Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.
--C.S. Lewis--

Tuesday, August 18, 2009

Driving A Stake Through The Heart Of The "Prevention" Canard

If you've paid any attention at all to the federal health care debate, you know that "prevention" and "wellness" seem to be the Holy Grail of health care cost reductions. Everyone, including the president, seems to think that we can simply screen and manage our way to solvency. So, with such a simple solution facing us, why haven't health care plans already cut their costs? After all, it is in their best interest financially, and most of them cover preventative services while offering some kind of wellness program. And yet, as president Obama so helpfully pointed out, we keep cutting off diabetics' feet rather than simply helping them manage their medicine and weight.

The answer is that most of the benefits of wellness and preventative care are a myth, at least when it comes to lowering costs. Think about it for a minute. Is the 300 pound diabetic who is in danger of losing their foot really unaware that their weight is unhealthy? Is there one person left in all of America who isn't aware that being severely overweight, not exercising, and smoking are all bad for you? We are fat, lazy smokers because it is EASY, not because we want to be. Short of paying your doctor to follow you around and slap Twinkies out of your hand, that isn't going to change.

As for screening, it may save lives, but not money. Chew on this for a moment. The US has the highest cancer survival rates in the western world, in part because we have some of the best early detection practices. And yet, WE'RE HAVING THIS DEBATE PRECISELY BECAUSE OUR COSTS ARE TOO HIGH! Perhaps screening isn't a magical budget cure-all. The problem with screening is that there isn't a way to screen only the folks who will develop diseases. That means you screen tons of people who won't ever develop problems, and the costs of their screenings have to be factored in to your equation.

Take colon cancer, with its legendarily fun endoscopies. The third most common form of cancer in the west, an American has about a 7% chance of getting it. Assuming that you start screening at 50, and will, on average, live to be 75, you'll get 6 preventative exams. With 93% of the population never developing the disease, that means every population of 100 health conscious people will have around 550 unnecessary screenings and about 7 people who benefit. This is, of course, assuming that early detection will cut treatment costs for the 7 people who will develop colon cancer. And it doesn't take into account the fact that people who already engage in less healthy behavior are the ones who are most likely to develop colon cancer and least likely to come in for screenings, while the health-conscious folks who willingly submit to being on the business end of a sigmoidoscope are already at less risk.

In case you want a slightly more authoritative source for all of this, try the CBO. They are the people tasked with telling us if the current proposals can actually, you know, work. And they say no.