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From the fact that people are very different it follows that, if we treat them equally, the result must be inequality in their actual position, and that the only way to place them in an equal position would be to treat them differently. Equality before the law and material equality are therefore not only different but are in conflict with each other; and we can achieve either one or the other, but not both at the same time

-- F.A. Hayak

Friday, August 14, 2009

Prevention Costs More Than Treatment

Nancy Pelosi and Steny Hoyer promise free mammograms and diabetes screening for all. Not only will this make us healthier, they said, it will also save us money. Writing in USA Today, they claim that

Reform will also mean higher-quality care by promoting preventive care so health problems can be addressed before they become crises. This, too, will save money. We'll be a much healthier country if all patients can receive regular checkups and tests, such as mammograms and diabetes exams, without paying a dime out-of-pocket.

Later, Obama sprinkled his fairy dust on a Portsmouth townhall saying that prevention not only saves lives, but also saves money. The audience swooned. Slap the forehead. Doh! Brilliant!

Er, time to back up. Prevention is enormously important and must be a critical part of any solution to the health-care problem -- but only for medical reasons, not economic.
 
How can this be true?
 
Charles Krauthammer (who is also a physician) writes
"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.

That's a hypothetical case. What's the real-life actuality in the United States today? A study in the journal Circulation found that for cardiovascular diseases and diabetes, "if all the recommended prevention activities 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. [CBO Directory Doug] Elmendorf additionally cites a definitive assessment in the New England Journal of Medicine that reviewed hundreds of studies on preventive care and found that more than 80 percent of preventive measures added to medical costs."

Read the whole article here.

Get it? Prevention increases medical costs, never reduces them or saves money.