Mark, you’re quite right to call out the often-repeated myth that preventive medicine saves money. Politicians (of both parties) love to say this, on its face it sounds very plausible, and of course there are individual cases when prevention saves money (though not as many as we might imagine). But in the aggregate, and as a matter of public policy, which is what the politicians are talking about, it just ain’t so. There are now literally decades of data on this question, and the answer is very clear: prevention does not save money. It does sometimes save lives, of course, it’s not bad medicine. It’s often very good medicine. But like a lot of good modern medicine, it’s very expensive. We can decide if it’s worth the cost or not, but let’s not ignore the cost, let alone imagine it will save us money.
The most recent serious scholarly review of the data on this question was an article in the journal Health Affairs earlier this year (here’s the link, but it requires a subscription). The author’s conclusion:
Over the four decades since cost-effectiveness analysis was first applied to health and medicine, hundreds of studies have shown that prevention usually adds to medical costs instead of reducing them. Medications for hypertension and elevated cholesterol, diet and exercise to prevent diabetes, and screening and early treatment for cancer all add more to medical costs than they save.
That doesn’t mean we shouldn’t pursue preventive medicine, it just means we shouldn’t pretend it’s going to reduce health care costs.