04 September 2009

An ounce of prevention is worth a pound on your door?

In the current health care debate, one idea that keeps getting tossed out there is that we could all be so much more healthy if only there were more "preventive care."

Let's set aside, for the moment, the well-established fact that universally applied preventive care would increase aggregate health care spending. Let's also leave aside that some doctors are beginning to question whether some screening does more harm than good. Those points have been discussed elsewhere - the Congressional Budget Office even pointed out that universal preventive care would increase, rather than decrease costs. There is another point that I think is far more fundamental, in particular as it pertains to the notion that preventive care will make us all healthier.

Preventive care consists of things like annual physical exams, and screenings for things heart disease, high blood pressure, and some cancers. And all of that is voluntary. Most of the people who do not currently receive preventive care already have insurance and income sufficient to pay for it.

To take one example, one study showed that as few as 61% of women over the age of 65 - a higher risk group for breast cancer - received regular mammograms. All of them were covered by Medicare, which pays for annual mammograms.

Similar statistics can be found for a variety of other recommended screening tests and preventive care examinations. Whatever the real benefits of preventive care, it can't help you if you don't get it.

Yet large numbers of us simply do not seek those procedures, even though we already have both "access" and insurance, and there is no reason to think those habits will change simply because our insurance company does.

So, if 40% of little old ladies don't want to get their annual mammograms, who's going to make them?

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