An ounce of prevention?

The Wall Street Journal published an outstanding essay by Abraham Verghese on the costs of preventative health care.

If you’ve paid attention to President Obama’s promise to reduce health costs and find the savings that will fund his health care reforms through actions like switching America’s focus toward preventative medicine, take note that while an ounce of prevention might be worth a pound of cure, it sure doesn’t cost less. From Verghese’s article:

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It is true that if the prevention strategies we are talking about are behavioral things—eat better, lose weight, exercise more, smoke less, wear a seat belt—then they cost very little and they do save money by keeping people healthy.

But if your preventive strategy is medical, if it involves us, if it consists of screening, finding medical conditions early, shaking the bushes for high cholesterols, or abnormal EKGs, markers for prostate cancer such as PSA, then more often than not you don’t save anything and you might generate more medical costs. Prevention is a good thing to do, but why equate it with saving money when it won’t? Think about this: discovering high cholesterol in a person who is feeling well, is really just discovering a risk factor and not a disease; it predicts that you have a greater chance of having a heart attack than someone with a normal cholesterol. Now you can reduce the probability of a heart attack by swallowing a statin, and it will make good sense for you personally, especially if you have other risk factors (male sex, smoking etc).. But if you are treating a population, keep in mind that you may have to treat several hundred people to prevent one heart attack. Using a statin costs about $150,000 for every year of life it saves in men, and even more in women (since their heart-attack risk is lower)—I don’t see the savings there.

This isn’t really surprising if you think about it. If preventative care were much cheaper, isn’t that what all the poor and uninsured Americans would pursue, rather than waiting until they end up in the emergency room?