The idea of having a “wellness” rather than a “disease” orientation is politically appealing, and politicians on both sides of the aisle promise painless savings of “billions” by “incenting doctors” to “keep people healthy.”
No-cost and low-cost choices—diet, exercise, avoiding risky behavior—are available to all Americans, without any involvement by health plans or government. The question in the “healthcare reform” debate is the forcible “reallocation” of resources from treatment of the sick and the injured to third-party-funded health programs ranging from smoking-cessation counseling to early detection of disease to drug therapy for blood pressure or lipid levels.
The blame-the-stakeholders approach—“a dollar spent on medical care is a dollar of income for someone”—usually sidesteps or minimizes the issue of denying or delaying care to patients who could immediately benefit, in order to reduce the future burden of illness in hypothetical others.
For the rationale of achieving cost control by this means, it is time to write an obituary, writes John Goodman.
The Obama Administration’s options for cost control represent “hope vs. reality,” write Theodore Marmor et al. (Ann Intern Med 2009;150:485-489). Emphasis on prevention, better chronic-disease management, outcome-based payment, and comparative effectiveness research are “ineffective as cost-control measures,” they conclude.
A review of 599 articles on preventive interventions published between 2000 and 2005 concluded that the vast majority do not save money, notes Victor Fuchs (JAMA 2009;301:963-964). In fact, 80% add more to medical costs than they save (Louise B. Russell, Health Affairs 2009;28:42-45).
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