Congressional Budget Expert Says Preventive Care Will Raise — Not Cut — Costs

Duh?

And this is surprising…. how? Way back when private insurers started pushing HMO’s the big “selling point” was that preventive medicine would be covered and it would bring down the cost of healthcare in the long-run. That worked real well, didn’t it? People don’t go for preventive care. It hasn’t worked in the last 25 years & it won’t work in the future.

The reality is that Democrats will say just about anything to sell the deal. Most likely, they don’t even understand the plan themselves, most haven’t even read it. They’re acting like sleezy used car salesmen, they could care less about the ultimate consequences. They do like, however, the idea of gov’t. getting their greedy hands on almost 20% of the economy where there will be plenty of ”side-benefits” for them & their friends. Face it, folks, we are getting a snow-job from a bunch of con men, chief among them you-know-who.

Nancy Pelosi, the cost-cutter. Say, Nancy, what about the executive jets for people like you that only cost $200 MILLION? Think about how much money we could save by getting rid of Nancy Pelosi & her friend, Chris Dodd?

thank you for this helpful information in the debate

The study shows that some preventive measures are cost effective and some are not. Then Elmendorf assumes that the reform will institute all preventive measures whether they are cost effective or not, and shows that that approach would not save very much money.
Its kind of like saying that there are effective military technologies and ineffective ones, then assuming that we are going to buy all military technologies whether they are effective or not, and then claiming that military technology overall is an ineffective investment.

I continue to think that the most efficient and comprehensive way to make sure people in the U.S. have healthcare access is to transfer current insurance premiums to a medicare/medicaid type program. Anything else is likely to be too costly, consume too much time in planning, and contain too many mistakes.

Define “necessary medical procedure”. Who decides what’s “necessary”.
Define “cost effective”. Who decides what’s cost effective.
There’s not one angel or saint in this country I would trust to run this program. Not. One. It is beyond the moral, ethical and intellectual capabilities of government and politicians to handle. Folly is right.

Watching the look on Obama, Pelosi and Waxman’s faces when the COB tells them yet again their farece of a government run health care bill is too costly——————-PRICELESS!!!!!

1) serious tort reform
2) secure the borders and kick out all illegal aliens. Send a bill (or seize assets) of illegal aliens, and their countries, to pay for the healthcare, education, and imprisonment when they were here criminally.
3) make income level, proven wealth, proven professional skills, or post-graduate education necessary for immigration to US
4) single-payer system. No health care insurance companies. Universal coverage for legal citizens from birth until college graduate or 25years old. Then if you make over a certain income threshold you buy your own insurance to help substisize the healthcare for deadbeats. However this also flags you in the system for preferential treatment (say if there is a waiting line at the doctor or dentist and its not an emergency.)
5) anybody can, if they wish, pay cash or buy private insurance for better services, private hospitals, etc.
6) no centralized database and doctor-patient privledge is preserved. (No Obama crony “czar” getting access to your private personal information.)
7) American companies no longer need to deal with the excessive costs of providing healthcare to their workers and can be more competitive.

Look for the CBO and Elmendorf to be marginalized. This administration will proffer the CBO doe not calculate accurately or take in to account extraneous factors, so called inter-active savings.Yet, the Dems don’t want to looks at such provable benefits from tax reductions. No, the new Democratic “public enemy number 1″ is not Michele Bachmann, but rather Doug Elmendorf. Plese refer to Inspector General Gerald Walpin.

Ed, who posted at 11:43 a.m. has it correct.
Congress MUST listen to the conerns of ALL POINTS OF VIEW on this problem. Most believe reform is needed but not a program that has been ill-prepared and rushed thru. Slow down and get it right this time.
Politicans are insulated from “the masses” and need to go to Wal-Mart, Sears, Denny’s, or other “common places” and talk with THE PEOPLE.

Sweet!
The Dems thought Obama was their savior and now he is destroying them.
He’s already ineffective and marginalized.

The Democrats really need to stop squirming around the truth and be honest about the health care bill and what the effects of it are going to be if it passes.
Politicians are mostly lawyers, the CBO is reports are supposed to be economic forcasts. Lawyer use different criteria then economists.
The CBO analysis on cap-and-trade was a financial report rather then an economics report, that makes it much narrower, and does not show the effect on the economy.

Sounds fishy.
It is my duty to report Elmendorf to Big Brother.

“Whether any preventive measure saves money or is a reasonable investment despite adding to costs depends entirely on the particular intervention and the specific population in question.”
So whether a preventive measure saves money or not depends on what is it and if it is properly target. DUH. Mammograms don’t make sense for men (although yes, men can get breast cancer) and CAT scans don’t make sense for anyone without other symptoms.
Perhaps if they didn’t use such a massively vague term as “preventative care” this would be more useful.
From the study:
“Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs.”
This headline really distorts reality in an effort to work up some conflict.

This debate sounds reminiscent of the health care debate from the early 90’s. I seem to remember that we were told that if we didn’t adopt the Clinton plan for national health care then the whole system would collapse and care would cease to exist. Forward to today and the political environment seems eerily similar to the coercing /threatening scare tactics that had been employed before. What I have noticed is that those supporting the legislation seem to fear a true national debate and shy away from discussing details of the plan. I’m not sure the American people as a whole can find the time to truly analyze how this would affect them. If the proponents were truly representing their constituents then they would at least outline the good, bad and/or evil and truly let the majority of the people decide if a socialistic type health care system is right for them. We have survived the last 16 years without nationalized healthcare when it was promoted as being mandatory for our survival. All I recommend for now is that we educate ourselves so that we understand the critical details in regard to the cost/benefits of what is being proposed. Would 6 months to a year of additional debate be so bad if this legislation is as beneficial/necessary as those who support it would like us to believe, I think not. I vote for getting the details and facts out so we are truly educated on what we’re getting before we sign on the bottom line. The whole idea is for the representatives to represent us, lets make them do their jobs.

SURPRISE, SURPRISE!!!

Its interesting that bureaucrats, like Elmendorf, are used by the anti-reformers’ to make their case. Isnt that what they say they are against? Shouldn’t medical professionals, who say that preventive care is the way to go, be the ones that Congress listens to?
Posted by: Mark from atlanta | Aug 9, 2009 2:15:43 PM
======================================= The vast majority of medical professionals do NOT agree with congress on this one either.
Please do not bring up the AMA, they only represent less than 20% of our nations medical professonals and it has been noted since the AMA endorsed Obama’s government run health care, many of that 20% are stepping away from the AMA.
Hmmmmmmmmmmm…….interesting!

Elmendorf cited an article from the New England Journal of Medicine that has a summary of a large number of studies but he did not look into the studies himself. Using one article to “filter” a large body of evidence is lazy research. This is at best, lazy, at worse it is intellectually dishonest.

“The vast majority of medical professionals do NOT agree with congress on this one either.” – Can you citation that backs up your claim? I was a medical professional and my wife still is and we have seen first hand how currupt, inefficient and…even deadly our current health system is.
Please cite your source on the opinions of medical professionals.

Sermo recently released results of a survey indicating that most doctors no longer want the AMA to represent them. According to the Sermo survey, 75% of physicians surveyed are not members of the AMA, and 91% of physicians surveyed do not believe the AMA accurately reflects their opinion as physicians.
Of the doctors surveyed, 87% think it is wrong that the AMA makes more money from insurance companies than it does from membership dues.
(Sermo reports that 4,156 physicians responded to a survey, conducted between July 1 and July 7, 2009; and 1,957 physicians responded to a survey, conducted between July 8 and July 16, 2009.)

Mark from Atlanta-I do know several nurses who support this bill,but I know many more who are concerned about its effects on their employment.Almost certainly hospitals will have to do more with less-people will be let go and smaller hospitals will close.As for physicians, I know literally hundreds of them and not ONE( even liberal Democrats) supports this bill.There may be more support among academic MDs but they are a small percentage of the total number of MDs.”Those that can do,those that can’t teach”.

I heard a man from the British Parliament yesterday discussing the national health program they have in England. As he stated, that was begun after WW2 when food and everything else was rationed, so it was a critical time . What he couldn’t fathom was why any country not at war as the Brits were would even consider such a disaster.
What proponents of the public health plan don’t mention when pointing to other countries is the fact that the third largest employer in the WORLD is the British health program. Yep, over 1 million administrators, not counting the other staff required and their numbers overwhelm the number of available doctors and nurses.
Britain doesn’t have an open ended immigration program, either, that adds millions to their program yearly as ours will.
When asked who were the losers in Britain, he immediately said the elderly were the biggest losers and that basically children were the primary beneficiaries. He related instances where the elderly were left in wards to starve to death.
This man isn’t a shouting zealot. He’s a respected member of the British parliament who knows the U.S. is preparing to walk into a huge trap from which there is no escape. As he put it very simply—once the health program begins, it’s tentacles reach into so many aspects of the government, it can never be ended even if it destroys the economy.
His information was sobering.

Has anyone seen what Congress gets for health care? The whole system is well run, and is a perfect example of less beaurocracy, and a great example of how it SHOULD be applied to Medicare.
Stop this government-control health care bill! We can reform Medicare first! Simple as that, if this administration wasn’t so hell bent on POWER AND CONTROL OVER THE AMERICAN PEOPLE!
Then TORT reform! It’s so simple that we will never do it. Federalism, by letting the states do these type of experiments, before we go nationwide, is the way to go. And we see that Massachussetts and Tennessee has tried it, and is failing miserably. Give states the incentive to try more. But don’t, FOR THE LOVE OF OUR REPUBLIC, jam government-controlled health care down our throats!
We will revolt!

The CBO are financial experts, economists, that type of people.
Congress is politicians, lawyers, that type of people.
The CBO estimates have a good record of being correct, Congress doesn’t.
Congress doesn’t fix things, they put more money into it if they like and take it out if they don’t. Programs hardly ever end, it is difficult for agencies to get Congress to end them even when the agency over them asks Congress to. It takes years sometimes.
Fix things, are you even in the same country and talking about the same Congress?
Posted by: Joyomama
As I read it, So CBO is saying the Dems are overestimating the savings, the Wh and Dems in Congress are saying CBO is underestimating the savings and saying preventative care may cost more, at least in the short run. So we have a “he estimates, she estimates” debate, and won’t know the answer until SOMETHING is enacted and we have data. At that point, congress can revisit the legislation and revise it, which happens all the time.
And in the meantime, my friend who won’t go to have her symptoms checked out because she is pretty sure she has lupus like her sisters and mother, but she can’t afford the doctors’ visit or a treatments, has to wait. Health care reform has been needed since the Depression. Seniors got a piece of it with Medicare. It’s time to confront the real cost to the country and its citizens from letting nearly 50 million of us — and growing daily — fall through the cracks in a terribly flawed system.

KMDay –
The AMA, which has endorsed Obama’s call for health care reform, has about 135,300 members who are practicing physicians, about 15% of the total number in the US. That places the estimate # of practicing physicians in the US at around 900,000. The 13,000 signatures from Sermo represent 1.4% of America’s physicians.

KMDay – Rregarding wait times in France: My daughter lived there for a year and she once had to call an ambulance and it arived with a doctor on it! It is not here experience alone – WHO has ranked France’s system as the best in world in terms of both cost control and positive medical outcomes. Where do you get your info on wait times? I would like to know.
Posted by: Mark from atlanta | Aug 9, 2009 2:42:25 PM
========================================Are you serious? France’s health care is NOT the best in the world, the PRICE TAG is because they tax the crap out of their citizens.
I am curious, was your daughter their visiting and using her American Insurance or was she milking France’s system as an illegal alien paying for nothing?
France picked up her tab or did they charge her insurance?
I thought I referenced wait times in Sweden? WIth respect to France, their government only cover I believe 74% of their health insurance and they do not cover dental OR vision.

“Why are we putting illegal aliens on the tax payer health care bill?”
So they start paying into the system instead of just draining it by getting emergency room care.

KMDay – I asked you to cite a source that said “medical professionals” did not support reform and you gave me a survey on how MDs feel about the AMA. Some MDs do not support the AMA because the AMA does not support single payer. In addition, medical professionals include nurses too you know. Do you have other surveys?
Posted by: Mark from atlanta | Aug 9, 2009 2:57:20 PM
=======================================
So you are dismissing a valid letter/petition of over 13,000 doctors who oppose Obama’s Government Run Health Care?
Nice…..I suppose giving you the name of the source and who was doing the talking of 13,000 doctors opposition to this farce of a bill is not big deal to you, but 13,000 is not a small number of doctors sir.
Do you have a source that demonstrated the vast majority of doctors do support Obama’s government run health care?

“Federalism, by letting the states do these type of experiments, before we go nationwide, is the way to go. And we see that Massachussetts and Tennessee has tried it, and is failing miserably.” – I dont understand your point. It seems contradictory.
Posted by: Mark from atlanta | Aug 9, 2009 3:01:25 PM
======================================= I am not trying to be rude, but are you intentionally playing dumb?
The poster copied someones post and then backed it with how poorly the states did with universal health care.
Tenn. is broke because of it, Mass. is as well and hospitals are suing the state because they are not paying what they are suppose to be paying AND, Hawaii had to do away with their Universal Health Plan for JUST CHILDREN within 7 months because it was bankrupting the state.
Do you seriously not understand that the government cannot run the plan they currently have in place?

“False choice.”
Well what is the choice then? Do we have consensus that preventative care helps prevent people from getting debilitating illnesses? Even if Elmendorf is correct–the CBO is just a governmental referee–who cares if it costs a little more to save these people?

“Federalism, by letting the states do these type of experiments, before we go nationwide, is the way to go. And we see that Massachussetts and Tennessee has tried it, and is failing miserably.” – No I am not playing dumb. I truly dont understand your point. Dont you think this statement seems contradictory by saying leave it up to the states and then citing cases where states have failed?

“seven state medical societies, three specialty medical associations, and two former President’s of the American Medical Association representing 43,000 doctors wrote that they were adamantly opposed to the Democrats’ bill” – Seven state societies out of fifty? Even the ones who do oppose it, such as the one here in Georgia, do not have consensus regarding opposition. And you did not answer my question regarding the other “medical professionals” – nurses.

Tort Reform is desp. needed.” – Yes, think tort reform is needed. A large portion of malpractice awards go to cover the cost of future injury-related care. Universal coverage would eliminate that portion of awards and lower malpractice premiums. Another reason to enact reform. What do you think?
Posted by: Mark from atlanta | Aug 9, 2009 3:10:22 PM
=======================================
Unfortunatly it does not lower the cost-there is nothing in the bill as it reads today that does lower the cost.
Right now soldiers cannot sue the government if they botch a surgery or kill a patient on the table. A 20 year old soldier lost both of his legs because a government doctor bothced a routine gal bladder surgery and severed an artery. He waited too long to get him to a private facility that could have contained the blood loss-instead, he lost both of his legs and now his family nor he sue the government for what they did.
Are you saying that because the government will run the program we cannot sue them for malpractice or are you assuming that because the government is jumping in and controlling the costs there will be no need for high malpractice insurance?
The capability to sue will still be there, therefore whether or not the government controls the price of health care is irrelevant to suing for an outrageous amount.

winz–
“That is one of the flaws with our political system, that in Committe a part of the bill that the vote was based on, can be put back in, removed, or changed.”
That’s not a flaw, it’s a design feature — seriously! The legislative process should involved debate, drafts, more debate, committees, debate, citizen input, veto threats, debate, lather, rinse, repeat. Or repeal (even Constitutional Amendments, if they are dumb enough, like Prohibition!)
What was not part of the original design: death threats, name-calling, being hung in effigy, legislation by lobby (i.e., when they draft the bill and Congress rubber stamps it), and questioning the patriotism for people one disagrees with.
I hope, if we can resist unproductive discourse (and call out those who persist in it) and we can make our desires known clearly and respectfully, a solution will emerge. It will not be perfect, and we may not all get what we want. But that’s how democracy is supposed to work, I think.

One thing no one seems to mention when ranting and raving about our “broken” health care system is that everyone ends up getting the care they need.
Well, actually, almost everyone – *see footnote below*
No insurance? No citizenship? No worries. Just take your kids to the local emergency room – which is legally bound not to turn you away – and set the public meter running for treating an earache or cold.
No insurance? Homeless? Alcohol problem? Just call 911 for a free ride to a clean bed and warm meal – a la Ricky Alardo, who has run up an estimated 3.9 million tab – paid for by taxpayers.
A mother With four kids with disabilities – and eight without – stated that “I’ve seen my share of NICUs, ICUs and ERs. And I’ve seen a lot of disadvantaged people receive EXACTLY the same care my family received. The only difference was that since we had insurance, we had to pay copays – and they didn’t.
On March 3, I reported on Rahm Emanuel’s game plan: “You never want a serious crisis to go to waste. What I mean by that is an opportunity to do things that you think you could not do before….”
So for months, the American public has been whipped into shape by CRISIS AFTER CRISIS, so the Obama Regime can Rahm ram through thousands of pages of unread legislation larded with political paybacks and power grabs which will prolong the crisis and leave us more stripped, dependent and vulnerable than ever.
Using emotionally manipulative propaganda like the following DNC ad, they get a dumbed-down culture on their side”
Lost in this ObamaHype is the fact that the US has the best health care in the world, as evidenced by our lower mortality rates:
* There is a 90% survival rate in the USA for five cancers – breast, prostate, thyroid, testicular and melanoma. In Europe, only ONE, testicular cancer, has a 90% survival rate.
From Why is Government Health Insurance Good Only for Some?
Tell me the truth: If you found you had breast cancer or prostate cancer, can you think of any other country you’d rather be in? Think this through, folks. Why destroy the world’s best health care system because a bunch of Marxists tell us we have to “fix” it with a plan that seems like bringing in a sledgehammer to fix a headache?
And then there is the cost. . . . which O&Co are trying to convince us will come only from the super-wealthy. C’mon, folks, the super-wealthy find ways to shield their money from taxes. It’s the middle class that always ends up footing the bill – often in secretive unofficial taxes slipped in under our noses. Looked at your phone bill recently? I don’t know about yours, but mine has extra charges adding up to 15% these days.
I heard a caller from Belgium on Laura Ingraham yesterday. When asked how government-controlled health care for all was working there, he answered that they had a 21% sales tax (21%!!!) and that they were not allowed to get second opinions.
And like everything else – the crisis, the urgency, the sky is falling if we don’t do this NOW!!!
Obama also says the other side does not have a plan. NOT TRUE!!! See the Heritage Foundation for dozens of articles analyzing and suggesting modifications which do not involve government takeover or risk to the high standards of care we not enjoy.
*Oh, and btw, we already have fully-controlled Government Health Care in the US. It’s found on Indian reservations, where money runs out and sick people are denied services – in some cases leading to unnecessary and untimely deaths. See Promises, Promises: Indian Health Care’s victims
Is that really what we want for our families?

“Would you like for me to do some more research for you Mark?” – Its up to you. I am just tired of outlandish folks making claims regarding reform that can’t be backed up by legitimate sources. You at least try which, in my opinion, puts you way ahead of most folks, my friend.
Posted by: Mark from atlanta | Aug 9, 2009 3:33:42 PM
======================================= Ya know, my apologies if I came across as a rude wench…I did not realize how my post sounded until you reposted it.
I suppose I get a tad frustrated as well because there is nothing that validates the state of emergency need to have government run health care.
I am all for goverment regulated health care so that insurance companies and pharm. industry are not killing us with their outrageous prices, but we must first look at what started this catalytic effect —– the introdcution of HMO’s comes to mind and i can give you one guess whose BS hair brain idea that was.

” the US has the best health care in the world, as evidenced by our lower mortality rates” – You cited only cancer care. /the US , according to the CDC and the WHO has lower life spans and lower infant survival rates than most European countries. Why did you selectively choose cancer survival and ignored these other stats on life expectancy and infant survival rates?

I like my health care just fine, thanks. Honduras can happen here. Yes it can!

Because Life Expectancy by itself is not a valid measure of health care quality.
Neither are Infant Mortality Rates.
Actually, there isn’t a formula that has been found valid enough to actually use it.
That is why WHO stopped putting out the rankings, and the WHO rankings weren’t even as simple as you are trying to do.
Posted by: Mark from atlanta
The US has the best health care in the world, as evidenced by our lower mortality rates” – You cited only cancer care. /the US , according to the CDC and the WHO has lower life spans and lower infant survival rates than most European countries. Why did you selectively choose cancer survival and ignored these other stats on life expectancy and infant survival rates?

Good work, Jack, but…I noticed this contradiction:
“The authors of that NEJM study wrote that “Sweeping statements about the cost-saving potential of prevention … are overreaching.”
Now, compare to the headline here:
Congressional Budget Expert Says Preventive Care Will Raise — Not Cut — Costs
…
hmmm….
…
This makes me think of an analogy:
Suppose the front of my home property has some expensive plants that will much more likely survive if I water them during the summer, but that the property also has a large driveway and stone courtyard. Suppose one proposal is to save plant replacement costs by watering the entire front property…
Suppose an auditor then reports: watering will likely add to costs since only about 20% of the area to be watered will really save costs, and the other 80% will not save costs.
This is reasonable and correct, but….
shall we say, needs a bit more?
What if the various news reports in the neighborhood rags then have headlines like: “Watering to add to net plant costs” or “Watering may add to costs of greenery”
This is our problem here.
Of course, I will water the plants themselves, not the concrete and stones, and save money on net versus replacing them each year instead of watering, etc.
Further, I will also have more, nicer looking plants — a benefit. They might include further benefits, such as cooling shade, etc. (analogous to healthy individuals being able to have fewer sick days and thus produce more.)
This kind of everyday common sense isn’t automatically ruled out from an incentive system for preventive care.
…
Here’a an alternative CBO statement:
…
“Some kinds of preventive care create net savings over long time periods, and other kinds do not. Therefore a plan that doesn’t focus primarily on the proven cost-effective preventive care measures will likely add to net costs.”
This would seem adequate to me.

“Because Life Expectancy by itself is not a valid measure of health care quality. Neither are Infant Mortality Rates.” – Epidemiologists at the CDC and other medical research bodies use this data all the time to measure the effectiveness of interventions. Look in any peer-reviewed medical journal. Infant survival rates correlate very well with quality, affordable pre-natal care. Ask an OB-GYN. Thats why the fact that all 19 countries with higher infant survival rates also have national health plans is considered significant.

1. Litigation costs makeup 1% of healthcare spending and are not truly a way of lowering costs. In California, tort reform has been in place for 30 years and has not changed the cost of malpractice premiums.
2. 59% of all physicians polled want a single payer system. The AMA only represents 30% of physicians and these are often specialists who already earn a lot of money.
3. 60% of Americans want healthcare reform. I don’t know what percentage want this plan. I know that I do not like it because I do not think it is far reaching.
4. This nonsense about “death squads” and forcing end of life decisions has got to stop. The fact of the matter is is that few patients have the death that they envision. They usually die in a manner not consistent with their wishes. The bill is simply outlining a need for patients to have review their final wishes.
Please know that it is normal for people to change their minds and wish to have everything done for them at the end of life. Spelling out your wishes just provides us the opportunity to know your wishes beforehand if you are not able to discuss those at the time your death is nearby.
5. As for triage, this is a necessary evil and is a part of a larger discussion about large scale mass casualty events. It is intended to address a shortage of supplies versus a surplus of patients.
For those of you that like the for profit system, I will note here that this system has no incentive to store or stock supplies in the event of a mass casualty incident because it does not earn the facility any money to do so. Most hospitals have actually very few supplies or rooms that are not in use constantly because it isn’t beneficial to their bottom line. A single payer system would be more likely to address this important public need.
In the meantime, we need to develop an intelligent plan to treat say 50,000 burn patients in the event of another September 11th situation and yes, by necessity, some people will not receive treatment.

“For those of you that like the for profit system,”
What exactly is it that you do for a living? Are you “for profit”? Do you work for free?

Another comment on this article: The comments are coming from our physician community. Keep in mind that they are focused on screening and testing. Here is an example of how personal accountability and true preventative care can work:
In Britain, patients do not receive pap smears every single year. If I remember correctly, it is every three years for patients between 18 and 30 and then even fewer after that.
Cervical cancer remains fairly rare and given the number of screenings that are done, relatively little economic benefit is derived.
Patients would be wise to avoid risky sexual behaviors that lead to cancer and receive fewer screenings. YOU ARE IN CONTROL OF YOUR HEALTH.
The same is true for colon cancer. For patients at risk, I would strongly suggest eating less red meat and maintaining a healthy weight and fewer screenings (save for those with family history)
The same came be said for diabetes, hypertension, etc. We have alarming rates of preventable diseases and we could do more to encourage patients to take their health into their own hands.

“YOU ARE IN CONTROL OF YOUR HEALTH.”
You are in control now. NOTHING can stop you from trying to be healthy.

“we could do more to encourage patients to take their health into their own hands.”
Naive. People are constantly bombarded with heaslth information. They choose to ignore it.
Put it on Oprah.

Everyone should read the great, short, linked New England Journal of Medicine review article Jake references above and gives a link to — it’s the 3rd link in Jake’s article. (I’d offer the link again, but I notice all links in comments are prohibited.)
Less than 5 minutes, but very worth it, if you want to understand the preventive care cost equation well.

One more fundamental point. The “cost-saving” types of preventive care the NEJM review article (linked in Jake’s article) by Cohen, et. al refer to are *only* medical costs!
So, for instance the savings created by fewer sick-days both for businesses and for tax revenues are not counted.
The CBO is also referring only to pure “cost-savings” in medical costs alone, without regard to external cost-savings such as fewer sick-days, etc.
Even by this narrow standard, several types of preventive care are medical cost-reducing.

Drjohn: My point isn’t that people are not in control of their own health now, my point is that they refuse to take ownership of their decisions. Its not naive. Its reality. They prefer to get fat, happy and diabetic because there are no consistent consequences for their behavior. They get more prescriptions and more care and believe they will get millions of dollars worth of dialysis in the future.
My point is that if they believed they wouldn’t get this care, they would be more mindful of their own health. In other words, it wouldn’t be a bad thing to tell them “no, you won’t be getting that dialysis for 25 years at 70+ years of age…”

Drjohn:
There is no logical fallacy in my argument that capping litigation does not reduce malpractice premiums. The obvious answer is that insurers are in the business of making money. Thus, the costs of litigation and the costs of premiums are not the only things that effect premiums. Obviously, they need to make a profit so before we go tramping on the rights that petitioners have in a court of law, let’s consider whether or not tort reform would actually change the costs of doing business as a physician. The obvious answer is its been tried and it didn’t work.
Further, the costs of litigation in healthcare total 1%. We are not exactly likely to have a huge impact on costs by examining this issue. I used to work in law firms and I remember reading that 97% of malpractice claims are filed against 3% of physicians so we see the same people being sued time and time again. I would suggest that the community look at its own members first.
75% of all med/mal claims are then dismissed at summary judgment, meaning that the suit never really got off the ground, keeping the expense of the nonsense lawsuits low. All of this against the backdrop that you need another physician to swear that you even have a claim against the first physician.
2. Government is here to serve all of us. Presently, 60% of us, including 59% of physicians polled, prefer reform so why should we accept the status quo.
3. Health care reform can mean any number of things. I personally would prefer to see the government heavily regulate the insurance industry, provide an opportunity to the wealthiest 10% to opt out and buy their own insurance and provide the opportunity for physicians to control their own pay by deciding how many patients they see or treat.
Regarding mass casualty incidences, my point is not that we need some overabundance of supplies (but we certainly need more than we have now). My point is that the current system actually works against public health interests.
Americans have been lulled into this false belief that the health care system can take care of them in the event of an emergency. Ha ha. The hospital system is largely for profit. If you are stable, you will sent to the charity hospital. If we don’t have the resources, its because hospitals are not invested in providing care, they are invested in making a profit.
I can see that we have ideological differences when it comes to providing care. To me, a single payer system, preferably modeled on the German system is humane and makes good common sense. It would also be cheaper to provide. (At my lase non-health care job, I paid 23% of my paycheck to medicare tax and health insurance premiums, the Germans pay 16% health care tax and of course, the deductibles are non-existent.)
posted by dr. john:
1. Unless tort reform was the only thing that has happened in the last 30 years that affects malpractice premiums your first statement dont prove anything, it is a logical fallacy.
2. Government is here to serve all of us, health care is here for us. Physicians are only a small part of us.
3. Health care reform does not meant government taking over our health care system.
4. Its a bill, once it is a law it gets interpreted, especially over time, and other laws, and administrative decisions do affect its actual practice.
5.If the concern is being prepared for a mass casualty incident then hospitals should not be where you are looking.
A) avoid the mass casualty cause
B) plan to repurpose areas to care of injuries
C) teach people to be prepared, and to do basic first aid
D) plan for transport of needed supplies, personal from other areas
E) plan to keep emergency communication and transport moving smoothly
And so on. Storing the supplies, or keeping beds empty for an event that should never occur is a waste of resources. If we are so ineffective at A) that we need to waste resources then we need to fix A)

I’m glad the subject of whether or not preventive medicine reduces costs has been broached, because I had already seen lots of this research cited in the CBO letter (and other related research). The logic is solid– preventative medicine is helpful and good, it can reduce costs for an individual, but at the same time raises overall costs. An excellent example I have seen is flu shots– if everyone is required to get a flu shot, that is an excellent way of preventing flu outbreaks and protects the individuals who would get the flu from getting it. But more people who get the flu shot would not go on to get the flu regardless of whether or not they had gotten this preventative treatment. So you are spending $30 a pop for every individual, some of who will be saved from the flu as a result and most of whom would not be affected one way or the other. It’s good for the health of the community, but is it cost effective?
The emphasis on preventive care the president and others have been pushing is laudable for improving the health of the nation. It is not, however, an effective means of cutting costs.

“Tort reform” is the desperate slogan of those seeking to limit victim’s rights.

Having pointed out the flawed (false) generalizations made in news headlines and also the misdirecting, summary-type statement at the beginning of the CBO letter (e.g.–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.”)…
well…though the misleading or misdirecting quick statements probably will be all that about 90% of those seeing such headlines and summaries take in…
…the CBO letter does, finally, on the 3rd page, state the common-sense conclusion, that should be the only generalization summary, should inform headlines, and should lead the letter as the summary statement:
“…Treatments for existing medical conditions range from those that save money to those that cost money in much the same way that preventive services do: About 20 percent save money, and about 60 percent have costs that many consider reasonable relative to their benefits, according to the study cited above. Thus, not only preventive services but medical services more generally could be evaluated in order to encourage high-value services of both types and discourage low-value ones.”
Exactly!
…
So…the CBO is accurate enough, just oddly edited in a way that ends up being misleading to those that read superficially, and take the opening statement at face value.

Re: court judgments on medical lawsuits..
Has anyone considered setting up a parallel court system, staffed by experts in medicine as well as judges, to take over any case that alleges malpractice?
My thought here is that such a judicial bureau could establish some common-sense rationale, with internal consistency, to rule on such cases after presentation of the evidence. A secondary benefit would potentially be expedited decisions in medically-related cases. Now, I imagine, there is a lot of time between the event and the judgment, as well as a lot of cost devoted to “educating” jurors.

Elmendorf says: “the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall,” Elmendorf wrote. “That result may seem counterintuitive.”
Why would this seem counter=intuitive? It makes a hell of a lot of sense to me. If you test everyone for prostate cancer as opposed to only those who have a family history, you are spending large amounts of money and finding growths that most likely will never grow and cause problems, but the doctor will want to remove it just to be safe anyway. This applies for breast cancer as well. A government mandate to check everyone is much less effective than letting knowledgeable doctors and informed patients make the decision. There is an argument that if you save one person than it is worth it, but it has been shown that Americans (without the help of governement health care) are screened at a higher rate for several medical issues than in countries with socialized medicine where they have the goal to screen every individual.

–”Tort reform” is the desperate slogan of those seeking to limit victim’s rights.–
I agree!

–”Tort reform” is the desperate slogan of those seeking to limit victim’s rights.–
I agree!
Posted by: John Edwards
By all means, Lets just let more people collect huge amounts of dollars for BS lawsuits.
Those who do not want to include Tort reform as part of the overall concept of health reform, do not really want reform at all.

The great irony here:
The CBO letter clearly admits, deep in the middle, that Preventive Care could indeed cut medical costs!
But…it’s hard to figure that out with the headlines and certain oddly edited summary sentences in the letter.
See my previous comment below for details.

Another thing the CBO doesn’t take into account is the cost of uninsured using the emergency room as their regular doctor. Emergency rooms, unlike regular doctors, cannot turn anyone away, so the uninsured frequently go their with non-emergency complaints because it’s the only way they can get a doctor to see them.
The cost of this is 20+ times what a regular office visit would cost and we all pay for it.
Nor do they account for the “preventative care” associated with simple regular checkups which require no expensive tests, often can catch things early, and which the uninsured have no access to at all. Even those emergency room visits don’t usually include a full examination–they only treat the complaint.

KR, if you know an ER that will charge a mere $2000 for an overnight stay I’d love to hear about it. For overnights you’re looking at more like ten times that.
But you’re right about the real costs– but then that’s the point, isn’t it? We are already paying, one way or another, for health care for the uninsured.
This bill is far from perfect, but then it is still a work in progress. We pay more for health care in the U.S. than any other developed nation. That’s unacceptable.
How is it that other countries can manage to provide a higher quality of health care for ALL citizens at a lower cost per capita?

I guess the CBO must belong to
that right-wing Republican Mob that’s
against President Obama’s Healthcare
Plan! Not!
Anyone who disagrees with the dictator
must be chastised and banished from
the country.
2012 can’t come soon enough!

JNinCA,
Well that certainly proves tort reform brings down medical costs. Not.
Ever heard the term “anecdotal evidence?” Did it occur to you it might make a difference which particular zip codes you tried? Both Ca. and NY have lots of zip codes. Plus there are more factors involved than tort reform.
Q. Alaska also has tort reform, so why are their health care costs also so much higher?
A. It aint that simple.

Few will read far into the CBO letter, so let me offer this missing highlight:
“…Treatments for existing medical conditions range from those that save money to those that cost money in much the same way that preventive services do: About 20 percent save money, and about 60 percent have costs that many consider reasonable relative to their benefits, according to the study cited above. Thus, not only preventive services but medical services more generally could be evaluated in order to encourage high-value services of both types and discourage low-value ones.”
Exactly!
Ergo, by selecting which preventive care to reward and increase, it is possible to reduce costs, especially when non-medical costs are included.

“We pay more for health care in the U.S. than any other developed nation. That’s unacceptable.”
This is very misleading. Generally speaking, an American will get more procedures and more newer technologies than these other developed nations, and that costs more money. Good health care costs good money, period. That doesn’t change no matter where you are. Many of these nations have completely different liability insurance, in some cases not even required because you cannot sue. But also if you really look at it, you’ll see that they pay MORE into their system and get less out. So when you say thats “unnacceptable”, I think someone has convinced you that its a bad thing that more money is spent on you than they do over there. That’s not necessarily true.
“How is it that other countries can manage to provide a higher quality of health care for ALL citizens at a lower cost per capita?”
Again, not really true. Most of the newer technologies, such as laser spine surgery, is not available under the government plan (gov. won’t pay for it). The government, in its infinite beauracracy, takes forever to approve new technologies. Also in terms of critical care, the US is the admitted leader in many critical care areas. And ALL of our citizens already do get health care, they don’t all have health insurance, which is different. And again, the lower cost per capita is misleading. To give you an example..
My in-laws live in Germany. They make a combined household income of around 90k a year. They pay 12% income tax for their health care. That comes out to about 1,000 Euro (1340 US) per month. My wife and I have an employer share plan that costs a total of 700 a month, has no deductables and mostly no copays. Germany just put in a $15 copay. My father in-law had back surgery 3 times, once to fix a disc, twice to try and fix scar tissue. After doing some research, they found that laser spine surgery works very well to remove scar tissue. However, government won’t pay for it.
So I don’t believe for a minute that the quality is better, but I do believe they pay less because the government approves less to pay.

life expectancy is not a “good” number either. We kill of more people due to urban vioence. plus our diets suck. so other facors influence life expectancy beside health care

Looking at individual costs is the wrong methodology. We have to look at this as epidemiologists do.
Currently we spend $7,000/year per capita for health care in America, more than double any other nation. We also pay that $7,000 for the 50 million people without health insurance. So right off the bat, we’re wasting $350 billion a year.
Where does it go?
That’s almost exactly the amount insurance companies pay to “administer” insurance, to run the process to try to make sure no uninsured person gets health care they didn’t pay for.
It costs us more to NOT deliver the care than to do it right.
Cost savings are realized easily over a population of 350 million — but, no, you can’t pinpoint it for any one person accurately. For 100,000, the accuracy is deadly. For 350 million, the savings are easy to find.

Lifestyle change in an individual choice and depends on the person (or one’s personality). People with true grit are motivated to achieve a fitness goal no matter what. Personally I am not one of those who can persevere through pain and setbacks. Here is my story.
I’m 45, and earlier this year I tried to change my lifestyle to lose weight and lower my risk for heart disease. My doctor encouraged me and even recommended a particular gym. So, I joined a health club and faced my gym-phobia head on (I’ve been afraid of returning to a gym since I had injured my knees 20 years ago when the trainer showing me how to use the leg press machine set the weights too high).
Things were going fine after the first month, and then my left side of my ribs started to hurt. The doctor thinks it was re-injury caused by the rowing machine (originally injured it when I fell off my bicycle years ago and hit the pavement on my left side). While my ribs healed, I started riding longer and using higher resistance on the stationary bike, as well as additional riding on my mountain bike on weekends. I thought the soreness after finishing a ride would go away after a day or two. However, from my previous experiences with knee tendinitis, I noticed it got worse after each workout. So I stopped exercising to heal. I did lose five pounds before I stopped, and I still continue my attempt to eat healthier.
Losing weight is easier said than done. I’ve had nothing but injuries since my “lifestyle change.” Sedentary people with a history of previous injuries can easily get hurt, discouraged and eventually quit. It’s like choosing between a lesser of two evils. 1) become more active and risk pain and injury to various parts of your body OR 2) remain sedentary and overweight and increase your risk for heart disease, stroke, diabetes and a shorter life in general. I feel like it’s a no-win scenario.