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Wednesday, September 2, 2009

The Dirty Little Secret of Costs and Preventative Care

A new study on the supposed cost savings of preventative care has put a mack truck hole in the idea that giving everyone access to preventative care will save health care costs.

Using data from long-standing clinical trials, researchers projected the cost of caring for people with Type 2 diabetes as they progress from diagnosis to various complications and death. Enrolling federally-insured patients in a simple but aggressive program to control the disease would cost the government $1,024 per person per year -- money that largely would be recovered after 25 years through lower spending on dialysis, kidney transplants, amputations and other forms of treatment, the study found.

However, except for the youngest diabetics, the additional services would add to overall health spending, not decrease it, the study shows.

Now, there's no doubt that everyone should support preventative care. Preventative care catches diseases before they start. It's important that everyone go to a primary care physician (something I don't practice) regularly to catch diseases before they start.

Here's what's important though. Those that support a major overhaul of the medical system proclaim that up to 50 million people don't have insurance. Those people become a burden on the system when they show up at emergency rooms. Those same people claim that if they received the proper health insurance they wouldn't be a burden on the health care system because they would catch their diseases early. As such, they would save everyone money.

Of course, that's just not the truth. We should all want a healthy society. So, everyone should be encouraged to vigorously get preventative care. It is very unhealthy to go without health insurance and not get it. Focusing on preventative medicine will make our society more healthy.

All of this is true. What it won't do is lower medical costs. That's especially true if preventative care is given to someone that can't afford. If someone gets a primary care physician their whole entire lives and doesn't pay for that service, that would be a huge financial burden on the system and much larger than if they showed up to the emergency rooms when they got sick. Constantly putting someone through a battery of tests to find a disease that is likely not there is the prudent and healthy thing to do. It does NOT however save the system money, especially when that person isn't paying for the tests.

That's because the dirty little secret is that it's much cheaper to have someone die early even from a major disease than to keep them alive and healthy until they grow old. Again, I'm in favor of preventative medicine. Beyond that, I'm in favor of speaking truthfully. So, if the president wants to provide preventative medicine to all because that will keep us all healthy, that's one thing. Yet, he also needs to be honest about the enormous cost to the medical system that this would provide. Claiming that his fixation on preventative medicine is a cost cutting tool is simply not truthful.


Rob said...

By that argument, the cheapest thing to do is to abort everyone. Abortions cost under $500 ( According to, the first year's cost of a baby is over $5000. I don't think you're advocating universal abortions. (Are you?!)

You're also engaging in several logical fallacies.

Fallacy #1: The study specifically discusses costs associated with people who have already been diagnosed with Type II diabetes. From that, you've chosen to extrapolate across the entire medical spectrum.

Fallacy #2: The study only looks at people who already have Type II diabetes. What is the cost/benefit ratio to helping people avoid contracting Type II diabetes in the first place? Things like weight management, exercise programs, nutrition, etc. Type II diabetes is one of the most avoidable diseases; 80% of people with the disease have a BMI of 25 or higher ( If everyone had a BMI under 25, what would the rate of Type II diabetes be?

Fallacy #3: Even assuming that the benefits of preventative care are overstated, that does not mean that universal health care is a bad thing. It just means that some people who want it are ignorant and/or deceitful.

mike volpe said...

I expected a comment like yours even though I was clear about what I said. Yes, they only had the money to study Type II Diabetes. Now, do you really think that it won't be different with other diseases?

I never said that preventative medicine is a bad thing. It's a very good thing, but people are making a universal health care argument because everyone will have preventative care which will lower costs, and that' just not true.

Rob said...

Yes, I do. If you consider cancer, there are dozens of studies (google for "cost savings cancer early detection") indicating that treating early stage cancer is a significant cost savings over treating late stage cancer. This is in addition to any quality of life improvements and/or mortality statistics.

Heart disease also benefits from this. See

I'll gladly concede that when someone has Type II diabetes, early treatment is not likely save money over late treatment. The study cited looks solid (though IANAD). However, that study is but one point in the statistical graph. Extrapolating one very specific conclusion to a generality is fraught with danger.

mike volpe said...

Nobody is arguing that preventative medicine won't improve everyone's life. I don't see any studies that show that preventative medicine will save health care costs.

Again, if you say that universal health care is a must because then everyone will get preventative medicine so we can treat diseases early and everyone lives longer, that's one thing. That's not what most are saying. They're saying that it's cheaper than having these folks go to an emergency room. That's totally different, and not true, and the point of my article.

Rob said...

I specifically said that early detection and treatment of both cancer and heart disease SAVES MONEY. I quote: "treating early stage cancer is a significant cost savings over treating late stage cancer. This is in addition to any quality of life improvements and/or mortality statistics."

So, yes, preventative care in those specific fields saves money. Complete coverage that provides early and immediate preventative care for those diseases (including smoking cessation, nutrition, and exercise programs) will save money. Lots of money. And, if you consider that Type II diabetes is, itself, a preventable disease, nearly all the monies cited in the study from your original post would also be saved if everyone exercised and was a healthy weight. Unless, of course, you don't consider smoking cessation, nutrition, and exercise as preventative programs.

You cannot take a study that has very specific boundaries and extrapolate that to everything, ignoring all sorts of counter examples.

mike volpe said...

You said but that doesn't necessarily make it so. I didn't see a study that showed this. Though, frankly it is beside the point. You aren't going to pick and choose only those with heart attacks and cancer and give them preventative medicine. You will give it to all. Most will have nothing. That's another reason why it is so expensive. That's because for most it will come up with nothing.

Again, if you say it's important because then everyone will be more healthy, that's one thing. If you say it will cost less that's just not true.

Tom said...

Hey Rob,

Don't bother arguing with Mike.
He is always right.

Clearly he shot his mouth off in this article and you have the research do prove him wrong.

But that wont stop him trying to prove he still has a point

Anonymous said...

Preventive medicine is a wonderful notion and it might even work. The trouble is that preventive measures have to be applied to all regardless of whether or not you were ever going to get the disease in question. Trying to prevent a disease or condition in someone who was never going to get the disease anyway is a monumental waste of money and resources.It will actuially be more expensive than just treating the disease when it presents.Maybe genetic screening will help fine tune preventive med to avoid this conundrum.

Anonymous said...

Yes! Finally something about preventative health.

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