House Democrats are in a funk. They have a huge health care plan that would hike taxes and cost a fortune, and responsible parties are pointing this out. The Congressional Budget Office’s Douglas Elmendorf, a Democratic appointee, says that the health care bill proposed in the House would cost in excess of one trillion dollars.
House Speaker Nancy Pelosi chided the nonpartisan CBO for “always giv[ing] you the worst-case scenario.” Health and Human Services Secretary Kathleen Sebelius claimed that CBO has “no scoring at this point, no cost savings at all for the prevention and wellness investments that we know will pay off long-term.”
But “prevention and wellness” money is a fantasy-case scenario. If they want to prevent high health care costs, Congress should try spending less.
Sound “preventive care” for ensuring your own individual health involves regular exercise, disciplined eating, and good nutrition — an apple a day. But today, “preventive care” means more trips to the doctor, more screenings, and, ultimately, more expenses.
Proponents of increased preventive medicine claim that early testing makes for the earlier diagnosis, and remedy, of serious-and potentially costly-diseases. They’re wrong. Hundreds of studies have shown just the opposite.
Take the holy grail of preventive medicine: Annual mammography for women over 40. A recent study from the International Journal of Health Services points out that mammography hasn’t been shown to be any more effective at detecting breast cancer than an annual manual examination by a nurse or other trained health professional.
This shouldn’t be surprising. A cancer can exist in the breast tissue for up to eight years before it is detectable by mammography. Large randomized controlled trials show no difference in mortality rates between women undergoing yearly or biyearly mammography screenings and those who do not.
While we hear plenty about the magical properties of “early diagnosis,” what these wide-scale tests often yield is overdiagnosis. This is particularly the case with ill-defined largely subjective “syndromes.”
Plenty of publicity has gone to mental-health issues such as the skyrocketing rates of “Attention Deficit and Hyperactivity Disorder.” But it also extends to more physical problems. H. Gilbert Welch, M.D., recently pointed out in the New York Times that an expansion of the definition of “osteoporosis” created 6.8 million new female osteoporosis patients overnight.
Recent expansions in the definitions of diabetes and “high cholesterol” have had similar effects. The result is not the early prevention of disease but of new classes of patients requiring ever more expensive treatment regimens.
Much of the higher medical bills are a result of the current health care system in which less and less of the costs of health care decisions are borne by the individual patient.
In fact, proponents of preventive medicine in the health-care establishment — typically those who are paid to do the tests and manufacture the testing equipment — have bemoaned the small co-pays that do exist. They complain that forcing patients to bear any of these costs will result in “not enough” testing.
Reformers now propose to push even more of the responsibility for payment onto third parties, encouraging tests which often result in expensive, long-term treatments for conditions that many times are only debatably health problems — all while somehow cutting costs.
This simply is not realistic, particularly not without some kind of rationing scheme. The only way to cut down on these costs is to put more responsibility in the hands of patients themselves — a proposition that doesn’t even occur to our central planners in Washington.
Zachary David Skaggs is a health policy analyst with Liberty Coalition.
