When government accountants run things, they see that preventive care increases expenditures. Their mandate is to reduce expenditures and they act accordingly.

Preventive care should be viewed as consumption, not as an investment that will pay a positive rate of return.

Charles Krauthammer’s editorial questioning the economics of preventive care is wrong. His view of prevention is very narrow and so is the government’s. Prevention is partly about screening tests. It is more about life style. Treating obesity effectively will decrease a lot of disease and it can be treated by public service announcements very cheaply. Changing cultural norms is what the government should be doing to prevent disease.

I like Krauthammer. He is using this piece of disinformation to make a point about government spending.

Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.

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. http://bit.ly/oIAt6

The government should be changing farm policy and changing fast food policy and saving money not spending money.

At long last school lunch policy is changing slowly.

Look at and read my war on obesity. http://bit.ly/G1AT3

Bariatric surgery is not the answer. Health is about quality of life and not about cost to the government or the employer. Health is not healthcare reform. The consumer has to drive his own health and healthcare. The government should be subsiding consumer driven health and healthcare. It can be done cheaply.

The burden of obesity on many chronic diseases is enormous. Diabetes is now 200 million dollars per year excluding days lost from work and the cost of a decrease in quality of life. I think healthcare reform has to start being looked at from a physician’s viewpoint and not a political viewpoint. Obama has it all wrong. It is expressed in my letters to him that can be found in my summary blogs. http://bit.ly/3w6iPx

Measuring 4 HbA1c per year is not the treatment of diabetes. Paying for this performance is not quality care. Getting 4 HbA1c measurement to become normalized is what quality care is about. This will prevent complications of diabetes and not the measurements.

Sincerely,

Stanley Feld, M.D.