David Brown's right: Prevention isn't cheap. In fact, it can be quite expensive. Here's why: When candidates talk rosily about the cost-saving possibilities of prevention, they're talking about individual cases on a limited time frame. So, the smoker who would've developed lung cancer and required chemotherapy, but instead just got an addiction pamphlet and a nicotine patch. Or the 40-something male with high cholesterol who's headed for heart attack but is diverted by statins. In both cases, it's clear to the listener that the preventive technology is much cheaper than the later intervention. But that's not how prevention works. First, it targets populations, not individuals. Forget the guy headed for the heart attack. We're talking everyone with high cholesterol, most of whom will never drop to their knees with shooting chest pains. To get to those who will be saved by statins, we need to prescribe them to many for whom the medication will make no difference. In order to save the few, we treat the many. And that's pricey. Or take the smoker. It's true that lung cancer is expensive. But so is old age. If someone dies early from smoking, that means we don't pay for them to survive a heart attack and then slowly deteriorate from dementia. Now, we don't want the smoker to die from lung cancer or the big eater to keel over from heart disease. But that doesn't mean preventive care that reaches them is a cost-saver. Rather it's higher value. We may spend more to make people healthy than we do to treat them when they get very sick. That's a good thing -- we want to make people healthy! But it may not be the cheaper thing. Which is why it's a shame that the political conversation around cost-savings is so focused on preventive care. Preventive care is great, but it's not likely to realize large savings. Sometimes, it will, like when it prevents an individual from contracting diabetes, or when we get people to walk more. But often, it won't. For savings, focusing purchasing on high value care is a better bet. We spend a lot of money on care we don't need, that does us no good, and that may in fact do us harm. Cut those costs from the system -- easier said than done, to be sure, but definitely possible -- and you really will be realizing pure savings. Preventive care should also be pursued, as it will make us healthier. But it won't necessarily make the system cheaper.
