
Preventative care doesn't save money - richardhod
https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html
======
Dwolb
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.

~~~
soVeryTired
Let old people die faster? It sounds callous to frame it in terms of dollars
and cents, but allowing people to choose to end their own lives might lift
some of the burden on our healthcare systems.

I'm still on the fence about the issue of euthanasia, but I think the Overton
window is shifting. In time, I think that debate will make the debate on
abortion look cordial.

~~~
paulmd
This is one of those topics that needs to be addressed but really cannot be
because it's just so callous (and because the AARP is such a significant lobby
in American politics).

I think assisted suicide should be legal. But even setting that aside, we
spend a _massive_ amount of money on prolonging people's lives for a few more
miserable weeks at the bitter end. That money would clearly be better used on
patients with better long-term prognoses, but this is unfortunately the stuff
that gets people screaming about death panels.

~~~
ComputerGuru
Fun fact: AARP is the biggest lobbying entity in the USA. And it’ll only get
bigger with baby boomers joining the club.

Edit: GenX, not baby boomers.

~~~
dragonwriter
> AARP is the biggest lobbying entity in the USA. And it’ll only get bigger
> with baby boomers joining the club.

The _youngest_ Boomer has been past the AARP full membership age for more than
20 years; newly eligible AARPers are in the younger half (nearly the youngest
third) of GenX. Plus, AARP offers full membership for free for a spouse
without age qualification, and associate memberships for under 50s. Which is
to say, there's not a lot of reason to expect that Boomers interested in
“joining the club” haven't all done so a long time ago, and are now exiting by
death more than entering, while new members are coming from the relative baby
bust of GenX.

------
Sacho
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
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
> 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.

------
crazygringo
> _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
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
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.

------
Gatsky
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
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
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-
emer...](https://m.medicalxpress.com/news/2017-07-impact-patient-emergency-
department.html)

------
laci27
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
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
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
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.

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

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

------
jrs235
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).

------
reasonattlm
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.

------
pkilgore
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)

------
danjoc
>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.

------
cryoshon
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.

------
bpicolo
I imagine it does for dentistry

------
crb002
Cutting sugar, not being wholly sedentary, and having life long friends is 90%
of preventative care.

------
bob_theslob646
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-
obam...](https://www.fastcompany.com/3067684/one-big-lesson-from-obamacare-
preventative-care-saves-lives-and-money))

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/introdu...](https://health.gov/dietaryguidelines/2015/guidelines/introduction/nutrition-
and-health-are-closely-related/\)\[2\])

Other papers and articles that disagree with the author.

([https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2008.0...](https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2008.0701\)\[Greater)
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.

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pmontra
Preventive, not preventative. Please fix the HN title.

~~~
bequanna
Both appear to be acceptable and share the same definitions.

[http://grammarist.com/spelling/preventative-
preventive/](http://grammarist.com/spelling/preventative-preventive/)

~~~
pmontra
But the title of the post uses the word preventive.

