I’ve been arguing for a long time that preventive medicine, while often producing good outcomes, does not always save money. It’s something we should put in the quality column, not the cost column. This hasn’t stopped lots of people, including President Obama and Larry Summers, from saying it’s one of the areas we could reduce cost. But CBO director Douglass Elmendorf agrees with me:
“Some preventive medicine is cost-saving as well as health improving,” Elmendorf said, when asked to respond to Summers’ point. “A much larger share is health improving but cost increasing. And there is some share that is just terrible because it makes health worse and costs money.”
“Not everything that sounds good for health is good for the budget,” he added. “[A] general increase in preventive medicine may or may not have the sorts of favorable budget effects that people expect. That surprises many people. But the very important [point] here is that for somebody who ultimately gets the disease, it is cost saving as well as health improving to catch it early. But to catch it early in that person you generally have to deliver the treatment or administer the test to a much larger set of people, most of who will not ultimately get that disease.”
Look, I’m not saying preventive medicine isn’t a good thing. It is. It’s important to recognize, though, that when you make people live longer (a good thing) they can cost more money overall (a bad thing). But let’s face it, the good of extending life is often worth the increased lifetime costs of care. We have to abandon the idea that the only things worth doing are both good in terms of quality and cost-savings. Trade-offs are natural. Sometimes things are worth doing and worth paying for.