The Case Against Preventive Care

Government-subsidized, anyway. Per Deepa's suggestion, I have been reading a couple conservative blogs, and I settled on The Corner (despite running into a Yay Pinochet! post in the most recent section. I cannot buy that his moderately beneficial economic policies in some way balance his brutal dictatorship.)

Anyway, preventive care as a goal has been touted by politicians across the spectrum (it was a centerpiece of Huckabee's healthcare agenda) Mark Steyn starts off railing against the idea that preventative medicine will, long-term, cost us less. I understand the logical progression--when doctor's services are much cheaper, they are used much more frequently than needed. This shouldn't guide us for all medicine, but for cases like prostate cancer where symptoms are often not be indicative of a serious health emergency coming, I could see how cost/benefit could be skewed. (H/T Leah on the example.) That's not as true for every disease though, which is why a nuanced policy is needed on the issues. Beyond that, I somewhat doubt Steyn's proposition that different forms of health care in the Western world have led to negligible differences in outcome. This is true when measuring outcome exclusively by average life expectancy, as he does, but it doesn't speak to folks like me who think the United States isn't a real fantastic place to be poor and sick but the best place to be rich and sick.

I think Yuval Levin has a reasonable reaction to the data here:

...of course there are individual cases when prevention saves money (though not as many as we might imagine). But in the aggregate, and as a matter of public policy, which is what the politicians are talking about, it just ain’t so. There are now literally decades of data on this question, and the answer is very clear: prevention does not save money. It does sometimes save lives, of course, it’s not bad medicine. It’s often very good medicine. But like a lot of good modern medicine, it’s very expensive. We can decide if it’s worth the cost or not, but let’s not ignore the cost, let alone imagine it will save us money.

On a bit of a digression, the Reason post cited by Steyn brings up a point I hit often (in a less oh-noes-commies way):

We've seen an explosion of intrusive legislation around the nation—sin taxes and ingredient bans, to name two. The more we collectivize health care policy the more your comrades will make it their business to demand preventive health calisthenics.

It's easy to say many bad health choices--fast food, smoking--are connected to poverty, but that's not exclusively the case. In quite a few cases, if we institute some form of universal healthcare, we may end up having to look at regulating certain health choices much more strictly or simply accepting subsidization of bad behavior. I'm beginning to think the latter might be worth it.

P.S. Ferny just caused me to notice that Mark Steyn's first link for the Dartmouth study is not direct, but an interpretation of a study by an "alternative medicine" doctor. Link fail, Mr. Steyn. (It's almost as though instead of searching legitimate sites for facts that would form his opinion, he formed an opinion and found matching facts!)