preventative medical care
Topics: Health
20 Sep 2007
From: Ervan Darnell
The cost effectiveness of preventive health care is debatable [1], but
for the moment accepting the widely held belief it is useful and under
provided, it's interesting to see how it's under-provided. Insurance
companies have no interest in paying for preventive health care when the
next carrier will pick up the tab for the condition. Actually, I'm not
sure it is under-provided, every insurance company I've had has paid for
routine check-ups and established screening procedures (e.g. mammograms
and colonoscopies). But, surely they are not aggressive about other
early detections (e.g. the full-body Ameriscan, a broad-spectrum
early-diagnosis MRI).
The tax code giving employers a tax break for buying insurance, but not
for individuals, has led to the situation where most get their health
insurance through their employer. As most people change jobs several
times in their life, insurance companies writing corporate polices lose
interest in the long-term health of covered individuals. I've written
before about how health insurance should be imputed income for
individuals and that would solve lots of problems. This is another.
But even worse, the big bills come in old age, which Medi* picks up.
Thus insurance companies treat the government as a dumping ground for
health problems and have less interest in preventative care.
Other than the comprehensive solution of medical freedom, there is an
intermediate solution that addresses the concern: have Medi* pay
insurance companies the amount that preventative health care saves the
Medi* system (when people transition from private insurance to Medi*).
That puts the incentive back in the right place and saves everyone money
in the long run. I never heard any liberal suggest this (maybe Clive
has as he has some professional connection to this business). But I
don't find it surprising that liberals wouldn't suggest this. When the
objective is the socialization of medical care, things like
'preventative care' are mere excuses to reach the conclusion and not
serious objections (I think of my Canadian friend waiting _years_ to get
a primary care physician, so much for routine check ups under
socialism). Economic tweaks to fix the stated problem will never
satisfy their ultimate goal.
It does beg an interesting question though: why do insurance companies
not do this already between themselves? I can see three possibilities:
1) Preventative health care doesn't actually save money (or the cost of
deciding how much preventative care someone actually received previously
exceeds its value).
2) It's illegal because it charges different rates based on health status.
3) The real cost and/or savings comes at the end, and thus Medi* has to
start percolating down the savings (if any).
For me, the conclusion is that either that there is no problem to fix
(case 1) or the government is at fault (cases 2 and 3). Fix 2, try 3,
and see if insurance companies internally percolate the cost down, and
by how much. That would be one way of estimating the proper amount.
[1] http://www.ncpa.org/ba/ba188.html
e.g.
>
> *The OTA study.* The Office of Technology Assessment (OTA) studied the
> cost-effectiveness of adding coverage for several preventive measures
> - including flu and pneumonia vaccines and screening tests for
> cervical and colon cancer - to the federal Medicare insurance program
> for the elderly. /None of the preventive measures was found to cut costs./
>
> A separate study by the OTA found that only three kinds of preventive
> care save money: prenatal care for poor women, tests in newborns for
> certain congenital disorders and most childhood immunizations.
>
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