High front-end expense of prevention programs may derail their widespread use and promise of future cost savings
So is an ounce of prevention really worth a pound of cure?
It certainly is for individuals. But most prevention programs are likely huge cost drivers for payers such as the federal government. And that particular payer plans to wrestle with massive and growing healthcare costs this summer as part of an effort to control runaway budget deficits.
With the prospect of a grueling summerlong battle over healthcare’s role in fueling the deficit, federal officials are making the highly intuitive yet scientifically shaky argument that prevention programs ultimately will save the government money.
“Clearly, we have to get our budget under control and some of that is going to require painful choices, but one of the things that we want to make clear is that prevention is a best buy,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said in an interview. “In public health we have the ability to reduce the number of people who smoke or are obese or who have diabetes, and that can have a huge impact on our healthcare costs.”
The cost-saving premise of prevention programs has become part of the response of senior administration healthcare officials—including Dr. Francis Collins, director of the National Institutes of Health, and Surgeon General Dr. Regina Benjamin—as Republicans have targeted healthcare programs, including high-profile prevention programs, in their quest to dismantle the Patient Protection and Affordable Care Act and significantly rein in federal spending.
Although the president and Senate Democratic leaders vow to stop such measures, passage in at least one legislative chamber increases the chances that Republicans could roll them into spending bills that become law.
Case for prevention
The championing of prevention as a matter of economic prudence echoes arguments during the fight for passage of the Patient Protection and Affordable Care Act that the measure would lower long-term healthcare costs by improving the populace’s health. That would be achieved, proponents said, by expanding insurance coverage (ensuring more people get care before they have acute medical needs) and with an array of other provisions.
“These savings can be achieved by standardizing quality care, incentivizing efficiency, investing in proven ways not only to treat illness but to prevent them,” President Barack Obama said in a May 11, 2009 speech.
In addition to specific preventive-care initiatives (See chart), the law eliminates out-ofpocket expenses for preventive-care visits for Medicare beneficiaries and requires that private insurers do the same.
On April 13, the House of Representatives voted to repeal the law’s Prevention and Public Health Fund, which authorizes the HHS secretary to distribute $17.75 billion from 2012-21. Democrats responded that Republicans were acting cynically to cut spending on prevention while claiming fiscal responsibility as their top priority.
“For decades our healthcare system has been designed to treat patients once they’re sick,” Rep. Anna Eshoo (D-Calif.) said in an April House floor speech. “This is inefficient and costly. The Prevention and Public Health Fund included in healthcare reform is finally starting to change this backward system and invest in efforts to keep people healthy.”
It’s a simple and powerful argument. And for some types of prevention initiatives, such claims are indisputably true.
The wide range of activities encompassed under “prevention” includes many clinical services, such as vaccinations or prescription medications that help people quit smoking and thus prevent disease. Some of these primary prevention programs are relatively inexpensive and can eliminate the future cost of treating expensive diseases, according to recent studies.
First lady Michelle Obama visits a school as part of the White House’s Let’s Move campaign, an effort by the administration to make Americans healthier.