Preventing Chuckles From Making A Mistake

Charles Krauthammer unloads all sorts of numbers proclaiming preventative health care doesn't save money. Mark Steyn tried this tack last month, and Chuckles is just as ridiculously off the mark in his column today.

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 Obamaworld, as explained by the president in his Tuesday town hall, if we pour money into primary care for diabetics instead of giving surgeons "$30,000, $40,000, $50,000" for a later amputation -- a whopper that misrepresents the surgeon's fee by a factor of at least 30 -- "that will save us money." Back on Earth, a rigorous 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. That's because prevention applied to large populations is very expensive, as shown by another report Elmendorf cites, a definitive review in the New England Journal of Medicine of hundreds of studies that found that more than 80 percent of preventive measures added to medical costs.

This doesn't mean we shouldn't be preventing illness. Of course we should. But in medicine, as in life, there is no free lunch. The idea that prevention is somehow intrinsically economically different from treatment -- that treatment increases costs and prevention lowers them -- is simply nonsense. Prevention is a wondrous good, but in the aggregate it costs society money. Nothing wrong with that. That's the whole premise of medicine. Treating a heart attack or setting a broken leg also costs society. But we do it because it alleviates human suffering. Preventing a heart attack with statins or breast cancer with mammograms is costly. But we do it because it reduces human suffering.

However, prevention is not, as so widely advertised, healing on the cheap. It is not the magic bullet for health-care costs.

You will hear some variation of that claim a hundred times in the coming health-care debate. Whenever you do, remember: It's nonsense -- empirically demonstrable and CBO-certified.

What Krauthammer is missing is that catching the disease early and treating it allows the person to be far more productive instead of bed-ridden in a hospital for long-term care...or dead. If health care were all about money, there would be no health care whatsoever, of course being healthy costs society money (which is apparently his main complaint.) Healthy workers get to contribute more to society, correct? Doesn't that increased productivity count for something as far as costs go?

Also, his numbers are wrong. If a test for a disease is going to be widespread, there's competitive forces at work among pharmaceutical companies to provide the cheapest, most accurate test. Second, any major disease that you would want to screen for is not going to cost merely $10,000 in additional treatment. That would barely cover one day in a hospital, let's be honest. That additional treatment for a terminal disease may exceed $1 million in total costs. Screening and early treatment on the other hand could save hundreds of thousands in the long run, plus the person being able to go back to work, and not to mention having beaten a deadly disease and being alive.

Suddenly that $500 test looks a hell of a lot better by comparison. The cost of the program will yes, go up. But the cost to society as a whole is offset by healthier, more productive members of society.

There's a much bigger picture here.