George Pantos, Esq., Former Washington General Counsel to Self-Insurance Institute of America (SIIA), MyHealthGuide Newsletter

BETHESDA, MD -- Charles Krauthammer wrote the article, The Great 'Prevention' Myth, that was published on August 14, 2009 in the Washington Post. The article states that "President Obama has lost the health-care debate... Accordingly, Democrats have trotted out various tax proposals to close the gap" such as prevention as saving heath care costs.

"This inconvenient truth comes, once again, from the CBO. In an Aug. 7 letter to Rep. Nathan Deal, CBO Director Doug Elmendorf writes: 'Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness.'"

"The fallacy here is confusing the individual with society. For the individual, catching something early generally reduces later spending for t hat condition. But, explains Elmendorf, we don't know in advance which patients are going to develop costly illnesses. To avert one case, "it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway." And this costs society money that would not have been spent otherwise.

"...a rigorous study in the journal Circulation found that for cardiovascular diseases and diabetes, 'if all the recommended prevention activities were applied with 100% success,' the prevention would cost almost 10 times as much as the savings, increasing the country's total medical bill by 162%. That's because prevention applied to large populations is very expensive, as shown by another report Elmendorf cites, a definitive review in the New England Journal of Medicine of hundreds of studies that found that more than 80% of preventive measures added to medical costs.

"... prevention is not, as so widely advertised, healing on the cheap. It is not the magic bullet for health-care costs. You will hear some variation of that claim a hundred times in the coming health-care debate. Whenever you do, remember: It's nonsense -- empirically demonstrable and CBO-certified."

George Pantos Responds

Mr. Krauthammer's premise is that preventive health care increases medical cost. He concludes that the added costs of preventive services such as clinical screenings exceed the savings from averted illnesses. However, his analysis is incomplete because he fails to note that prevention also can occur thru inexpensive (often free) individual risk profiles such as Health Risk Assessments (HSAs) that can detect a propensity for future problems before illness occurs. Based on completion of simple yet in-depth questionnaires , such non-laboratory related screenings can serve as a harbinger of problems related to cost drivers such as obesity and smoking which add nearly 80 billion dollars in cost to the nation's health bill.

Employer sponsored wellness programs are successful market-based examples of prevention (intervention) that is working without adding to medical costs. Predictive modeling and data analytics also show early promise in preventing illness and reducing health costs--without the expenditure of a single dime in government spending. Predictive technology ( the ACG System) developed by Johns Hopkins University, one of the world's most respected academic and medical research institutions, permits early identification of health risk based on analysis of already available claims data.

While clinical screening is valuable in detecting disease and can be costly, prevention that detects disease before it occurs is a "priceless" way to avoid expensive treatment while lowering costs and improving individual health .A 2009 Report from the Health Research Center refers to a Miliken Institute Report noting that savings from modest improvements in risk factors such as unhealthy behaviors could bring about 40 million fewer cases of chronic disease and reduce economic costs by $1.1 trillion annually in treatment costs and productivity by 2023. So much for the "myth".