MasterPo says: This blog is about topics and issues that are of importance to me. I am not one of the countless blogging lemmings that are tripping over each other scurrying down the hill and off the cliff of blogging oblivion trying to write the greatest blog on the latest topic de'jour. Your comments are welcome.

July 25, 2009

Healthcare Prevention Does NOT Make Financial Sense!

The shining star of the Obama national healthcare plan is the claim of H-U-G-E savings that will come from constant testing and thereby early detection of diseases when treatment will be (maybe) simpler and cheaper than if the disease is allowed to progress further before being found and treated. President Obama insists that early detection and treatment will save billions and pay for the national healthcare plan plus more.

I say: Impossible!

It simply does not make sense.

When you look at the process of what it means to really have medical tests performed and the costs involved all long the way I just don't see how it can possibly save a penny. In fact, it will end up costing a lot more than no testing!

Here's why:

Preventive tests cost money!

What ever that test maybe it costs to administer the test, have the results reviewed by an expert, and presented back to the patient. Even if the test is completely negative these costs must be paid each and every time the test is performed. And since the point of testing is to catch a problem early on that means years and years of testing before anything is found – if anything at all ever is found!

For example –

The American Cancer Society recommends breast cancer screening in women start at age 40. That means mammograms. And I happen to know (from family experience) the cost of a mammogram test is approximately $2,000 (rounded).

According to U.S. government figures the average life expectancy for a woman in the U.S. is 76 years. That means a minimum of 26 years of mammogram testing. Give these two facts, at $2,000 per test that means starting from age 40 to age 76 the total cost of mammogram testing would be $52,000. And that amount is probably on the low side because costs always go up and it presumes 76 is the mortality. If costs go up as they always do and/or if the woman lives past that age the total cost goes even higher!

Now consider what it means if for those 26 years the woman never test positive for cancer (thankfully!). That means $52,000 was, for all intents and purposes, wasted on testing since it never returned a positive result. There is no recovery of that cost! I agree it is good peace of mind to know she doesn't have breast cancer, peace of mind doesn't off set the cost much less result in a cost savings.

But let's consider if she does unfortunately get diagnosed with cancer. Let's say 10 years (and $20,000 later in costs) into testing a mammogram reveals a lump. Further tests are need to determine if it's cancer or benign (there are non-cancerous grows too that don't cause illness). That's additional cost as well. Let's continue and assume it is cancer. Treatment is started. Doesn't matter what kind – surgery, chemo, radiation, whatever. That has a cost too. Now let's say the treatment is successful and the cancer is totally eradicated. Very good news! But the costs don't stop there. Now future testing resumes (especially after a prior cancer diagnosis) for the rest of her life. More on going costs.

So to sum it up you first have the costs of the initial testing to maybe find cancer, the costs of the treatment if and when cancer is in fact found, and the costs of the future testing after treatment to see if it has relapsed.

Where is the H-U-G-E savings???

Further, very often it may take several tests to determine if there is or is not a medical problem. We have all had the experience (and if you haven't yet you will, I guarantee it) of your doctor performing some routine test then telling you this or that result is slightly higher/lower than it should be. As such he wants to run an additional test. Or the doctor wants to send you to a specialist. Either way there could 5, 6, 7 or more tests performed. Each with its own costs (and usually growing in expense as the detail of the tests rise). Even at the end of all the testing very often there is no conclusive result positive or negative! The final answer very often can simply be "Come back in 6 months for another test".

Even more cost.

I agree that sometimes the cost to treat an illness is less the sooner the illness is found. But that definitely isn't in stone either. In many cases there is only a single or a limited number of treatments no matter at what stage the disease is and it costs the same.
But even if it is cheaper to treat sooner rather than later, the initial and follow up costs of testing are still the same as well as spending money to treat the disease itself when found. Maybe not a much spent on treatment but still a cost.

So I just don't see how there is going to be H-U-G-E savings from early testing.

I would also remind my readers that when the HMO system first came on the scene it too was touted as being a great cost controller. The concept of the Health Maintenance Organization would but early testing and preventive activities ahead of reactionary treatment and therefore reduce healthcare costs while making people healthier.

Anyone think HMO's have significantly reduced healthcare costs and/or made people more healthier?

As the saying goes: "Show me the money!"

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