The CBO issued a report on the ineffectiveness of preventive care. The report states:
" Preventive medical care includes services such as cancer screening, cholesterol management, and vaccines. In making its estimates of the budgetary effects of expanded governmental support for preventive care, CBO takes into account any estimated savings that would result from greater use of such care as well as the estimated costs of that additional care. Although different types of preventive care have different effects on spending, the evidence suggests that for most preventiveservices, expanded utilization leads to higher, not lower, medical spending overall."
The NEJM article used as a reference by Cohen et al states:
"Indeed, some evidence does suggest that there are opportunities to save money and improve
health through prevention. Preventable causes of death, such as tobacco smoking, poor diet andphysical inactivity, and misuse of alcohol have been estimated to be responsible for 900,000 deaths annually — nearly 40% of total yearly mortality in the United States. Moreover, some of the measures identified by the U.S. Preventive Services Task Force, such as counseling adults to quit smoking, screening for colorectal cancer, and providing influenza vaccination, reduce mortality either at low cost or at a cost savings."
As they say, 40% is not chopped liver. Thus the outright dismissal of screening is a bit much. Let us continue to my favorite topic, Type 2 Diabetes. In the paper by Hu et al on Type 2 Diabetes in women the authors state:
"Our findings support the hypothesis that the majority of cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle."
In our analysis we have determined that Type 2 Diabetes results in a cost of about 12% of the total health care budget and furthermore the growth in health care costs as a percent of GDP is correlated to the increase in obesity and overweight with 99%+ correlation. This is a lifestyle issue and a prevention issue. Take the 40% mentioned above, add 12% from Type 2 Diabetes and if my arithmetic is correct we have 52% (I apologize if I have added apples and oranges but I seek to make the point". That is quite a large number.
Yet Krauthammer states:
"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. "
The data appears to reject this conclusion. Prevention, albeit requiring patient cooperation, does prevent disease and save money. Just measuring HbA1c does nothing. To paraphrase Osler, if all else fails, look and listen to the patient. Obesity is the primary cause of Type 2 Diabetes as is smoking on lung diseases, and much of cardiovascular diseases. The devil is in the details and perhaps the naysayers should look a bit more in the details.
Yet this still posits the question as how does one get obese people to reduce their burden. One can look at a Pigou type approach and tax the consumption chain, namely carbs, tax the effect change, namely weighing people as part of their tax return, or just bearing an exploding, pardon the pun, burden on all of us. Prevention in many areas is the beginning of the process, not the end, and one should not abandon the beginning. Selecting the way to get to the end may be politically more difficult.
" Preventive medical care includes services such as cancer screening, cholesterol management, and vaccines. In making its estimates of the budgetary effects of expanded governmental support for preventive care, CBO takes into account any estimated savings that would result from greater use of such care as well as the estimated costs of that additional care. Although different types of preventive care have different effects on spending, the evidence suggests that for most preventiveservices, expanded utilization leads to higher, not lower, medical spending overall."
The NEJM article used as a reference by Cohen et al states:
"Indeed, some evidence does suggest that there are opportunities to save money and improve
health through prevention. Preventable causes of death, such as tobacco smoking, poor diet andphysical inactivity, and misuse of alcohol have been estimated to be responsible for 900,000 deaths annually — nearly 40% of total yearly mortality in the United States. Moreover, some of the measures identified by the U.S. Preventive Services Task Force, such as counseling adults to quit smoking, screening for colorectal cancer, and providing influenza vaccination, reduce mortality either at low cost or at a cost savings."
As they say, 40% is not chopped liver. Thus the outright dismissal of screening is a bit much. Let us continue to my favorite topic, Type 2 Diabetes. In the paper by Hu et al on Type 2 Diabetes in women the authors state:
"Our findings support the hypothesis that the majority of cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle."
In our analysis we have determined that Type 2 Diabetes results in a cost of about 12% of the total health care budget and furthermore the growth in health care costs as a percent of GDP is correlated to the increase in obesity and overweight with 99%+ correlation. This is a lifestyle issue and a prevention issue. Take the 40% mentioned above, add 12% from Type 2 Diabetes and if my arithmetic is correct we have 52% (I apologize if I have added apples and oranges but I seek to make the point". That is quite a large number.
Yet Krauthammer states:
"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. "
The data appears to reject this conclusion. Prevention, albeit requiring patient cooperation, does prevent disease and save money. Just measuring HbA1c does nothing. To paraphrase Osler, if all else fails, look and listen to the patient. Obesity is the primary cause of Type 2 Diabetes as is smoking on lung diseases, and much of cardiovascular diseases. The devil is in the details and perhaps the naysayers should look a bit more in the details.
Yet this still posits the question as how does one get obese people to reduce their burden. One can look at a Pigou type approach and tax the consumption chain, namely carbs, tax the effect change, namely weighing people as part of their tax return, or just bearing an exploding, pardon the pun, burden on all of us. Prevention in many areas is the beginning of the process, not the end, and one should not abandon the beginning. Selecting the way to get to the end may be politically more difficult.
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