David Brown over at the Washington Post wrote an article yesterday noting that prevention isn’t necessarily cheaper than “doing nothing” and letting people get sick. Well, “Duh,” I say.
Prevention is an intervention, it’s just an intervention that occurs prior to disease onset rather than after. I’m not sure where the argument is here. The results — longer, healthier lives — aren’t measured in dollars (unless you account for loss productivity or economic loss from a shortened life). What cost would you put on an extra year of life on a person’s life? $1,000? $10,000? $100,000?
The real answer is that prevention saves money and lives in some cases, and costs money but still saves lives in others. The only reason “prevention” looks more expensive in the mathematical models done by the Dutch researchers in the Feb. issue of PLoS Medicine is because the healthier people lived the longest.
So yeah, if economics is the sole yardstick, people who die earlier are always going to skew the results to the sicker people who die sooner. Luckily, health care isn’t doled out by economics, but by doctors and researchers looking to help people. Help them not just with an episodic illness, but also to understand how to prevent or reduce the risk of future episodes of illness.
I am not sure what is the purpose of the WP article. The conclusion is: “Prevention can be a great investment, but it’s still an investment. Nothing in the modern health-care economy is cheap”. Duh, I say too. You could make the same argument about education. And so the solution would be to limit availability of education to save costs??
What I found most surprising in the article is the total lack of mention of the current evolution of the medical system. The argument that it is expensive to have preventive interventions because they must be given to the entire population that “may be” at risk represents the old model. With the development of predictive medicine those costs could go down significantly, even though a whole new category of ethical issues will have to be solved.
The argument that it’s expensive to have preventive interventions is STUPID! CRAZY! What are they thinking? What are their priorities?
What are we (the patients), a cost center to be optimized??
It’s often cheaper to let people get sick?? Is this thinking promoted by someone who has children?? Or who loves ANYONE?
Or perhaps it’s people who simply don’t have a soul, and are quite happy to look at us as things to be optimized, with numbers on our heads.
Now, if they’re talking about a common cold, that’s one thing. And of course there’s a limit – I could get a CT scan every few weeks to keep an eye on my tumors, but it would cost a fortune and we already know it wouldn’t improve outcomes. But to assess that, you have to dig into the article and think, and too many people don’t.
My gut right now is objecting not so much to the content of the article but to the almost reckless subhead, “studies show it’s often cheaper to let people get sick.” It’s so, so easy for something like that to catch the eye of a policy-maker. The Post should have been more careful – and even more responsible.