Preventative care doesn't save money

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.

Reminds me of a section of Dr. Bartlett's talk on sustainability(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).

> 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.

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.

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.

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

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

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).

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.

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

>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.

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.

I imagine it does for dentistry

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

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...)

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]

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...

Other papers and articles that disagree with the author.

(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.

Preventive, not preventative. Please fix the HN title.