Please pause for a moment of silence….[Jesu, Joy of Man's Desiring (with choral)]….Thank you. The idea that preventive medicine saves money is dead. Mammograms don't pay for themselves. Nor do Pap smears. Nor prostate cancer tests. Nor general checkups for healthy people. Etc., etc., etc. Yes, there are some exceptions — childhood immunizations and prenatal care for at-risk mothers, for example. But the exceptions are few and far between. Louise Russell, who knows more about the economics of preventive care than anyone, put some additional nails in the coffin in a recent article [gated, but with abstract] in Health Affairs:
Over the past four decades, hundreds of studies have shown that prevention usually adds to medical spending. [Examination of] 279 cost-effectiveness ratios for preventive interventions (and 1,221 ratios for treatments) from 599 studies published between 2000 and 2005 [show that] less than 20 percent of the preventive options (and a similar percentage for treatment) fall in the cost-saving category — 80 percent add more to medical costs than they save.
Does preventive care save lives? Of course. Does it save money for some patients? Definitely. But the cost of screening healthy patients outweighs the savings on patients whose diseases are caught in their early stages. Preventive medicine is desirable. But there's no free lunch.
For this real downer moment,
who is better than Johnny Cash?
Here's the bottom line. Preventive care is not like an investment good that pays a positive rate of return. Instead, it's like a consumption good. Preventive care leads to better health. But the enjoyment of that result must be traded against the enjoyment of other goods and services we also consume. I know this discovery will not bother most loyal readers. However, it will be crushing news to others.
When did the patient die? More than two decades ago. Almost ten years after the death of Elvis, if memory serves. Yet many people haven't gotten the word. Think how many trees have been felled, supplying thousands of pages, supporting millions of words, by legions of misguided souls — all in the belief that the idea is alive and well. Think how many political candidates — Republican and Democrat, conservative and liberal — repeated the error in the last election.
So feel free to pass this obit along to the uninformed. You'll be helping the environment, saving trees and eradicating public policy illiteracy — all in one fell swoop. Oh, and tell them Elvis is dead as well.