I just saw Michael Steele on Wolf Blitzer saying that the primary focus of the Republican Party right now is to defeat the Democrat’s healthcare reform plans. Given their horrible showing in the past few elections, you’d think the Republicans might want to spend their time coming up with some ideas of their own instead of just trying to stomp on the Democrats big projects. But that’s a topic for another, longer post.

For now I just wanted to comment on one of the dumbest things I’ve heard in months – the latest Republican talking point repeated in this interview by Michael Steele:

“Where in American History, or anywhere for that matter, have you saved money by spending more money? Do you do that? Is that how you run your household?”

This, Mr. Steele, is exactly how I run my household. And if you don’t, then you’re a fucking idiot.

For example, this spring when water was leaking into my upstairs bedroom, I spent a small amount of money to have the roof fixed so I wouldn’t have to spend lots of money later replacing my ceiling and my roof.

It’s called preventive maintenance, Mr. Steele, and it’s even more important with health care than it is with home care.

  • Matt N.

    I love it how you leftists treat services like health care as if we live in a word free of scarcity. It is as if health care, thanks to Lord Obama, will flow from the heavens like manna.

  • Regardless of how you feel about my ‘leftist’ opinions, you have to admit the talking point is stupid.

    We spend money now to save money later in almost every area of our lives.

    Businesses invest in more efficient equipment now and save money long term because of this efficiency.

    We spend money on vaccinations now to avoid the higher medical costs associated with the flu later.

    Steele’s talking point doesn’t make any sense.

  • Brian O’Connell

    A lot of people assume that preventive maintenance in medicine saves money, but it generally doesn’t. Vaccinations are a rare exception. Here’s an article on this. Preventive medicine is more expensive in the long run.

    I didn’t see the Steele interview, but I’m thinking the key word in the quote is “more”. You don’t save money by spending more money, obviously. And preventive medicine does cost more money.

    And Joseph, your example isn’t preventive maintenance, since you already had a leak. Preventive maintenance in that example would be fixing the roof *before* anything went wrong. I think you can see there that that’s not necessarily a cost-saving effort. Though it can sometimes still be the right decision, but best left to the homeowner.

  • Steele’s example was the house – and it was a poorly chosen one because there are so many examples that immediately come to mind of house-related spending that completely disprove the point he is trying to make.

    It’s a poor argument and crappy talking point. That was my point.

    And fixing a small problem before it becomes a big problem IS preventive maintenance: “inspection, detection, and correction of incipient failures either before they occur or before they develop into major defects.”

  • Brian O’Connell

    Well I didn’t see the Steele interview- maybe he did muck it up. But knowing the underlying facts, I can see what he was getting at.

    Let’s say a preventive service, like skin cancer screening, if there is such a thing (IANAD), costs $100. For 100 people, this will be $10,000. And let’s say that this preventive service prevents or catches early 1 case of skin cancer per these 100 people.

    It should be clear at this point that whether or not this preventive service saves money depends on the cost of treating that one case had there been no preventive medicine.

    If it costs $20,000 to treat, then it will have saved $10,000. If it costs $5,000, then this preventive service isn’t saving any money. It costs double.

    Now of course we can decide that even though it costs more, it’s still worth it to prevent that one person from getting full blown skin cancer. But you can’t argue that this is a cost-saving measure.

    And studies have shown, as I’ve linked to earlier, that on the whole, preventive medicine does cost more, because of all the money you’re spending on those 99 healthy people.

  • I really wasn’t planning on getting into a conversation about health care or the specifics of the multiple different plans currently being proposed. But you do make a pretty good argument for a larger, single-payer-type system:

    Sure, testing 100 people might cost $100 a person. But if everyone is covered – if millions and millions of tests are performed – then the cost of the test will certainly go down.

    I’m not advocating this solution – though I’m certainly not against it either. I have pretty good insurance now – but I also understand that having millions of Americans who only see a doctor when their symptoms are so severe that they need to go to the emergency room is driving my health care costs up. And I also understand that having millions of uninsured people in our country who can’t afford to see a doctor and can’t afford proper medicine means that my family and I are more likely to get sick.

    Preventive medical care is more than just one overpriced test to prevent some rare disease. It’s bigger than that. It impacts our entire country and every aspect of our economy. Preventive medical care means making sure the parents of the sick kid at my daughters’ school can afford medical care for their son so that he doesn’t infect all of the other kids in the class. It means getting treatment for the two employees of my small business so they don’t miss work and cost the company and themselves money.

    It is in EVERYONE’S best interest that EVERYONE is healthy.

  • Brian O’Connell

    “But if everyone is covered ? if millions and millions of tests are performed ? then the cost of the test will certainly go down.”

    No. It’s not like preventive medicine is brand new. There are already millions of tests performed. Mammograms, colonoscopies, HIV tests, you name it. Those costs aren’t coming down much just because we increase by some percentage the number of times they’re given. They’re probably near their best price point already. But you’re just guessing.

    “…I also understand that having millions of Americans who only see a doctor when their symptoms are so severe that they need to go to the emergency room is driving my health care costs up.”

    ER care is especially expensive, but studies show that preventive care is on the whole more expensive. If you didn’t believe my first link, here’s something from the New England Journal of Medicine, specifically addressing politicians’ claims that preventive care saves money. First graf:

    With health care once again a leading issue in a presidential race, candidates have offered plans for controlling spiraling costs while enhancing the quality of care. A popular component of such plans involves greater promotion of preventive health measures. The first element in Hillary Clinton’s plan is to “focus on prevention: wellness not sickness.” John Edwards has stated that “study after study shows that primary and preventive care greatly reduces future health care costs, as well as increasing patients’ health.” Mike Huckabee has said that a focus on prevention “would save countless lives, pain and suffering by the victims of chronic conditions, and billions of dollars.” Barack Obama has argued that “too little is spent on prevention and public health.”

    Finding, from the next to last graf:

    Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.

    Here’s the article. Note, it’s not even close: the vast majority of preventive care costs more.

    Then you go on to make a silly point about communicable diseases, but most preventive care has to do with cancer, high blood pressure, cholesterol, heart disease, etc. By its nature, preventive care doesn’t do much about communicable diseases. Your daughter isn’t going to catch diabetes from her classmate, and her classmate’s communicable disease isn’t likely to be caught via preventive medicine.

    You go on to make the point that catching diseases earlier can save society money in the long run, as with your two employees. This can be true. But this isn’t what Democrats are selling us. If Dems said, “Preventive medicine will mean increased healthcare costs, but we’ll be better off because we’ll be healthier as a country, and we may save more money as a society in the long run,” I’d say fine.

    But that’s not what they’re saying. They’re saying that preventive medicine will lower healthcare costs. This isn’t so. Surely the reality-based party will respect the science here?

  • Matt N.

    Preventative health care should be a decision left to individuals, and not left for it to be a political/policy question. I don’t want Nancy Pelosi or Steele telling me how to take care of myself, thanks.

  • I’m sorry to tell you this, Matt, but the decision is never left up to you or even your doctor. All care is managed care unless you are super rich and don’t need to bother with health insurance.

    Insurance companies are very specific about which tests and procedures they will and won’t pay for – and even how much they will pay for the procedures they do cover.

    This is how they control costs and avoid spending more than they take in. They are, for the most part, for-profit companies and without these types of cost controls would never remain viable.

    Any public option will, of course, have similiar cost controls in place.

  • I think Brian picks and chooses what he wants out of the NEJM article. It also says:

    Of course, our review reflects a selected sample of studies in the peer-reviewed literature and does not cover all possible opportunities to spend resources to improve health. In addition, there may be inconsistency among the studies in terms of the methods used.

    The full context of the “finding from next to last graf” is as follows:

    Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not. Careful analysis of the costs and benefits of specific interventions, rather than broad generalizations, is critical. Such analysis could identify not only cost-saving preventive measures but also preventive measures that deliver substantial health benefits relative to their net costs; this analysis could also identify treatments that are cost-saving or highly efficient (i.e., cost-effective).

    This does not at all make the point that preventive measures are more costly on whole. Some are, some are not. Even more could be found to be more effective than treatment.

    I think it’s pretty clear if you figure out ways to make prevention work (including changing behaviors), keeping people healthy in this manner is cheaper in the long run. Nobody would argue that eating right, exercising, and maintaining a good body weight is MORE costly than triple heart bypass surgery. One of our overriding health care problems has been the focus on treatment, which is obviously more profitable from a pharmaceutical standpoint than prevention.

    The conclusion of Brian’s article is interesting and something I think most would agree with:

    In the face of increasingly constrained resources, there is a realistic way of achieving better health results: conduct careful analysis to identify evidence-based opportunities for more efficient delivery of health care ? whether prevention or treatment ? and then restructure the system to create incentives that encourage the appropriate delivery of efficient interventions.

    I did find an interesting story on one of the articles lead authors, Joshua T. Cohen, though:


    @8: Of course Matt completely ignores the cost TO HIM of other people making poor decisions. It’s called “public health” for a reason. When you begin to cost me money, in a free market society, I’m going to want to recover those costs. Common sense. Thanks for all your running and weight loss, Matt. I appreciate your effort to help reduce my health care costs by staying healthy and out of the hospital. I’d much rather pay – in the form of my premiums – for your periodic screenings than a few stints.

  • That is none of your business, Eric, but thank you for reemphasizing the intrusiveness inherent in this sort of health care model. After all this Patriot Act talk during the Bush years, I suppose you guys lost that civil libertarian streak once Lord Obama was elected? You are such a charming and handsome man (edited for clarity).

    So what is the answer? Change the tax code so there isn’t such a huge incentive to have health care tied to employer. Then, have tax-free savings accounts for health care expenses, where employees can buy catastrophic coverage. This will encourage people to start asking doctors how much procedures cost, and have an incentive to avoid unnecessary procedures. Then all health care will be just like the very competitive lasik surgery industry, where doctors advertise like crazy and even print their home phone numbers in the newspapers.

    The very reason why this is not understood by the Democrat left is simply a product of the lack of understanding of economics. The market forces I’m talking about exist, even if you choose to ignore them.

  • Lasik surgery isn’t health care, Matt, any more than plastic surgery.

    And the LAST person I’m going to call when my daughter is sick is the pediatrician who advertises his crazy low prices on TV at 3am during reruns of Law and Order.

  • Matt N.

    The point isn’t that they will have a crummy advertising campaign. Instead, the point is that competition, introducing price mechanisms, is key. You know that, but are just making a joke.

  • For once I wasn’t making a joke. What I’m saying is that Lasik, like plastic surgery, is an optional medical procedure that is pretty much the same no matter where you go. It’s a commodity, the demand for which can be swayed by pricing.

    Consumers can spend time finding the lowest price for their lasik surgery or wait until they have saved enough money to get their boobs enlarged. Or they can choose not to do it all if the prices are too high or if they don’t have the money right now.

    If you get strep throat or appendicitis you need attention immediately. You aren’t going to get out the phone book and starting calling around for the best prices on an appendectomy.

    I know you think your nice little free market model can be neatly applied to everything from soy beans to education – but it just isn’t that simple.

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