Michelle Bachmann could be our next president.

[Skeptic Ginger]

Well, it's saying that the vast majority of preventive care doesn't save money, ....

-Bri

It does not say that. You don't know what you are talking about.

 

[Skeptic Ginger]

I think it sums up the point being discussed here rather nicely. The blanket statement that "PM saves money" is not supported by evidence.


In the letters tab for the article you will find a similar comment in a letter to the authors, the authors responded by saying "...our analysis of 1500 comparisons described in 599 articles drawn from the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org) did in fact include a number of community-based interventions."


I think you are mis-reading the article. It clearly concludes that while some prevention saves money, the vast majority do not. That is why the blanket claims by politicians that "PM saves money" are incorrect.

The rest of your post seems to be aimed at an argument I never made.

Seeing as how I'm in the medical field, specifically on the prevention side of infectious disease, I'll take my interpretation over yours. You both are misunderstanding the review. Sorry, but you are.

 

[JoeTheJuggler]

I think you are mis-reading the article. It clearly concludes that while some prevention saves money, the vast majority do not. That is why the blanket claims by politicians that "PM saves money" are incorrect.

I believe you. After all, if PM saves people's lives, those same people will, in the long run, incur more health care expenses than if they'd just died of a preventable condition that might have been caught, for example, by a screening test in a regular check-up (i.e. preventive medicine).

 

[leftysergeant]

I believe you. After all, if PM saves people's lives, those same people will, in the long run, incur more health care expenses than if they'd just died of a preventable condition that might have been caught, for example, by a screening test in a regular check-up (i.e. preventive medicine).

Right, then. Not doing the tests saves the insurance comanies money.

It leaves families devastated and broke, creditors out of luck, government services to the needy over-burdened and selfish insurance actuaries patting themselves on the back.

 

[Bri]

It does not say that. You don't know what you are talking about.

Of course it does. According to the study, the vast majority (over 80%) of preventative measures reviewed in the health economic literature do not save money.

Here's a Newsweek interview with two of the authors:

Sen. Barack Obama's campaign links "disease-management programs" to smaller price tags for health care, and Sen. John McCain's says that "by emphasizing prevention … we can reduce health-care costs." But wait, can we? A recent paper in The New England Journal of Medicine says the conventional wisdom is wrong: preventive-care programs usually result in higher payouts, not lower ones.

...

But only 19 percent of the preventive interventions you looked at ended up saving money. Some cost a lot more.
NEUMANN: One example is prostate-cancer screening. It seems to be inefficient.
You have to spend a lot to catch the few cases that threaten people's health.
NEUMANN: And you might intervene medically when it wasn't necessary. So you get better health at very high costs, or you possibly get even worse health.
COHEN: Savings claims for smoking cessation programs are also controversial.

http://www.newsweek.com/2008/08/22/the-politics-of-prevention.html

Another study conducted by researchers from the American Diabetes Association, American Heart Association and the American Cancer Society concluded the following concerning prevention of cardiovascular disease:

Aggressive application of nationally recommended prevention activities could prevent a high proportion of the CAD events and strokes that are otherwise expected to occur in adults in the United States today. However, as they are currently delivered, most of the prevention activities will substantially increase costs. If preventive strategies are to achieve their full potential, ways must be found to reduce the costs and deliver prevention activities more efficiently.

http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.108.190186v1

So while prevention is effective for preventing disease, most preventive measures are not cost-effective. We should do them because they save lives, not because they save money.

-Bri

 

[JohnnyG]

Seeing as how I'm in the medical field, specifically on the prevention side of infectious disease, I'll take my interpretation over yours. You both are misunderstanding the review. Sorry, but you are.

People in the medical field have no stranglehold on reading comprehension.

 

[JohnnyG]

I believe you. After all, if PM saves people's lives, those same people will, in the long run, incur more health care expenses than if they'd just died of a preventable condition that might have been caught, for example, by a screening test in a regular check-up (i.e. preventive medicine).

Another reading comprehension fail. Nobody is advocating against preventive medicine, only the argument that it saves money.

 

[Bri]

I believe you. After all, if PM saves people's lives, those same people will, in the long run, incur more health care expenses than if they'd just died of a preventable condition that might have been caught, for example, by a screening test in a regular check-up (i.e. preventive medicine).

I don't know if you're just joking here, but that's not what the study looked at. I believe they looked only at the total cost of a preventive measure compared to the cost of treatment for the smaller number of people who would get the disease without the preventive measure.

-Bri

 

[JoeTheJuggler]

I don't know if you're just joking here, but that's not what the study looked at. I believe they looked only at the total cost of a preventive measure compared to the cost of treatment for the smaller number of people who would get the disease without the preventive measure.

Basically I was making the same point you did. However if "cost" does not include health outcomes, I reject any such measurement as an abuse of language. [ETA: At best, it's comparing apples and oranges to compare the costs if there are different outcomes.]

The observation that PM doesn't save money (or increases costs) I find similar to the assertion that the New Deal made the Depression last longer. Of course it did, because it kept so many people from starving to death.

 

[leftysergeant]

Well, that trash-talking, faux-Christian bimbo has just gone and slapped a few million good Americans right in the face. The idiot wants to cut veterans' benefits now. What is wrong with that greedy little moron? Is it better to make life harder for a disabled veteran than to charge the Walton larvae and the Koch bothers more in income taxes?

Any soldier who would vote for that lunatic is an idiot. She is not good for America's defenses.

http://www.airforcetimes.com/news/2011/01/military-michele-bachmann-veterans-budget-cuts-012811w/

 

[Bri]

Basically I was making the same point you did. However if "cost" does not include health outcomes, I reject any such measurement as an abuse of language.

OK, but we were discussing this in the context of politicians insisting that increased preventive measures will save lives and save money (they often put it in terms of a win-win situation). The point was that the evidence suggests a much more complicated picture. While it may be well worth the extra costs to prevent disease, most types of preventive procedures cost more money than they save overall.

-Bri

 

[leftysergeant]

While it may be well worth the extra costs to prevent disease, most types of preventive procedures cost more money than they save overall.

your problem is that you are just thinking about what it costs the insurance companies.

That the people who are not getting those health screenings wind up going bankrupt when the health problem, in all its intractible ghastliness manifests itself, drags down more productive sectors of the ecconomy.

 

[Bri]

your problem is that you are just thinking about what it costs the insurance companies.

That the people who are not getting those health screenings wind up going bankrupt when the health problem, in all its intractible ghastliness manifests itself, drags down more productive sectors of the ecconomy.

The context is usually in reference to whether you can count increased preventive measures as a net cost savings when considering the cost of universal health care. The evidence (and the CBO) suggest that not to be the case.

-Bri

 

[leftysergeant]

The context is usually in reference to whether you can count increased preventive measures as a net cost savings when considering the cost of universal health care. The evidence (and the CBO) suggest that not to be the case.

It costs less to remove a polyp than to treat colon cancer.

It's really that simple.

 

[Bri]

Removing a polyp isn't really the type of procedure being discussed. We're talking about doing something to healthy people to prevent disease or to detect a disease early (before there are symptoms). For example, screening for prostate cancer. The problem is that you have to do these procedures to a large number of healthy people in order to prevent the disease that would present itself in a much smaller number of people without the procedure.

-Bri

 

[JoeTheJuggler]

The context is usually in reference to whether you can count increased preventive measures as a net cost savings when considering the cost of universal health care. The evidence (and the CBO) suggest that not to be the case.

Yes, I understand this. But again, I think it's not accurate first not to count a difference in outcomes as "costs" and also to compare costs without controlling for outcomes. My point is, it should be a cost-benefit analysis and not simply an analysis of cost. As a comprehensive cost-benefit analysis, I suspect preventive medicine increase the efficiency of our health care dollars.

It costs less to remove a polyp than to treat colon cancer.

It's really that simple.

And even if it weren't cheaper, just getting a polyp removed is an entirely different outcome than having colon cancer. Even if the treatment costs were exactly the same, I would consider removing the polyp that might become cancer a better outcome than the result of treating colon cancer.

 

[JoeTheJuggler]

Removing a polyp isn't really the type of procedure being discussed. We're talking about doing something to healthy people to prevent disease or to detect a disease early (before there are symptoms). The problem is that you have to do these procedures to a large number of healthy people in order to prevent the disease that would present itself in a much smaller number of people without the procedure.

I think he meant that preventive medicine (screenings) is why you can remove a polyp before it becomes colon cancer. You caught it early enough to require a less invasive (and less expensive) treatment.
That's what I assumed anyway.

 

[JoeTheJuggler]

How about, cost of immunizations compared to cost of treating the diseases they prevent? (And again, I would add into the cost either getting sick or not.)

 

[Bri]

I think he meant that preventive medicine (screenings) is why you can remove a polyp before it becomes colon cancer. You caught it early enough to be a less invasive (and less expensive) treatment.
That's what I assumed anyway.

If that's the case, then he's falling into the trap. Colon cancer screening increases costs because it has to be administered to a very large number of healthy people in order to detect colon cancer in a relatively small number of people who would get it.

-Bri

 

[Bri]

How about, cost of immunizations compared to cost of treating the diseases they prevent? (And again, I would add into the cost either getting sick or not.)

Immunizations are among the 19% of procedures that were shown to be cost effective according to the study.

-Bri