7 ms·

Preventative care doesn't save money

71 points by richardhod 9y ago

turbohz 9y ago
"... but it improves quality of life at a very reasonable price."
laci27 9y ago
But of course it saves money.. on the long run. Yes, it does cost more upfront, and yes, people will be using the 'free doctor' more, in the short term, but over the lifetime of the patient, it costs considerable less to prevent, than to 'fix'. Of course, you could say that people who 'suddenly' need fixing will live less, so overall the state will save money cause they will be dead sooner, but i'm pretty sure that's NOT the point of healthcare.
- Hermel 9y ago
  Of course, there is always a trade-off. For example, it is not worth spending 100$ for a 1% reduction in the risk of getting a disease that costs 1000$ to cure. If you really believe that prevention always pays off, why aren't you wearing a helmet right now?
  - nolok 9y ago
    Very poor exemple. Him not wearing a helmet right now has nothing do to with costs, its about practicality and societal norms. Even on construction sites we had to makes laws saying it is mandatory or big fines to get people to wear them.
    - Hermel 9y ago
      Not all cost is of monetary nature. Wearing a helmet costs you comfort, agility, and time. That's why we only do it when the risks outweigh the costs. Which is exactly the point: sometimes the risks outweigh the costs of prevention, sometimes they do not. Thus, this was an excellent example.
  - laci27 9y ago
    You're right. Like all things in life, one should use common sense when interacting with the world. No one (i hope) wants to spend their budget irrationally. So in your example, I would let the doctor decide if that $100 is spend better on curing rather than preventing. And that 1% reduction you came up as an example is not 1% for the entire population, it may be 1% to me and you, but maybe 50% for someone older, or with a specific condition...
  - soVeryTired 9y ago
    What makes you think I'm not?
- txsh 9y ago
  RTFA. It does not save money.
  - austinprete 9y ago
    Using an acronym doesn't invalidate this HN guideline: "Please don't insinuate that someone hasn't read an article." Also, does having an article claiming something now make that thing fact, is there no room for discussion or dialogue, or a questioning of the statistics provided, as soon as an article asserting an opinion is published? If you are going to argue against his point, why not at least point out the specifics of the article that invalidated it, or towards some other data, rather than just saying, "read the fucking article" and moving on?
    - deleted 9y ago
      [deleted]
  - laci27 9y ago
    I did read it and I get the angle of it. it's not always cost effective, like all things in life, one should use common sense. But in general terms, preventative care does work well and costs the state less, at least in the UK.
    - compiler-guy 9y ago
      The article is a summary of a a study that reviews over 500 other papers dealing with how preventative care may or may not save money. It concludes that only childhood immunizations and one other thing save money. And that fifteen additional interventions are extremely low cost. This is an unintuitive result, but backed by a careful review of quite a bit of evidence. What evidence shows preventative care does save money?
- kgwgk 9y ago
  > But of course it saves money.. on the long run. Some of these preventive measures do, and some don’t. In some cases you spend more money and get less quality of life in return. If you think that they are « of course » a good idea by principle and don’t do the calculation you won’t be able to distinguish the useful from the wasteful.
SFjulie1 9y ago
Vaccine being preventive care, I do agree it is better to let epidemy spread and let the weak die by millions, thus having a population as healthy as in middle age. We could also stop the preventive care of teeth and only let people got to the dentist while their heart is as rotten as their teeth.
Dwolb 9y ago
I found this to be an extremely interesting point: >In the short term, less smoking would lead to decreased spending because of reductions in health care spending for those who had smoked. >In the long run, all of those people living longer would lead to increases in spending in many programs, including health care. The more people who quit smoking, the higher the deficit from health care — barely offset by the revenue from taxing cigarettes. So yes, if our goal is to “reduce healthcare spending” letting people die younger, faster would indeed do this. However if our goal is to “improve quality of life for people at the lowest possible cost” we most likely need to invest in preventative care. I would like to hear more from the authors on their synthesis.
- mjw1007 9y ago
  Similarly from the linked Robert Wood Johnson Foundation report: «Prevention can reduce the incidence of disease, but savings may be partially offset by health care costs associated with increased longevity.» Perhaps a useful way of looking at things would be to imagine we had access to a graph of the function from (preventative health care, emergency health care) → life expectancy, and see what it looks like for constant life expectancy. If you could increase the preventative part by less than you decrease the emergency part, then I think in one sense it's fair to say that preventative care saves money.
- robkop 9y ago
  Letting people die younger, faster makes sense that it would reduce healthcare spending but what doesn't make sense to me is that you loose all future productivity and value that these people create. They say that the costs are barely offset by cigarette tax revenue but that doesn't take into account all future tax revenue that would be generated by letting these people live.
  - scarface74 9y ago
    I hate to sound callous, but on average, how productive are older people? Living longer doesn't necessarily imply working longer. It could just lead to costing more in treating chronic conditions.
Gatsky 9y ago
The article says we need to take a wider perspective than just healthcare spending, but gives only one example of this with smoking, which happens to be one of the few 'preventative' interventions which both costs money to implement, and reduces revenue at the same time. As such, I am unconvinced of the entire thesis. It also uses a silly example of emergency room use after the ACA - of course after drasticallly changing the number of people with health insurance, there will not be efficient or ideal use of healthcare services. Many of the previously uninsured people probably aren't even aware of the concept of primary care. The link between health and labour productivity only gets stronger as the population ages. Given this, I would need to see some compelling arguments that keeping people healthier for longer does not actually save money, but none are forthcoming in this article.
- gbacon 9y ago
  The point of the ER example is it runs counter to one of ACA’s important justification claims, viz. requiring all manner of preventive care coverage — even from low-premium, high-deductible plans — would reduce ER usage by giving the formerly uninsured the option of primary care. Even though now the ER isn’t “the only place they can go,” the author asserts that some choose to visit the ER as a matter of convenience. Reality isn’t likely to be quite this simple, e.g., another likely factor is a shortage of physicians accepting Medicaid. The example isn’t silly at all. Central to ACA advocacy was how high American healthcare spending was relative to other countries and that costs would fall with ER-as-primary gone.
  - Gatsky 9y ago
    I still maintain it is a lazy example, and indeed probably just wrong[1]. The last insurance expansion was as recent as 2014, yet there is no discussion of trends over time. [1]https://m.medicalxpress.com/news/2017-07-impact-patient-emergency-department.html https://m.medicalxpress.com/news/2017-07-impact-patient-emer...
- analog31 9y ago
  In my view the use of emergency rooms was a red herring -- blaming the poor for being wasteful. I've been to the ER a couple times for relatively non emergency care. When you walk in the door, you go to a window, and if you don't have a real critical emergency, they direct you down a hallway into a facility on site that looks and operates exactly like a regular "urgent" or "primary" care facility. It seems no less efficient to provide primary care in the same building as an emergency room, as to provide it in a separate building down the street. If you're having a heart attack, then you get the real thing: Eight attendants, machine that goes "ping" and so forth. Now, of course the billing process may be different. With free health care, there would be no billing process.
Sacho 9y ago
Reminds me of a section of Dr. Bartlett's talk on sustainability(https://youtu.be/TBtW51D_q2Q?t=860 https://youtu.be/TBtW51D_q2Q?t=860). It is very interesting to see how a government is forced to grapple with the financial implications of well-meaning policies. Perhaps this is why preventative care needs to be billed as a cost-saving measure, otherwise you have to justify it over many other life-improving programs(education, law and order, defense, even other medical care programs). The CBO report cited in the article also highlights another troubling point, the insolvency of our social policies: "From about the middle of the second decade onward, however, the effects of increased longevity would outweigh decreases in per capita health care spending, and outlays would rise; but until about the mid-2060s, that growth in outlays would be more than offset by the increase in tax revenues from higher earnings. The largest deficit reduction from the health-related effects — about 0.005% of GDP annually — would occur from about 2030 to 2035. After the mid-2060s, the deficit would be larger than otherwise because the higher outlays would outweigh the health-related revenue increase." (simplified, the taxes paid by healthier, longer-living citizens are not enough to offset the extra medical care they are afforded).
- roenxi 9y ago
  I'm not actually going to read the CBO report, but this article has a bad taste; it looks like political problems being mis-interpreted by the reporter as technical revelation. If long-term impacts on the health system are considered, long-term tax & other productivity related payments need to be considered also. If this is net-negative, then that indicates a problem with the tax system (or possibly the healthcare system is to generous in the long term). That is intensely political ground to say the least. Surely the issues with preventative care are closely linked to the solvency issue.
  - zbentley 9y ago
    > If this is net-negative, then that indicates a problem with the tax system (or possibly the healthcare system is to generous in the long term). Given the number of anecdotal and statistical horrors that occur where the US healthcare system denies large numbers of people care that is unambiguously necessary, I suspect that the larger financial issue lies in the tax system. To be clear: there are huge areas of terrible waste and broken behavior in the healthcare system (to the point that it costs far more than comparable systems in other countries), I just think the missing taxation-responsibility angle is more significant.
jrs235 9y ago
People are mentioning letting people die faster and earlier should reduce costs. But that's too simple. It would reduce costs for the initial payers but the costs (capital and labor) would remain the same for the short term meaning costs for services would have to rise for the providers to pay their fixed capital financing costs and to not have to lay off any labor. It's like inflation. How your buying per is affected depends on when/if you get the new money. Until labor costs go down and we don't have a push for an "MRI on every block" costs won't go down. There seems to be more support jobs today particularly for coding and billing and dealing with insurances which is why single payer is thought to be a way to reduce costs by reducing overhead. It ought to work but then we better be prepared to help those workers who get displaced... Which just shifts the cost(s) somewhere else (sometime needs to pay to retrain displaced workers whose skills and knowledge are no longer needed or possibly even pay unemployment or even welfare to jobless individuals).
danjoc 9y ago
>These included immunizations, counseling, and screening for disease. Researchers modeled what would happen if up to 90 percent of these services were used The science is settled. We have a model for proof.
pmontra 9y ago
Preventive, not preventative. Please fix the HN title.
- bequanna 9y ago
  Both appear to be acceptable and share the same definitions. http://grammarist.com/spelling/preventative-preventive/ http://grammarist.com/spelling/preventative-preventive/
  - pmontra 9y ago
    But the title of the post uses the word preventive.
pkilgore 9y ago
The key paragraph, with added emphasis: >One reason for this is that all prevention is not the same. The task force doesn’t model costs in its calculations; it models effectiveness and a preponderance of benefits and harms. When something works, and its positive effects outweigh its adverse ones, a recommendation is made. Aaron (the author) and his partners blog here[1], it's a very good site if this sort of thing interests you. [1]https://theincidentaleconomist.com https://theincidentaleconomist.com
bob_theslob646 9y ago
The author, in my opinion,does not do enough to talk about one of things that most Americans can control:nutrition & exercise. The author also fails to mention that American medical system lives for treating rather than curing because treating makes the health industry makes more money. >Preventive Care Saves Money? Sorry, It’s Too Good to Be True Why is it that I can find this? >A new study from researchers at Indiana and Cornell Universities looked at the effects of the Affordable Care Act’s (ACA) Medicaid expansion on a specific group: low-income, non-elderly, non-disabled childless adults–folks who wouldn’t normally be eligible for coverage without the ACA. This group is now 17% more likely to have health insurance, 7% more likely to have a personal doctor, and 11% “less likely to report that cost was a barrier to their health care,” according to a statement from the Indiana University Newsroom. (https://www.fastcompany.com/3067684/one-big-lesson-from-obamacare-preventative-care-saves-lives-and-money https://www.fastcompany.com/3067684/one-big-lesson-from-obam...) Definition of Preventative Healthcare. >Preventive healthcare (alternately preventive medicine or prophylaxis) consists of measures taken for disease prevention, as opposed to disease treatment.(https://en.wikipedia.org/wiki/Preventive_healthcare)[1] https://en.wikipedia.org/wiki/Preventive_healthcare)[1] I cannot speak of this for the EU, but in the U.S. does anyone pause and wonder why their is not more education on nutrition? Does that ultimately have a huge effect on what diseases we may get? > Over the past century, essential nutrient deficiencies have dramatically decreased, many infectious diseases have been conquered, and the majority of the U.S. population can now anticipate a long and productive life. > However, as infectious disease rates have dropped, the rates of noncommunicable diseases—specifically, chronic diet-related diseases—have risen, due in part to changes in lifestyle behaviors. > A history of poor eating and physical activity patterns have a cumulative effect and have contributed to significant nutrition- and physical activity-related health challenges that now face the U.S. population. > About half of all American adults—117 million individuals—have one or more preventable chronic diseases, many of which are related_ to poor quality eating patterns and physical inactivity_. (https://health.gov/dietaryguidelines/2015/guidelines/introduction/nutrition-and-health-are-closely-related/)[2] https://health.gov/dietaryguidelines/2015/guidelines/introdu... Other papers and articles that disagree with the author. (https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2008.0701)[Greater https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2008.0... Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or No Cost Michael V. Maciosek1, Ashley B. Coffield2, Thomas J. Flottemesch3, ... See all authors AFFILIATIONS PUBLISHED:SEPTEMBER 2010Free Access] My point is that the answer is quite complicated and to state something as simple as the author does is, disingenuous.
crazygringo 9y ago
> If we really want to know whether prevention saves money, maybe we should take a wider perspective. Does spending on prevention save the country money over all? A recent report from the Congressional Budget Office in the New England Journal of Medicine suggests the answer is no. The budget office modeled how a policy to reduce smoking through higher cigarette taxes might affect federal spending... In the long run, all of those people living longer would lead to increases in spending in many programs, including health care. The more people who quit smoking, the higher the deficit from health care — barely offset by the revenue from taxing cigarettes. What about those peoples' economic productivity as they work for another decade? What about the other jobs they help maintain by spending the money they make from their productivity? What about the care they provide to their grandkids? This article takes an incredibly myopic view. If we're sticking to pure economics, the metric shouldn't be to decrease lifetime health care costs... the metric should be to decrease the ratio of lifetime health care costs to lifetime economic productivity, broadly measured.
- boxed 9y ago
  Even if they did take economic activity into accounting that seems besides the point. The same argument would make it a really good idea to introduce the death penalty for reaching retirement age! If you optimize for something stupid you get stupid results.
  - gutnor 9y ago
    There is a bit of a nihilist nature to it too. Current modern society only achievement is making people live better, longer. There is no scientific, objective reason to do that. It is only the arbitrary (slightly helped by biology) value we put on human life that makes us do that. You can look at about everything, be it healthcare, government, defence, or even economy and money and the only cold logical conclusion is that it serves no purpose. Makes me think we better be careful with AI. Overly survivalist AI can kill all humans, the opposite is one that eventually find out that killing all human now is the fastest way to help humanity reach its natural conclusion.
crb002 9y ago
Cutting sugar, not being wholly sedentary, and having life long friends is 90% of preventative care.
bpicolo 9y ago
I imagine it does for dentistry
polskibus 9y ago
Did they analyse European preventative care programmes too? Maybe preventative care can save money, just not in the US ?
cryoshon 9y ago
here is a fallacy that is frequently made: everything needs to be profitable. no, not everything needs to be profitable. we accept that things that are for use by the general public as essential to their life are not held to the standard of being profitable. this is why we offer food stamps and control the rates for water delivery and electricity delivery very strictly. healthcare doesn't need to be profitable, it needs to increase people's longevity and their quality of life. full stop. anything else-- anything less-- anything more cruel in the conversation is completely unwelcome and hopelessly off-base. it's like the people who try to argue that public transit needs to make a profit. no, it's a public utility. it needs to not bleed the public's money dry, sure, but its primary objective is providing a service rather than making money. making money isn't even a tertiary goal. once again, it's a public service. flagged this article for being too stupid to be on HN; other people in the comments have already pointed out the article's glaring methodological flaws, poor rhetoric, and its malicious moral standpoint.
reasonattlm 9y ago
Leaving aside for a moment the issues of healthcare being wrapped up in a system of regulation and entitlement that makes a healthy marketplace impossible, and growth in demand harmful rather than beneficial. Putting that to one side, the reason why present day preventative care does little to the numbers is that (a) most costs occur due to age-related disease, and (b) present day medicine can produce only marginally positive outcomes at great expensive when it comes to aging and its consequences. It is still outperformed in many areas by lifestyle choices. Sufficiently good preventative medicine will save money, because it will address the root causes of aging and thereby reduce risk and severity of age-related disease, while lengthening healthy and overall life span. It doesn't even have to be cheap. It just has to be less cheap than the cost of attempting and failing cope with aging. But in practice it will largely be cheap. Senolytic therapies to clear senescent cells are a pharmaceutical approach to age-related conditions that improves the situation for near all individuals and pathologies of aging, cost-effectively. Those tested to date reduce inflammation, partially resolve loss of regenerative capacity, turn back atherosclerosis, restore loss of tissue elasticity to some degree, effectively treat osteoarthritis, effectively treat fibrosis, clear out many forms of bad immune cell, remove a contributing cause of Parkinson's disease, and so for for a much longer list. The reason it will be so much better is that it targets a root cause of aging, a form of damage, and directly repairs at least some of it (25-50% of senescent cells destroyed in some of the measured tissues for some of the approaches). One of the candidate therapies, dasatinib/quercetin, costs ~ $30-100 / dose. Take it once every few years.

71 points by richardhod 9y ago

"... but it improves quality of life at a very reasonable price."

But of course it saves money.. on the long run. Yes, it does cost more upfront, and yes, people will be using the 'free doctor' more, in the short term, but over the lifetime of the patient, it costs considerable less to prevent, than to 'fix'. Of course, you could say that people who 'suddenly' need fixing will live less, so overall the state will save money cause they will be dead sooner, but i'm pretty sure that's NOT the point of healthcare.

Hermel 9y ago
Of course, there is always a trade-off. For example, it is not worth spending 100$ for a 1% reduction in the risk of getting a disease that costs 1000$ to cure. If you really believe that prevention always pays off, why aren't you wearing a helmet right now?
- nolok 9y ago
  Very poor exemple. Him not wearing a helmet right now has nothing do to with costs, its about practicality and societal norms. Even on construction sites we had to makes laws saying it is mandatory or big fines to get people to wear them.
  - Hermel 9y ago
    Not all cost is of monetary nature. Wearing a helmet costs you comfort, agility, and time. That's why we only do it when the risks outweigh the costs. Which is exactly the point: sometimes the risks outweigh the costs of prevention, sometimes they do not. Thus, this was an excellent example.
- laci27 9y ago
  You're right. Like all things in life, one should use common sense when interacting with the world. No one (i hope) wants to spend their budget irrationally. So in your example, I would let the doctor decide if that $100 is spend better on curing rather than preventing. And that 1% reduction you came up as an example is not 1% for the entire population, it may be 1% to me and you, but maybe 50% for someone older, or with a specific condition...
- soVeryTired 9y ago
  What makes you think I'm not?
txsh 9y ago
RTFA. It does not save money.
- austinprete 9y ago
  Using an acronym doesn't invalidate this HN guideline: "Please don't insinuate that someone hasn't read an article." Also, does having an article claiming something now make that thing fact, is there no room for discussion or dialogue, or a questioning of the statistics provided, as soon as an article asserting an opinion is published? If you are going to argue against his point, why not at least point out the specifics of the article that invalidated it, or towards some other data, rather than just saying, "read the fucking article" and moving on?
  - deleted 9y ago
    [deleted]
- laci27 9y ago
  I did read it and I get the angle of it. it's not always cost effective, like all things in life, one should use common sense. But in general terms, preventative care does work well and costs the state less, at least in the UK.
  - compiler-guy 9y ago
    The article is a summary of a a study that reviews over 500 other papers dealing with how preventative care may or may not save money. It concludes that only childhood immunizations and one other thing save money. And that fifteen additional interventions are extremely low cost. This is an unintuitive result, but backed by a careful review of quite a bit of evidence. What evidence shows preventative care does save money?
kgwgk 9y ago
> But of course it saves money.. on the long run. Some of these preventive measures do, and some don’t. In some cases you spend more money and get less quality of life in return. If you think that they are « of course » a good idea by principle and don’t do the calculation you won’t be able to distinguish the useful from the wasteful.

SFjulie1 9y ago

Vaccine being preventive care, I do agree it is better to let epidemy spread and let the weak die by millions, thus having a population as healthy as in middle age. We could also stop the preventive care of teeth and only let people got to the dentist while their heart is as rotten as their teeth.

Dwolb 9y ago

I found this to be an extremely interesting point: >In the short term, less smoking would lead to decreased spending because of reductions in health care spending for those who had smoked. >In the long run, all of those people living longer would lead to increases in spending in many programs, including health care. The more people who quit smoking, the higher the deficit from health care — barely offset by the revenue from taxing cigarettes. So yes, if our goal is to “reduce healthcare spending” letting people die younger, faster would indeed do this. However if our goal is to “improve quality of life for people at the lowest possible cost” we most likely need to invest in preventative care. I would like to hear more from the authors on their synthesis.

mjw1007 9y ago
Similarly from the linked Robert Wood Johnson Foundation report: «Prevention can reduce the incidence of disease, but savings may be partially offset by health care costs associated with increased longevity.» Perhaps a useful way of looking at things would be to imagine we had access to a graph of the function from (preventative health care, emergency health care) → life expectancy, and see what it looks like for constant life expectancy. If you could increase the preventative part by less than you decrease the emergency part, then I think in one sense it's fair to say that preventative care saves money.
robkop 9y ago
Letting people die younger, faster makes sense that it would reduce healthcare spending but what doesn't make sense to me is that you loose all future productivity and value that these people create. They say that the costs are barely offset by cigarette tax revenue but that doesn't take into account all future tax revenue that would be generated by letting these people live.
- scarface74 9y ago
  I hate to sound callous, but on average, how productive are older people? Living longer doesn't necessarily imply working longer. It could just lead to costing more in treating chronic conditions.

Gatsky 9y ago

The article says we need to take a wider perspective than just healthcare spending, but gives only one example of this with smoking, which happens to be one of the few 'preventative' interventions which both costs money to implement, and reduces revenue at the same time. As such, I am unconvinced of the entire thesis. It also uses a silly example of emergency room use after the ACA - of course after drasticallly changing the number of people with health insurance, there will not be efficient or ideal use of healthcare services. Many of the previously uninsured people probably aren't even aware of the concept of primary care. The link between health and labour productivity only gets stronger as the population ages. Given this, I would need to see some compelling arguments that keeping people healthier for longer does not actually save money, but none are forthcoming in this article.

gbacon 9y ago
The point of the ER example is it runs counter to one of ACA’s important justification claims, viz. requiring all manner of preventive care coverage — even from low-premium, high-deductible plans — would reduce ER usage by giving the formerly uninsured the option of primary care. Even though now the ER isn’t “the only place they can go,” the author asserts that some choose to visit the ER as a matter of convenience. Reality isn’t likely to be quite this simple, e.g., another likely factor is a shortage of physicians accepting Medicaid. The example isn’t silly at all. Central to ACA advocacy was how high American healthcare spending was relative to other countries and that costs would fall with ER-as-primary gone.
- Gatsky 9y ago
  I still maintain it is a lazy example, and indeed probably just wrong[1]. The last insurance expansion was as recent as 2014, yet there is no discussion of trends over time. [1]https://m.medicalxpress.com/news/2017-07-impact-patient-emergency-department.html https://m.medicalxpress.com/news/2017-07-impact-patient-emer...
analog31 9y ago
In my view the use of emergency rooms was a red herring -- blaming the poor for being wasteful. I've been to the ER a couple times for relatively non emergency care. When you walk in the door, you go to a window, and if you don't have a real critical emergency, they direct you down a hallway into a facility on site that looks and operates exactly like a regular "urgent" or "primary" care facility. It seems no less efficient to provide primary care in the same building as an emergency room, as to provide it in a separate building down the street. If you're having a heart attack, then you get the real thing: Eight attendants, machine that goes "ping" and so forth. Now, of course the billing process may be different. With free health care, there would be no billing process.

Sacho 9y ago

Reminds me of a section of Dr. Bartlett's talk on sustainability(https://youtu.be/TBtW51D_q2Q?t=860 https://youtu.be/TBtW51D_q2Q?t=860). It is very interesting to see how a government is forced to grapple with the financial implications of well-meaning policies. Perhaps this is why preventative care needs to be billed as a cost-saving measure, otherwise you have to justify it over many other life-improving programs(education, law and order, defense, even other medical care programs). The CBO report cited in the article also highlights another troubling point, the insolvency of our social policies: "From about the middle of the second decade onward, however, the effects of increased longevity would outweigh decreases in per capita health care spending, and outlays would rise; but until about the mid-2060s, that growth in outlays would be more than offset by the increase in tax revenues from higher earnings. The largest deficit reduction from the health-related effects — about 0.005% of GDP annually — would occur from about 2030 to 2035. After the mid-2060s, the deficit would be larger than otherwise because the higher outlays would outweigh the health-related revenue increase." (simplified, the taxes paid by healthier, longer-living citizens are not enough to offset the extra medical care they are afforded).

roenxi 9y ago
I'm not actually going to read the CBO report, but this article has a bad taste; it looks like political problems being mis-interpreted by the reporter as technical revelation. If long-term impacts on the health system are considered, long-term tax & other productivity related payments need to be considered also. If this is net-negative, then that indicates a problem with the tax system (or possibly the healthcare system is to generous in the long term). That is intensely political ground to say the least. Surely the issues with preventative care are closely linked to the solvency issue.
- zbentley 9y ago
  > If this is net-negative, then that indicates a problem with the tax system (or possibly the healthcare system is to generous in the long term). Given the number of anecdotal and statistical horrors that occur where the US healthcare system denies large numbers of people care that is unambiguously necessary, I suspect that the larger financial issue lies in the tax system. To be clear: there are huge areas of terrible waste and broken behavior in the healthcare system (to the point that it costs far more than comparable systems in other countries), I just think the missing taxation-responsibility angle is more significant.

jrs235 9y ago

People are mentioning letting people die faster and earlier should reduce costs. But that's too simple. It would reduce costs for the initial payers but the costs (capital and labor) would remain the same for the short term meaning costs for services would have to rise for the providers to pay their fixed capital financing costs and to not have to lay off any labor. It's like inflation. How your buying per is affected depends on when/if you get the new money. Until labor costs go down and we don't have a push for an "MRI on every block" costs won't go down. There seems to be more support jobs today particularly for coding and billing and dealing with insurances which is why single payer is thought to be a way to reduce costs by reducing overhead. It ought to work but then we better be prepared to help those workers who get displaced... Which just shifts the cost(s) somewhere else (sometime needs to pay to retrain displaced workers whose skills and knowledge are no longer needed or possibly even pay unemployment or even welfare to jobless individuals).

danjoc 9y ago

>These included immunizations, counseling, and screening for disease. Researchers modeled what would happen if up to 90 percent of these services were used The science is settled. We have a model for proof.

pmontra 9y ago

Preventive, not preventative. Please fix the HN title.

bequanna 9y ago
Both appear to be acceptable and share the same definitions. http://grammarist.com/spelling/preventative-preventive/ http://grammarist.com/spelling/preventative-preventive/
- pmontra 9y ago
  But the title of the post uses the word preventive.

pkilgore 9y ago

The key paragraph, with added emphasis: >One reason for this is that all prevention is not the same. The task force doesn’t model costs in its calculations; it models effectiveness and a preponderance of benefits and harms. When something works, and its positive effects outweigh its adverse ones, a recommendation is made. Aaron (the author) and his partners blog here[1], it's a very good site if this sort of thing interests you. [1]https://theincidentaleconomist.com https://theincidentaleconomist.com

bob_theslob646 9y ago

The author, in my opinion,does not do enough to talk about one of things that most Americans can control:nutrition & exercise. The author also fails to mention that American medical system lives for treating rather than curing because treating makes the health industry makes more money. >Preventive Care Saves Money? Sorry, It’s Too Good to Be True Why is it that I can find this? >A new study from researchers at Indiana and Cornell Universities looked at the effects of the Affordable Care Act’s (ACA) Medicaid expansion on a specific group: low-income, non-elderly, non-disabled childless adults–folks who wouldn’t normally be eligible for coverage without the ACA. This group is now 17% more likely to have health insurance, 7% more likely to have a personal doctor, and 11% “less likely to report that cost was a barrier to their health care,” according to a statement from the Indiana University Newsroom. (https://www.fastcompany.com/3067684/one-big-lesson-from-obamacare-preventative-care-saves-lives-and-money https://www.fastcompany.com/3067684/one-big-lesson-from-obam...) Definition of Preventative Healthcare. >Preventive healthcare (alternately preventive medicine or prophylaxis) consists of measures taken for disease prevention, as opposed to disease treatment.(https://en.wikipedia.org/wiki/Preventive_healthcare)[1] https://en.wikipedia.org/wiki/Preventive_healthcare)[1] I cannot speak of this for the EU, but in the U.S. does anyone pause and wonder why their is not more education on nutrition? Does that ultimately have a huge effect on what diseases we may get? > Over the past century, essential nutrient deficiencies have dramatically decreased, many infectious diseases have been conquered, and the majority of the U.S. population can now anticipate a long and productive life. > However, as infectious disease rates have dropped, the rates of noncommunicable diseases—specifically, chronic diet-related diseases—have risen, due in part to changes in lifestyle behaviors. > A history of poor eating and physical activity patterns have a cumulative effect and have contributed to significant nutrition- and physical activity-related health challenges that now face the U.S. population. > About half of all American adults—117 million individuals—have one or more preventable chronic diseases, many of which are related_ to poor quality eating patterns and physical inactivity_. (https://health.gov/dietaryguidelines/2015/guidelines/introduction/nutrition-and-health-are-closely-related/)[2] https://health.gov/dietaryguidelines/2015/guidelines/introdu... Other papers and articles that disagree with the author. (https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2008.0701)[Greater https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2008.0... Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or No Cost Michael V. Maciosek1, Ashley B. Coffield2, Thomas J. Flottemesch3, ... See all authors AFFILIATIONS PUBLISHED:SEPTEMBER 2010Free Access] My point is that the answer is quite complicated and to state something as simple as the author does is, disingenuous.

crazygringo 9y ago

> If we really want to know whether prevention saves money, maybe we should take a wider perspective. Does spending on prevention save the country money over all? A recent report from the Congressional Budget Office in the New England Journal of Medicine suggests the answer is no. The budget office modeled how a policy to reduce smoking through higher cigarette taxes might affect federal spending... In the long run, all of those people living longer would lead to increases in spending in many programs, including health care. The more people who quit smoking, the higher the deficit from health care — barely offset by the revenue from taxing cigarettes. What about those peoples' economic productivity as they work for another decade? What about the other jobs they help maintain by spending the money they make from their productivity? What about the care they provide to their grandkids? This article takes an incredibly myopic view. If we're sticking to pure economics, the metric shouldn't be to decrease lifetime health care costs... the metric should be to decrease the ratio of lifetime health care costs to lifetime economic productivity, broadly measured.

boxed 9y ago
Even if they did take economic activity into accounting that seems besides the point. The same argument would make it a really good idea to introduce the death penalty for reaching retirement age! If you optimize for something stupid you get stupid results.
- gutnor 9y ago
  There is a bit of a nihilist nature to it too. Current modern society only achievement is making people live better, longer. There is no scientific, objective reason to do that. It is only the arbitrary (slightly helped by biology) value we put on human life that makes us do that. You can look at about everything, be it healthcare, government, defence, or even economy and money and the only cold logical conclusion is that it serves no purpose. Makes me think we better be careful with AI. Overly survivalist AI can kill all humans, the opposite is one that eventually find out that killing all human now is the fastest way to help humanity reach its natural conclusion.

crb002 9y ago

Cutting sugar, not being wholly sedentary, and having life long friends is 90% of preventative care.

bpicolo 9y ago

I imagine it does for dentistry

polskibus 9y ago

Did they analyse European preventative care programmes too? Maybe preventative care can save money, just not in the US ?

cryoshon 9y ago

here is a fallacy that is frequently made: everything needs to be profitable. no, not everything needs to be profitable. we accept that things that are for use by the general public as essential to their life are not held to the standard of being profitable. this is why we offer food stamps and control the rates for water delivery and electricity delivery very strictly. healthcare doesn't need to be profitable, it needs to increase people's longevity and their quality of life. full stop. anything else-- anything less-- anything more cruel in the conversation is completely unwelcome and hopelessly off-base. it's like the people who try to argue that public transit needs to make a profit. no, it's a public utility. it needs to not bleed the public's money dry, sure, but its primary objective is providing a service rather than making money. making money isn't even a tertiary goal. once again, it's a public service. flagged this article for being too stupid to be on HN; other people in the comments have already pointed out the article's glaring methodological flaws, poor rhetoric, and its malicious moral standpoint.

reasonattlm 9y ago

Leaving aside for a moment the issues of healthcare being wrapped up in a system of regulation and entitlement that makes a healthy marketplace impossible, and growth in demand harmful rather than beneficial. Putting that to one side, the reason why present day preventative care does little to the numbers is that (a) most costs occur due to age-related disease, and (b) present day medicine can produce only marginally positive outcomes at great expensive when it comes to aging and its consequences. It is still outperformed in many areas by lifestyle choices. Sufficiently good preventative medicine will save money, because it will address the root causes of aging and thereby reduce risk and severity of age-related disease, while lengthening healthy and overall life span. It doesn't even have to be cheap. It just has to be less cheap than the cost of attempting and failing cope with aging. But in practice it will largely be cheap. Senolytic therapies to clear senescent cells are a pharmaceutical approach to age-related conditions that improves the situation for near all individuals and pathologies of aging, cost-effectively. Those tested to date reduce inflammation, partially resolve loss of regenerative capacity, turn back atherosclerosis, restore loss of tissue elasticity to some degree, effectively treat osteoarthritis, effectively treat fibrosis, clear out many forms of bad immune cell, remove a contributing cause of Parkinson's disease, and so for for a much longer list. The reason it will be so much better is that it targets a root cause of aging, a form of damage, and directly repairs at least some of it (25-50% of senescent cells destroyed in some of the measured tissues for some of the approaches). One of the candidate therapies, dasatinib/quercetin, costs ~ $30-100 / dose. Take it once every few years.