People need to be paying far less for preventative care out of pocket. When they have to pay for preventative care, a lot of them (especially low income) just skip it. And then small problems turn into big, expensive problems.
We want diabetics to come in for periodic foot exams so they don't have to get their feet amputated later.
> People need to be paying far less for preventative care out of pocket. When they have to pay for preventative care, a lot of them (especially low income) just skip it.
We've posted the links repeatedly - preventative care improves quality of life but doesn't reduce cost.
And, pre-natal care is FREE in the US, yet many poor folks don't bother.
In other words, both assumptions for your argument are false.
"preventative care improves quality of life but doesn't reduce cost"
That strikes me as a very questionable assertion. Health problems always get worse with time, becoming more complex and expensive to fix the longer you leave them. How could prevention possibly not reduce costs?
> That strikes me as a very questionable assertion. Health problems always get worse with time, becoming more complex and expensive to fix the longer you leave them. How could prevention possibly not reduce costs?
(1) Folks who live longer consume more medical resources, not less. (Dying is always expensive but living also has costs, so shorter lived people cost less.)
(2) Preventative care doesn't always work. In fact, it usually doesn't. If it's cheap enough, that can be okay, but if it isn't....
(3) Saving someone from one or even a couple of causes of death is rarely enough. (That's why it often makes sense to ignore prostate cancer. Yes, it may get worse if left untreated, but old men die of lots of things.)
The numbers always matter. Health care is hellishly complicated.
Ah, you're talking about lifetime costs. I was thinking in terms of per-incident.
You also seem to be thinking in terms of end-stage "keep them alive vs. let them die" issues. I was thinking more along the lines of toothaches, infected cuts, etc. Yes, it does get more complex - both medically and morally - as the patient gets older.
I'll agree with you on the "hellishly complicated" part though. The politics of elderly care are a moral minefield.
> Ah, you're talking about lifetime costs. I was thinking in terms of per-incident.
Lifetime is the only rational way to think about it on "govt scale".
Per-incident is really hard to sample correctly. Yes, if you can get someone to not be diabetic, you've saved money, but we're already trying a lot of preventative care so if you look at the incidents as opportunities, you're wrong.
Yes, we're already doing a lot of preventative care, and we're not seeing the results that its advocates claim. (Simple example - Every doctor already says "lose weight".) Most chronic diabetes folks are fairly resistent to preventative care, at least the inexpensive sort, and the expensive stuff isn't close to cost effective AND they backslide.
Here's a question - smoking has gone down by 50% over the past 20 years. Are we spending less on lung cancer?
> The politics of elderly care are a moral minefield.
Yup. 70% of US medical spending is on old people. If you're going to cut spending by 30%, a huge fraction of that has to come from old people.
Probably because it keeps people alive longer, so that they need more care. Smokers, allegedly, are much cheaper to care for in the long term than non-smokers, because they die early.
Because preventive medical intervention and testing doesn't work. Lifestyle changes work, but getting a bunch of fat cola guzzlers into doctors' offices more often has no impact on the care they will later require.
The article addresses this by saying there could be vouchers or some way for the government to encourage people to go to them. And don't forget that in his system, the low income people would be subsidized anyway, so they might be in a better position to get preventative care than they are now.
