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Thursday, February 8th, 2018
The curious logic of Professor Adam Carroll
Last week, Indiana University School of Medicine professor Adam Carroll filed a piece for the New York Times with a provocative premise. Titled Preventive care saves money? Sorry, it’s too good to be true, it argued that investing in preventative care doesn’t actually yield savings. Here’s its opening and closing:
We can agree that good things usually do cost money, but this seems like especially curious logic to get to that conclusion. Yes, if fewer people smoke, more people will live longer to get sick of other things and die instead from that, requiring treatment along the way that might be expensive. But this is sort of like arguing that fire alarms don’t save money in the housing market because the homes that don’t burn down within one hundred years become more expensive to maintain.
True, it saved an awful lot of money when that New York State lottery winner put off going to the doctor till he found out he had stage four cancer.
Since he couldn’t afford to catch it earlier, he just straight up died, skipping right past all that expensive chemotherapy, hospital, and hospice care, for months or years of remission and return.
By Carroll’s reasoning, we really should count improved access to reproductive autonomy as monumental healthcare savings because it means you’re not only saving the cost of an unplanned pregnancy or abortion, you’re also saving the economy from a lifetime of future healthcare costs.
Euthanasia on demand, especially for people over 80, would involve lots of cost-saving, and what care could possibly be more preventative than making sure no one ever needs to use health services again?
So that’s just not a useful or really even an honest way to look at things, even if that’s what the studies he references were saying, and I’m not convinced they were, especially when it comes to emergency room visits increasing.
‘When people can afford to go to the Emergency Room without bankrupting themselves, they’re more likely to.’ Well, yes, and an increase in people using the Emergency Room still seems entirely consistent with lowering healthcare spending overall because, for a lot of people, their preventive care is going in to get something checked out when it’s really hurting instead of about to kill them.
Indeed, expanding Medicaid meant more people with injuries requiring emergency care actually bothered to go get it.
Carroll dismisses a study that found that all sorts of preventative care would lead to savings in healthcare of ‘only’ $3.7 billion per year in 2006.
But it saves money to accomplish this each year:
‘People healthy enough not to die’ tends to involve cost-savings in the sense that a lot of money has been invested in a given person already in education and job skills. ‘People healthy enough not to be ill for extended periods of time or permanently disabled’ saves money, too. It might save money not to ever change your oil, but a car that no longer runs is considerably less useful as a car.
Somalia doesn’t spend very much on preventative healthcare, and the costs show up in people who are unnecessarily infirmed and need someone else to take care of them instead of engaging in productive economic activity.
Most suspicious is the fact that Carroll went about making his case by focusing on an uptick in emergency room visits and people surviving lung cancer to die of heart disease rather than a more straightforward look at how other OECD nations’ increased availability of preventative care seems to result in people living longer, healthier lives while their governments spend less on healthcare overall.
To be fair, Carroll is making only a soft sort of argument, but I don’t think his links support his claim, that his claim even makes sense on its own terms, or that even if those were valid, that’s the most sensible conclusion.
# Written by David A Johnson :: 11:39 AM
Categories: Healthcare, Policy Topics
Tags: Insurance & Coverage
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