As I study and think about the healthcare issue, I’ve had this feeling that one thing simply could not be right. Proponents of Obamacare have argued, and many Americans seem convinced, that preventative medicine, those checkups, tests and procedures designed to find something wrong can save money by nipping problems in the bud, saving tons of money down the road after a situation has become more serious. This thinking is so strong that even in high deductible health plans preventative services often do not conform to the deductible and are covered in full or part on a first dollar basis to encourage their use to save others lots of money and reduce premium costs in the long run. Is this actually a fact or more fallacious nanny state thinking?
Let’s say a checkup does find something wrong, even in someone with no symptoms at the time. Then what? When available, treatments would be applied, medications or even surgery would be administered to address the issue. Yet these treatments themselves are often very expensive and that cost must be spread across all insured. Whereas, had the condition not been discovered early, by the time the patient experiences symptoms treatment may no longer be an option and expensive end of life treatments may be incurred followed by an early death. Yet even in this situation, treatments (expenses) that could have prolonged life have not been incurred, and while expensive end of life treatment did occur, it occurs for everyone not experiencing a sudden death sooner or later. Then too, at the moment of death (which none of us will escape), medical expenses for that individual immediately drop to zero forever. This all makes avoiding preventative care seem like it could be the cheaper, if even fatal, option.
None of this is to suggest that we do anything to discourage preventative care either, as there isn’t much argument that such steps and discoveries can prolong life, even if at great expense over time. The point, it seems to me, is that in a society that subscribes to individual liberty what business is it of mine what the next person decides is the right approach for them, especially if it turns out that encouraging greater use of preventative care does not in reality save money as is so often claimed.
Another consideration is that preventative services are at the lower end of what is affordable and as such should never be included in insurance at all. Doing so defies the purpose of insurance to begin with, that being limiting the risk of encountering the otherwise unaffordable. Additionally, in a truly free market, with prices mutually agreed by the provider and consumer, preventative services would be the most likely to be heavily discounted as they are gateway transactions. Any discovery that would require further intervention would often take place at the point of the exam. This has not been lost on Pep Boys or recently Meineke when they advertise they will diagnose that check engine light in your car for FREE! Of course in our convoluted system any physician who accepts Medicare or Medicaid would be committing fraud for extending such an offer.
This then leads to the question of what about the poor who want preventative care but may not be able to afford it on their own. Even here allowing market forces to work is a preferable approach. Funding Health Savings Accounts to provide for normal health related expenses and allowing participants to eventually keep funds not used encourages wise spending and respects the poor’s discretion and dignity in making their own choices.
Of course the no cost preventative care of eating a balanced diet and exercising regularly is probably the most effective approach in reducing costs aside from direct payment and is not dependent at all on economic status or situation. Yet here again respect for the liberty of others precludes requirements to exercise or eat a certain diet. It is simply, although wise, not the business of others in a free society respectful of liberty.
Now you may and should ask if there exist any studies to support my thoughts presented here. A Google search “does preventative medicine save money” says “yes”. In fact there are so many sources in agreement that I will simply challenge you to do the search for yourself. I’ll only note that sources include the New England Journal of Medicine, the Wall Street Journal, and ABC News among others.