as eloquent a case for your position. Then we can talk.
August 14th, 2009 at 4:22 pm
That’s a fine and much more sophisticated argument than the one offered by Krauthammer.
It’s very solid for cancers, slightly less so for other diseases.
I would suggest that, if you lump together the entire population and screen everyone for everything, his argument is gold.
I would say, instead, that you find savings and health improvement by a smaller and more focused screening process aimed at specific diseases and concentrating on people with identified as at-risk.
But that coming from me, a feeble fuster.
Of course, if you want to actually look a bit, you might find a few non-stupid folks suggesting similar thoughts.
August 14th, 2009 at 4:56 pm
Certainly. Unfortunately, that’s not the way that the Prez and All the Prez’s Peeps put the proposition. They’re constantly trying to assuage concerns about the cost of the program by pointing to the magical cost savings that will come from screening. One of the Prez’s favorites is, indeed, the diabetes argument. We can all except for some very weird people agree that good therapy beats the heck out of amputation of favorite limbs, but it’s extremely dishonest – much more dishonest than, say, arguing that “death panels” are a built-in feature of the approach represented by the house bill – to pretend that it’s an answer to the cost problem.
August 14th, 2009 at 5:21 pm
We can agree also that the cost savings claimed aren’t going to offset adding coverage for tens of millions, CK. I suspect that if somehow all the claimed savings are realized, we’re not going to be see rebate checks either.
August 14th, 2009 at 5:29 pm
Bear in mind that when we all are tested for everything and that all diseases are prevented we are still going to have a problem: we can’t all live forever. As a matter of fact, none of us can. At some point you will either die naturally or contract some unpreventable disease. The nastier symptoms of diabetes may be preventable, but if you save someone from a preventable earlier death from diabetes they are still eventually going to die from something. My point is not that preventive medicine is bad – -it’s why I go to the gym several times a week and have my blood pressure checked at the grocery store and try to watch what I eat — but that cost “savings” gained by preventing an earlier death may be spent later in prolonging the life of that same person from a non-preventable disease. So far Obama hasn’t promised to deliver us from death yet … and given his track record not many of us are inclined to believe him were he to do so.
August 14th, 2009 at 5:37 pm