4 ms·

Your view is a commonly-held one, and makes a lot of sense; unfortunately there is very little support for it. One data point to the contrary is the Oregon Heal

by nickff 1y ago

Your view is a commonly-held one, and makes a lot of sense; unfortunately there is very little support for it. One data point to the contrary is the Oregon Health Care Study, which showed that 'free' preventative care increased healthcare spending, but did not improve lifespan or reduce long-term cost.

radlad 1y ago
I'm not sure they determined that it did not improve lifespans. Here's some snippets from the Wikipedia article (https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experiment https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim...): > On average, Medicaid coverage increased annual medical spending by approximately $1,172 relative to spending in the control group. The researchers looked at mortality rates, but they could not reach any conclusions because of the extremely low death rate of the general population of able-bodied Oregon adults aged 19 to 64. > In the first year after the lottery, Medicaid coverage was associated with higher rates of health care use, a lower probability of having medical debts sent to a collection agency, and higher self-reported mental and physical health. In the 18 months following the lottery, researchers found that Medicaid increased emergency department visits. > Approximately two years after the lottery, researchers found that Medicaid had no statistically significant impact on physical health measures, but "it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."
hombre_fatal 1y ago
But it only looked at two year outcomes, yet you made a claim about long-term health and cost outcomes. For example, it found that diagnoses and medication increased. If you are diagnosed with heart disease and you begin an intervention, you probably see no change in mortality in two years especially since it took decades for you to progress to that point in the first place.
- barchar 1y ago
  In two years maybe you have a different insurance co though. Otoh this is why we invented reinsurance
tehjoker 1y ago
Such a counterintuitive study, when there are highly motivated political actors trying to deprive people of social benefits, makes me highly skeptical. Catching bad things early is almost always better. Diabetes, cancer, heart disease, etc, cost hundreds of thousands to millions of dollars to treat caught late and prevent people from working or doing things they like to do, and mere thousands to treat early while preserving their quality of life.
- cogman10 1y ago
  Cancer, in particular, can be practically free to insurance if caught early. Colon and skin cancer are the poster children. Colon cancer can be treated in the process of doing the screening when caught early. And skin cancer is a pretty minor "just lop off that mole" procedure that also ends up being the treatment. Letting it grow and catching it when symptoms arise is terribly expensive. The chemo, surgery, scans, and frequent doctors visits are all crazy expensive. About the only way I could see preventative care not costing less is if you just let the people die and call it god's will rather than calling it a death that could have been prevented.
  - theologic 1y ago
    Another variation of this are GLP 1 drugs. Obesity costs USA $1.75T (https://milkeninstitute.org/content-hub/news-releases/economic-impact-obesity-increased-14-trillion-says-milken-institute https://milkeninstitute.org/content-hub/news-releases/econom..., grossed up for inflation) Number of people that are obese: 100M Annual economic impact from obesity per person: $17,500 per year GLP-1 "For All": $6,000 per year (assuming multiple vendors, and some will be over vs under) Savings: $11,500 per year per person. Economic impact: Around $1T This should free up around 3% of GDP for better uses of money rather than just fixing up people. Obviously, the devil is in the details, but the potential impact is so massive that it should be deeply studied.
    - dzhiurgis 1y ago
      Could US gov just buy out one the patents and make it free for all?
johnQdeveloper 1y ago
Anecdotally, if I hadn't gotten tested as part of a long term physical I wouldn't know about stuff that would cause my body to fail much younger than it would otherwise and lead to an early death. So hey, at least in my case, it worked as the commonly held belief states. And that study doesn't look at multi-decade long term effects like diabetes, etc. where you need it for a decade (or longer!) untreated (or poorly managed) before it kills ya. But it still kills ya years early. So even the "raising rates of diabetes detection" in combination with your belief from that study proves you incorrect when people talk long term.
Calavar 1y ago
The Oregon Health Care Study followed patients for 2 years initially, then it was expanded out to 3 years. That's an absurdly short interval. The idea is that increased primary care services will have benefits 10 or 15 years down the line by preventing chronic disease from reaching a critical state. For example, preventing prediabetes from reaching diabetes and then diabetic end stage renal disease (which would require dialysis at a cost of 5 figures per person per month). You're not going to see that over 2 to 3 years.

by nickff 1y ago

radlad 1y ago

I'm not sure they determined that it did not improve lifespans. Here's some snippets from the Wikipedia article (https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experiment https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim...): > On average, Medicaid coverage increased annual medical spending by approximately $1,172 relative to spending in the control group. The researchers looked at mortality rates, but they could not reach any conclusions because of the extremely low death rate of the general population of able-bodied Oregon adults aged 19 to 64. > In the first year after the lottery, Medicaid coverage was associated with higher rates of health care use, a lower probability of having medical debts sent to a collection agency, and higher self-reported mental and physical health. In the 18 months following the lottery, researchers found that Medicaid increased emergency department visits. > Approximately two years after the lottery, researchers found that Medicaid had no statistically significant impact on physical health measures, but "it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."

hombre_fatal 1y ago

But it only looked at two year outcomes, yet you made a claim about long-term health and cost outcomes. For example, it found that diagnoses and medication increased. If you are diagnosed with heart disease and you begin an intervention, you probably see no change in mortality in two years especially since it took decades for you to progress to that point in the first place.

barchar 1y ago
In two years maybe you have a different insurance co though. Otoh this is why we invented reinsurance

tehjoker 1y ago

Such a counterintuitive study, when there are highly motivated political actors trying to deprive people of social benefits, makes me highly skeptical. Catching bad things early is almost always better. Diabetes, cancer, heart disease, etc, cost hundreds of thousands to millions of dollars to treat caught late and prevent people from working or doing things they like to do, and mere thousands to treat early while preserving their quality of life.

cogman10 1y ago
Cancer, in particular, can be practically free to insurance if caught early. Colon and skin cancer are the poster children. Colon cancer can be treated in the process of doing the screening when caught early. And skin cancer is a pretty minor "just lop off that mole" procedure that also ends up being the treatment. Letting it grow and catching it when symptoms arise is terribly expensive. The chemo, surgery, scans, and frequent doctors visits are all crazy expensive. About the only way I could see preventative care not costing less is if you just let the people die and call it god's will rather than calling it a death that could have been prevented.
- theologic 1y ago
  Another variation of this are GLP 1 drugs. Obesity costs USA $1.75T (https://milkeninstitute.org/content-hub/news-releases/economic-impact-obesity-increased-14-trillion-says-milken-institute https://milkeninstitute.org/content-hub/news-releases/econom..., grossed up for inflation) Number of people that are obese: 100M Annual economic impact from obesity per person: $17,500 per year GLP-1 "For All": $6,000 per year (assuming multiple vendors, and some will be over vs under) Savings: $11,500 per year per person. Economic impact: Around $1T This should free up around 3% of GDP for better uses of money rather than just fixing up people. Obviously, the devil is in the details, but the potential impact is so massive that it should be deeply studied.
  - dzhiurgis 1y ago
    Could US gov just buy out one the patents and make it free for all?

johnQdeveloper 1y ago

Anecdotally, if I hadn't gotten tested as part of a long term physical I wouldn't know about stuff that would cause my body to fail much younger than it would otherwise and lead to an early death. So hey, at least in my case, it worked as the commonly held belief states. And that study doesn't look at multi-decade long term effects like diabetes, etc. where you need it for a decade (or longer!) untreated (or poorly managed) before it kills ya. But it still kills ya years early. So even the "raising rates of diabetes detection" in combination with your belief from that study proves you incorrect when people talk long term.

Calavar 1y ago

The Oregon Health Care Study followed patients for 2 years initially, then it was expanded out to 3 years. That's an absurdly short interval. The idea is that increased primary care services will have benefits 10 or 15 years down the line by preventing chronic disease from reaching a critical state. For example, preventing prediabetes from reaching diabetes and then diabetic end stage renal disease (which would require dialysis at a cost of 5 figures per person per month). You're not going to see that over 2 to 3 years.