Prevention might be a cure for more than just health care costs

Last week's developments on health reform were mixed:  the President urged Congress to keep plugging away at health reform legislation, as he traveled to Italy; the Blue Dog Democrats set their jaws on the possible price of health reform; and in the meantime, people just kept on doing stuff to improve health care anyway, like the Centers for Medicaid and Medicare Services quietly adding information on hospital re-admission rates to its Hospital Compare web site.  Even though it’s not easy to use, this web site can tell you how hospitals do on things like, uh, patients dying, and how hospitals do on factors like people showing up again at their doors, within the 30-day window after they exited.

Matthew Miller also wrote an article last week on Fortune.com about how investing in prevention won’t save us any health care dollars.  In this article, he calls prevention the “faux panacea” in the health reform debate, and points to the paucity of evidence that exists for whether prevention will end up costing us less, or more, over the long run.

Matthew Miller’s article makes some interesting points, but mostly in response to people who were foolish enough to make some sort of sweeping claim that investments in prevention would solve all of our health care economic woes. 

It has been pretty clear, from the beginning of this legislation debate, that there ARE no silver bullets to our health and health care problems.  Because, let’s face it:  we have a LOT of problems, and many of these problems took years to take root, and spiral out of control (there’s a creeping kudzu metaphor in here somewhere), and many of them will also take years to undo, although government leadership and action could accelerate the fixes.  If one really takes stock of our smorgasbord of problems having to do with obesity, public health threats, broken payment and delivery systems, and patients and consumers who lack insurance and can’t get the right care, who in their right minds would argue that anything is a panacea when it comes to health reform?   

The other point is, Matthew Miller seems to put “prevention” in a tiny box—labeling it as “taking meds and getting special checkups and the like,”—when the real game-changer, he asserts, is behavior change.  But isn’t it possible to see how one could lead to the other?  How, if healthier behaviors are encouraged across multiple settings—like in your doctors’ office, or at your place of work, or in your community—that these investments in prevention could lead to behavior change?  I actually thought that was the point of investing in prevention in the first place.
 
Paralysis—doing nothing—is clearly not the answer.  But in figuring out what is the answer, we are going to have to make hard choices about which components of health reform legislation make it to the finish line, because we’re in an economic climate where we should have to make hard choices, and we should recognize that some things will take precedence over the others.  But prevention has always struck me as one of those tough things to argue against, like motherhood and apple pie.  There may be no significant evidence, as of yet, that prevention will yield huge cost-savings, but it’s probably the right thing to do, anyway, for reasons that go beyond our overall pocketbook.  
 
Update:  for more on this topic, and to hear it better said, click here.