I hear you all of the time on Stand-UP!  Thanks for doing what you are doing.  I have a question/observation. I read your post about preventive care (which I’ve always called preventative – just learned that wasn’t actually a word recently).

Look, I’m not saying preventive medicine isn’t a good thing.  It is.  It’s important to recognize, though, that when you make people live longer (a good thing) they can cost more money overall (a bad thing).  But let’s face it, the good of extending life is often worth the increased lifetime costs of care.  We have to abandon the idea that the only things worth doing are both good in terms of quality and cost-savings.  Trade-offs are natural.  Sometimes things are worth doing and worth paying for.

So it makes sense that if we prevent someone from getting sick, he or she live longer, and if someone lives longer, that person will have a higher overall bill for medical care.  However, wouldn’t that person also pay taxes/premiums for a longer time to?  I’ve never heard anyone address this side of the equation and I thought you’d be the person to ask.  It almost seems to me that the argument is like a company saying”well its not profitable to keep employees because the longer they work here, the more we have to pay them.”True, but you’re getting work in return.”

That’s not my best analogy to date but its the first thing I came up with.  So, I agree that preventive care should be in the quality column, but I’m wondering why it can’t be in the cost savings side as well.

Ah, but you’re just asking if we will collect enough money to pay for the increased costs.  Yes, we might.

You need to differentiate between the money going into the insurance system and the money going out.  The money going out is actual health care costs.  That’s what I’m talking about when I say preventive care might not save money.  Yes, it’s possible we can collect enough money going in (in taxes and premiums) to cover that, but that’s not the point.  People claim preventive care will decrease the need for money going out for care.  That’s what’s debatable.

“Some preventive medicine is cost-saving as well as health improving,” Elmendorf said, when asked to respond to Summers’ point. “A much larger share is health improving but cost increasing. And there is some share that is just terrible because it makes health worse and costs money.”

“Not everything that sounds good for health is good for the budget,” he added. “[A] general increase in preventive medicine may or may not have the sorts of favorable budget effects that people expect. That surprises many people. But the very important [point] here is that for somebody who ultimately gets the disease, it is cost saving as well as health improving to catch it early. But to catch it early in that person you generally have to deliver the treatment or administer the test to a much larger set of people, most of who will not ultimately get that disease.”

Look, I’m not saying preventive medicine isn’t a good thing.  It is.  It’s important to recognize, though, that when you make people live longer (a good thing) they can cost more money overall (a bad thing).  But let’s face it, the good of extending life is often worth the increased lifetime costs of care.  We have to abandon the idea that the only things worth doing are both good in terms of quality and cost-savings.  Trade-offs are natural.  Sometimes things are worth doing and worth paying for.