Myth 8. Spending more on prevention and “wellness” will enable us to spend less on medical care while improving health.

The idea of having a “wellness” rather than a “disease” orientation is politically appealing, and politicians on both sides of the aisle promise painless savings of “billions” by “incenting doctors” to “keep people healthy.”

No-cost and low-cost choices—diet, exercise, avoiding risky behavior—are available to all Americans, without any involvement by health plans or government. The question in the “healthcare reform” debate is the forcible “reallocation” of resources from treatment of the sick and the injured to third-party-funded health programs ranging from smoking-cessation counseling to early detection of disease to drug therapy for blood pressure or lipid levels.

The blame-the-stakeholders approach—“a dollar spent on medical care is a dollar of income for someone”—usually sidesteps or minimizes the issue of denying or delaying care to patients who could immediately benefit, in order to reduce the future burden of illness in hypothetical others.

For the rationale of achieving cost control by this means, it is time to write an obituary, writes John Goodman.

The Obama Administration’s options for cost control represent “hope vs. reality,” write Theodore Marmor et al. (Ann Intern Med 2009;150:485-489). Emphasis on prevention, better chronic-disease management, outcome-based payment, and comparative effectiveness research are “ineffective as cost-control measures,” they conclude.

A review of 599 articles on preventive interventions published between 2000 and 2005 concluded that the vast majority do not save money, notes Victor Fuchs (JAMA 2009;301:963-964). In fact, 80% add more to medical costs than they save (Louise B. Russell, Health Affairs 2009;28:42-45).

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5 thoughts on “Myth 8. Spending more on prevention and “wellness” will enable us to spend less on medical care while improving health.

  1. Preventive care and wellness depend on the ability of the patient to participate in these lofty concepts. After 34 years of medical treatment of the “human animal” and seeing more failure than accomplishment in those two areas, I take a very dim view of the possibility of saving a dime using those two modalities. Either Obama and friends know nothing about medicine, or they are trying to systematically destroy the jewel that is American health care. I think we can safely remove the “either/or” and say both are true.
    Obama proves himself a pathological liar every time he states that he will give every American the same health care that the congress and senate enjoy. It’s a flagrant lie that he could ever do that, and he knows it, yet he can stand there and say it without even flinching.

    Good luck, America! You need luck and a lot of heavenly oversight to be able to survive this amoral mockery of a president.

    Stuart Agren, M.D.

  2. Consider this: No matter what type of “wellness” program one might undertake, one is going to die, eventually. If one lives for an extended time, it is likely that more resources will be required, not fewer, as one ages. To fund the resources, one must pay, or in government-speak, one must “allocate” resources via the tax code.

    There is virtually an unlimited demand for medical services, especially later in one’s life. The only reality check on this is a free market, which means that each individual has to make decisions about his own life and his own goals, and each should have the freedom to contract with a physician in terms of dollars or voluntary charity — without the involvement of government, except to enforce the contract.

    When, however, governments overstep their bounds and promise health care for all, what results is unlimited demand for the stolen dollars, a demand that cannot possibly be filled, and which necessarily results in rationing by the government.

    Government’s only proper function is the protection of individual rights, not redistribution of wealth. Individual rights are not a claim on the products of others, but on one’s own action and effort. When Washington understands this, if they ever do, there might be a chance to return to a rational medical care policy in the United States. Short of this, there is no hope, only meaningless rhetoric that will result in the further bankruptcy of America and the deaths of millions.

    The American Government has a moral obligation to reverse this lethal trend toward statism and return to capitalism.

    Mark A. Hurt, MD

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  4. Mr Hurt states: “Government’s only proper function is the protection of individual rights, not redistribution of wealth.”
    Forcing the rich to share their wealth is not violating individual rights and greed is not a virtue.

    Mr Hurt also states: “The only reality check on this is a free market, which means that each individual has to make decisions about his own life and his own goals, and each should have the freedom to contract with a physician [...]”
    A market in which the physician and the private insurance company battle for the spoils while many a citizen has to decide between food/shelter and health care is not free.

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