In our July/August print edition, I
debunked the myth that preventive care would bend the health
care cost curve, as the White House keeps insisting.
The Congressional Budget Office has now joined the push back:
Preventive medical care includes services such
as cancer screening, cholesterol management, and vaccines. In
making its estimates of the budgetary effects of expanded
governmental support for such care, CBO takes into account any
estimated savings to the government that would result from
greater use of preventive care as well as the estimated costs
of that additional care. Although different types of preventive
care have different effects on spending, the evidence suggests
that for most preventive services, expanded utilization leads
to higher, not lower, medical spending overall.
That result may seem counterintuitive. For example, many
observers point to cases in which a simple medical test, if
given early enough, can reveal a condition that is treatable at
a fraction of the cost of treating that same illness after it
has progressed. But when analyzing the effects of preventive
care on total spending for health care, it is important to
recognize that doctors do not know beforehand which patients
are going to develop costly illnesses. To avert one case of
acute illness, it is usually necessary to provide preventive
care to many patients, most of whom would not have suffered
that illness anyway. Judging the overall effect on medical
spending requires analysts to calculate not just the savings
from the relatively few individuals who would avoid more
expensive treatment later, but also the costs of the many who
would make greater use of preventive care.