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More prevention will not cut health care costs. Tuesday’s Post:
Most of us naturally assume that preventing a disease is cheaper than waiting for the disease to appear and then treating it. That belief is especially dear to politicians, who often view prevention as an underused weapon in the battle against health-care costs. …
In 1986, a health economist named Louise B. Russell published "Is Prevention Better Than Cure?," in which she concluded that prevention activities tend to cost more than they save. Since the book’s appearance, her observation has been borne out by studies of hundreds of interventions — everything from offering mammograms to all women and prescribing drugs to people with high cholesterol to requiring passenger-side air bags in cars and shortening the response time of ambulances. …
For example, Australian researchers tried out a program in which general practitioners watched a video and read a booklet about how to help their patients lower their heart attack risk. The patients were then given a series of videos and a self-help booklet on the same topic. How cost-effective is this instruction? When it is provided for women at low risk of heart disease, $9.8 million has to be spent for every year of life saved in the prevention of premature heart attack deaths. …
Some disease-preventing activities … save money, although they are relatively rare. Childhood vaccinations are the classic examples. … Providing a single colonoscopy to men 60 to 64 years old also saves money. …
Similar to the finding that prevention rarely saves money is the calculation that people in good health probably rack up higher lifetime medical costs than their less-healthy brethren. The reason? Healthy people tend to live longer.
Added: I’m mentioned in today’s NYT re prediction markets, alas again as the extremist.
Prevention Costs
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Manon de Gaillande and Matt Blass:
I really liked both your comments. Manon, your point is well taken about people being tired of propaganda telling them to eat less. Actually, I get annoyed by it, too. Propaganda, not surprisingly, doesn't work when people's psychologies immediately produce various seemingly logical reasons NOT to change their lifestyles. Most people who see propaganda (aside from those already practicing preventive measures) are probably thinking one or more of the following thoughts:
A) I will enjoy life less if I change my diet (I don't like healthy food)B) I don't know how to actually apply thatC) I would like to be healthier, but I don't have the timeC) I'm young; I'll worry about that laterD) I don't need to worry because I'm not fat
Propaganda doesn't even address those roadblocks in people's psyches that have virtually doomed it to failure before it even starts.
As a person who tries to live a very healthy life, I am perhaps biased. I'm sold on the benefits of living healthy and I think it's well worth the effort, both for the benefits now as well as in the future. I don't have those psychological biases I mentioned above; but I also know that I had to work extremely hard and learn a lot to get over them. I can't expect others to work that hard at it when they've got other things going on in their lives. I don't blame them for thinking those things.
The thing is, I enjoy food just as much now that I eat healthy as I did when I ate whatever I wanted (I actually enjoy food more, but that's beside the point). I enjoy life more. I'm just as happy. I understand how much more physical and mental energy I now have because of it, even though I'm only 28. I understand that even though I couldn't get fat if I tried (lucky genes), low BMI doesn't necessarily make someone healthy. I understand that what I eat now affects my health in the future. And so on.
But should people have to work as hard as I did to realize that? I've dedicated a lot of time to learning those things.
I think people could digest and understand the reasons for eating healthy (without working as hard as I did) if we can give them something well-presented-- more than just a quick shot of propaganda. You know, if we could actually address those psychological concerns in a more detailed sort of way. In retrospect, I do understand that the knowledge is out there. If we can get the knowledge to people, and we don't ignore their concerns, they'll be on board. I am often surprised to see how much people really do want to know the details of prevention. Also how much they enjoy healthy food that's prepared right. They just don't have the technical knowledge or the time to learn it.
I think people can overcome their food biases through better education (and improved food supply as mentioned before). The beauty of it is that once we overcome the inertia we're in now, good health will become almost automatic as the attitude is passed from parent to child. The medical system will then become far less expensive to run.
But you're right; it's not easy. I think it's worth it, though.