Critical Condition

“We Are Coming Around the Curve”

Or so says House Speaker Nancy Pelosi in this San Francisco Chronicle piece, so consider yourself warned.

The paper’s excellent Washington correspondent, Carolyn Lochhead, explains issues of cost, prevention, and mandates in the emerging health care legislation. A key bit:

Expanding preventive care has been billed as a way to reduce costs, but it is more likely to increase them.

The idea that preventing chronic disease would not save money seems counterintuitive. But Jay Bhattacharya, director of Stanford University’s Center for Primary Care and Outcomes Research, poses an example of a patient saved from a heart attack who later dies from a more costly cancer.

“People have to die of something,” he said. “If you save them from one thing, they’re going to die of something else, and that something else can be more expensive.”

Prevention adds costs in another way: To prevent one person from getting a disease often requires spending money on many more people who would never have gotten sick. Most people who get the measles vaccine never would have gotten measles, but it is impossible to know who those people are beforehand.

This insight is hardly new, for people paying close attention to health care issues, but the notion that prevention saves money is still widely believed, resulting in some pretty silly commentary. Of course, this is not to suggest that preventive care isn’t a valuable thing. The point is simply that it doesn’t pay for itself. There will never be a medical perpetual-motion machine, no matter how hard the Leader wishes it were so.

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