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CBO: Preventive Care May Likely Lead to a Pain in the Wallet

By Lori Montgomery
Expanding preventive medical services may well improve public health, but it is highly unlikely to save the government money, the Congressional Budget Office said Friday.

In a letter to leaders of the House Energy and Commerce Committee, CBO director Douglas Elmendorf said the evidence suggests that the cost of making services such as cancer screening, cholesterol management, vaccinations and wellness training broadly available would far outweigh any savings ultimately generated.

"Athough 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," Elmendorf wrote.

The director cited a study published last year in the New England Journal of Medicine that found "slightly fewer than 20 percent of [preventive] services that were examined save money, while the rest add to costs."

Another recent study conducted by researchers from the American Diabetes Association, the American Heart Association, and the American Cancer Society found that highly recommended preventive measures such as monitoring blood pressure for diabetics and checking cholesterol levels for people at high risk of heart disease "would substantially reduce the projected number of heart attacks and strokes that occurred."

However, the tests "would also increase total spending on medical care because the ultimate savings would offset only about 10 percent of the costs of the preventive services, on average," Elmendorf wrote.

His letter directly contradicts the claims of some lawmakers, including House Speaker Nancy Pelosi (D-Calif.), who last month argued that spending money on prevention should lower the overall costs of legislation to overhaul the nation's health care system.

By Lori Montgomery  |  August 7, 2009; 9:06 PM ET
Categories:  Health Reform , House  
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This has been blindingly obvious for quite a long time--preventive services lead to better health, but they cost a lot more than they save. So, exactly where is the money for a health overhaul to come from ? You guessed it, from you and me--because Democrats exist to do two things only---TAX and SPEND

Posted by: dan1138 | August 7, 2009 11:49 PM | Report abuse

One canard of this preventive care net cost discussion is including cancer screening after it is already well and widely understood that cancer screening is not cost-effective as a preventive strategy.

Advocates of preventive care as a cost-reduction strategy presume basic common sense would be used to implement such preventive strategies -- emphasizing those proven to be effective and especially those that are the most cost-effective.

The blanket statements that "preventive care will not save money", etc., seem contentious since it is quite easy to be more accurate and complete, with little effort:

e.g. -- "Some kinds of preventive care create net savings over long time periods, and other kinds do not. Therefore a cost-savings strategy would rely on the types of preventive care shown to create cost-savings."

That's not rocket science. What's up with the CBO?

Posted by: HalHorvath | August 8, 2009 12:47 AM | Report abuse

Let me add the modifier "most" in reference to "cancer screening".

This is just everyday common sense, to me, to use cost-effectiveness research as a guide to chose what preventive care to support.

Why would anyone presume otherwise?

Well, perhaps it is a concern if the normal experience of the CBO is that contractors, etc., will take advantage of any imprecise specifications.

What bothers me though isn't for the CBO to presume the worst.

What bothers me is for the CBO to then use blanket, imprecise language in an obstructionist way, when only a few extra words would allow precision and completeness.

Posted by: HalHorvath | August 8, 2009 1:18 AM | Report abuse

Insurance companies bet on the odds that their customers will die before they can spend their share of medical insurance premiums, therefore, prevention and detection endangers their profit margin. They will fight viciously to prevent that from happening. The misinformation wars have begun in earnest.

Posted by: stosp | August 8, 2009 1:20 AM | Report abuse

Perhaps the only solution for these complexities of ultimate costs will be to bring all of the presumptions, every one, out into the light of day.

For instance, what is the calculation of end-of-life care costs at 85 years old vs. end-of-life care costs at 55 years old?

We may need to deconstruct the CBO analysis in a transparent way. Like an analysis-audit.

If anyone is already analysis the CBO analysis, please point me to them.

Posted by: HalHorvath | August 8, 2009 1:25 AM | Report abuse

My mother died of cancer at age 96. Once we had the diagnoses, we checked her into hospice. What else can you do with an elderly patient that cannot survive the heroic treatments the medical community can dream up. I have watched too many of my relatives in their 70s and 80s subjected to aggressive treatment with no real likelihood of success. Luckily, I live in Oregon where assisted suicide is legal.

Posted by: smclennan1 | August 8, 2009 1:50 AM | Report abuse

Conservatives seem to care about saving money more than improving health, so millions of their fellow human beings will live longer. This seems highly amoral, selfish and unChristian.

Posted by: Aprogressiveindependent | August 8, 2009 2:15 AM | Report abuse

First they said that covering the uninsured would save money because they wouldn't use the ER ... That was shot down by the CBO when they showed that the cost of providing insurance to the uninsured would dwarf an ER savings.

Now the CBO has shot down there other big supposed cost saver ... giving free screenings to everyone.

To be honest I don't think anyone has the bullet proof answers on how to cut costs yet. As the CBO does say it will take experimentation and time.

Banking the "cost savings" from reform to start a new universal coverage entitlement will be a massive failure.

Let's simply do insurance reform with an individual mandate and see how things go.

I think everyone is scared of BIG change right now.

Posted by: cautious | August 8, 2009 3:48 AM | Report abuse

People have to take some responsibility for themselves!

I say, let's set premiums to what people pay for cell phone service. People you wouldn't think could afford a cell phone turn up with them - even kids.

Then let's set coverage to pay for what premiums, with a little risk estimation will cover.

Everything else a person has to pay for out of pocket.

What'd you bet costs would stop rising?

Posted by: RedBird27 | August 8, 2009 8:07 AM | Report abuse

I could not disagree more with the statement that prevention does not save money.

Personal example my wife gets yearly mammograms, cancer was discovered, lumpectomy, radiations, a serious regiment to help the immune system do its job. 5 years later she is doing great.

Her sister no self, exam no mammograms, double mastectomy, recontructive surgery, 6 years for almost continues treatment. She didn't make it.

Don't tell me her sisters treatment didn't cost the insurance companies untold tens of thousands more.

Posted by: Leo40 | August 8, 2009 9:05 AM | Report abuse

It is well established that screenings for three cancers - breast, cervical and colon - and early detection can result in remissions in most cases. Assume that mammogram costs $500 and since a breast cancer patient costs $15,000 annually, and assuming treatments for about 5 years the question is simple - would you spend $500 to avoid a $75,000 charge? I am oversimplifying it - but the math is direct and CBO has access to the data and should be able to calculate the risk not necessarily accept blindly what is published in the literature. Of course, this is just the medical cost and doesn't include the "societal" costs. As a recent NY Times article pointed out, not all screenings work - but some do. These broad brush statements don't cast a favorable light on CBO.

Posted by: TumTum | August 8, 2009 9:06 AM | Report abuse

It is ridiculous for the CBO to state the situation in such vague terms. In fact, this article is even a worse abstract of the arguments against preventive care. It should be obvious to anyone here that not all doctors are merely business people with no concern for patient care and for controlling costs. They are in an adversarial position with patients, hospitals and HMOs because that is how healthcare is currently structured in the United States.

As others here posting have clearly and rationally stated, it depends on what methods and procedures are truly proven to have cost-reducing preventive efficacy. I think we can pursue a rational and effective healthcare policy that is not filled with all the exceptions and patched together compromises that we are seeing in the currently proposed bill as it stands.

And what can we now expect from Congress and any report that comes from that purchased body of legislators? It is easy to see why we all feel betrayed by government and why we fear a so-called public option. This is the true tragedy of the United States - the complete failure of our republican (not, democratic, we are not a true democracy, but a republic, take a look at the Constitution, the Federalist Papers and even the Pledge of Allegiance) institutions to move forward and form comprehensive policy for the commonwealth.

But what else can we fight for at this point?
The federal government can and must be called to account and civil responsibility if we want to keep what little remains of our democratic ethos.

For others here posting who think this is a "statist" attitude, then so be it. I am a statist apparently by your definition. The problem is that I wish we had a state that acted as such when it needs to. The state must direct and set the stage for public policy, not control or over-govern. But our state is one which has lost its true function and has become the means by which the wealthy and the corporate govern us all and for their interests, not for ours, the people, that is.

How is it that

Posted by: gwymer | August 8, 2009 10:23 AM | Report abuse

Did any of you who ridicule the CBO report actually read the story? It says the 80/20 rule applies here too. That is, only 20% of the preventive tests that are being sold to us as saving costs actually do save overall costs. The rest just add to the bill.

Posted by: smclennan1 | August 8, 2009 11:15 AM | Report abuse

Put simply, it is cheaper to let people die quickly. That may not be the most humane solution but it is the cheapest. I think people need to weigh whether they are willing to pay a little more for reducing the pain and suffering that goes with disease vs. spending a little to improve the health of an individual.

Posted by: cdierd1944 | August 8, 2009 12:16 PM | Report abuse

I'm not sure that I trust this report. In the first place, the data presented by Montgomery is far to skimpy to draw any conclusions. For example, this sentence "slightly fewer than 20 percent of [preventive] services that were examined save money, while the rest add to costs." could mean just about anything in the absence of more detail. It obviously depends on the type of service

Also, the report ignores medical advances that will be made in the near future, both in detection and treatment.

Posted by: dougd1 | August 8, 2009 1:36 PM | Report abuse

dan1138 is here defending the right of the Conservatives to think in bumper sticker phrases.

Posted by: dfc102 | August 8, 2009 1:44 PM | Report abuse


I think everyone agrees that some preventive care is cost-reducing, and some isn't. Perhaps many of us knew this already, months ago.

So what do you yourself think of these headlines?

"CBO: Preventive Care May Likely Lead to a Pain in the Wallet"

"Expanding Preventive Care May Add to Costs, CBO Says" (Letter Cites Health Benefits but Few Savings)

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.

This kind of everyday common sense isn't automatically ruled out from an incentive system for preventive care.

So a headline on the order of "Expanding Preventive Care May Add to Costs, CBO Says
Letter Cites Health Benefits but Few Savings"

is not adequate, to my way of thinking.

Further, if the CBO uses language that lends itself to such headlines, then the CBO language is inadequate also, to my way of thinking.

In contrast if the CBO used more unambiguous and accurate language like:

"Some kinds of preventive care create net savings over long time periods, and other kinds do not. Therefore a plan that doesn't discriminate among preventive care cost-savings effects will likely add to net costs."

this would seem adequate to me.

Posted by: HalHorvath | August 8, 2009 4:01 PM | Report abuse

In this Country, Money is more important than "LIFE". Amazing the Party of "PRO-LIFE" only concern about Life before Birth.
The Future of this nation is at stake here, and the people who fight to keep things as they are, will not be here at the "FALL" of America.
We can 'RALLY' together for WAR, yet be divided over Health Care for the Nation.

We can spend "TRILLIONS OF DOLLARS", for WAR, yet refuse to spend money for Health Care.

Are we all Hypocrites, or are We just one step closer to the END of this, GREAT NATION?
The World watch's in " SHOCK AND AWE", as the did in 2002.

At that time America was Invading another Nation, under "FALSE PRETENDS", in the name of "NATION BUILDING", yet We won't Build this Nation.

Health Care Reform has been an Issue since World War II, in this Country. "Now is the time to Settle that Issue."

Posted by: austininc4 | August 8, 2009 11:10 PM | Report abuse

When we lived in Hawaii years ago, we were insured by Kaiser Permanente. Our contract required an annual physical for both my husband and myself at the same appointed time. This led to early detection of any problems plus we received appropriate screenings and counseling for overall good health. We believe this saved Kaiser money in the long run because our premiums were stable the entire four years we lived there. An ounce of prevention . . .

Posted by: Chris66 | August 10, 2009 2:15 PM | Report abuse

Let me get this straight -- many of you think it is better to let people get sick rather than try to prevent them from getting sick. Why? Because it's cheaper! I guess it's a matter of priorities.

Posted by: Billl2 | August 10, 2009 5:46 PM | Report abuse

"Preventive care" is really a misnomer, isn't it?

Does having a yearly physical really "prevent" anything bad from happening? Does it "prevent" us from getting cancer? Does it "prevent" diabetes? Does it "prevent" heart disease? Does it "prevent" high blood pressure?

The answer to all of these is a collective "NO"....sure, it may provide an earlier intervention of a health problem, before it becomes a bigger maybe it should be called "Intervention Care"?

Only proper diet, exercise, no smoking, etc. will "prevent" anything...and even that's not guaranteed! And only YOU can institute these behaviors yourself...your doctor can talk to you until he's blue in the face to lose weight, quit smoking, start walking three times a week...but YOU must have the fortitude to carry them out.

In the end, it comes back to personal responsibility...a phrase despised by many, especially on the left, because it actually takes government out of the equation. (Yah!)

Posted by: boosterprez | August 12, 2009 12:25 PM | Report abuse

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