Over the weekend, Jeremy wrote:
Ezra, you buy into one of the major fallacies that exists today in health care research: that preventing chronic disease saves money. In fact, if future medical costs are taken into account, virtually all cost-effectiveness research shows that preventing a chronic disease like diabetes would cost the health care system almost immeasurable amounts of money.Why? You mention that diabetes subtracts 12 years from a person's life. If we add those 12 years back by preventing the disease, the health care system will have to pay for (generally) more expensive medical care during this time period. So, instead of paying for 20 years of diabetes care, we are paying for 32 years of health care, including care for much more expensive diseases (e.g. dementia, CHF, etc) that tend to effect the elderly.
You hear this sort of thing a lot, and it is, I think, a bit confused. There are two questions when we're talking about health care spending. The first is total outlay: How many units of U.S. currency we use in a year. The second is value: How much are we getting for each dollar?Paying $60,000 for a Corolla and paying $60,000 for a Lexus might take the same bite out of your bank account, but they're not equally desirable outcomes. Paying hundreds of thousands of dollars to treat preventable chronic diseases like diabetes is a bad value. It's money the U.S. taxpayer should not have to spend. Given that the stated goal of that money is keeping Americans healthy, it's better spent on diseases that can't be cheaply prevented, like most forms of cancer, than diseases that can be cheaply prevented, like, in theory, type 2 diabetes. We want, in other words, to get the most health for our dollar. Paying upkeep on preventable chronic diseases doesn't get us there.
