An Ounce of Prevention Is Still Expensive

From the Washington Post, last Tuesday – In the Balance

This article caused a little outrage in some of the comments, but I have to agree with the basic premise. Health care wonk, Ezra Klein does, too. The article makes the case that the prospect of reducing medical costs by preventing illnesses is somewhat overrated. There was some very wonky disagreement with Ezra, too. That’s not to say that preventing illness isn’t worth doing. No one is saying that. There are things with value that can’t be measured with dollars. It’s just always seemed fairly logical that healthy people might live better and longer, but we all start to deteriorate eventually. A real strong heart and unclogged arteries can draw that deterioration out for a lot of very expensive years.

For anecdotal examples I don’t have to look any farther than my parents. My father, who was never too interested in best practices, healthwise, literally dropped dead at age 69. He’d been retired for only six months. He and my mother had gone into the antiques business upon retirement and he was happily engaged in that when his heart stopped. It was a shock to the family, but put little strain on the medical system or his health insurance. My mother, on the other hand, tried to keep up with the dos and don’ts of keeping one’s health and lived to eight-five. That far outstripped expectations of longevity based on her .She didn’t come from a long lived family. Preventative care staved off the conditions that took her parents and aunts and uncles so much earlier in life.

Out of her eight-five years, all but the last year and a half were good one. She was vital, busy and productive. She was also very expensive to the medical system for years before she died. Death took her just before there would have been no choice but for her to be in a nursing home. Lots of other people, many of whom enjoyed good health until they didn’t anymore, spend years in them, due to a need for 24/7 skilled care. We have learned a lot about how to increase longevity, but we have not developed a way to ensure that we’ll go quietly into that good night without developing expensive medical conditions first. No matter how long it takes to come down with something.

I’m not arguing against preventative health care. It is a human imperative to live as long as possible and to seek as good as possible a quality of life while doing that. Hell, I’d be happy as a clam with a single payer system that paid for screenings of every kind, medication as indicated and help with behavior modification if wanted.

I am concerned with the way the national dialogue is focusing on prevention as an important way to reduce costs. That is steadily devolving into a situation where we blame the sick person for costing too much because of choices they’ve made. It seems very similar to the way we now blame people for not having enough money, even if they’ve worked all their lives.


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