The Politics of Prevention

Preventive care sounds like a win-win—conventional wisdom says it makes for both healthier patients and lower health-care costs. It's a favorite topic of politicians, even more so than usual this year. Sen. Barack Obama's campaign links "disease-management programs" to smaller price tags for health care, and Sen. John McCain's says that "by emphasizing prevention … we can reduce health-care costs." But wait, can we? A recent paper in The New England Journal of Medicine says the conventional wisdom is wrong: preventive-care programs usually result in higher payouts, not lower ones. So will the candidates' preventive-care plans add even more dollars to what we already pay? NEWSWEEK's Mary Carmichael spoke with two of the paper's authors, Peter Neumann and Joshua Cohen, both health-policy researchers at Tufts Medical Center:

CARMICHAEL: Why do politicians like preventive care so much?
COHEN: Because it sounds like common sense. We've all heard "an ounce of prevention is worth a pound of cure."

NEUMANN: It also sounds painless. It's a way to talk about health care without talking about cutting payments or limiting choices. So it's a great message, even if it's a very broad one.

Too broad, according to your paper.
NEUMANN: The blanket statement that prevention will save money and improve health is too simplistic. Sometimes it saves money, sometimes it doesn't.

What's an example of preventive care that does save money?
COHEN: One is childhood immunization on the recommended schedule. The problem is that a lot of kids are already on that schedule—we've gotten the bang for that buck. Another is the use of aspirin in middle-aged people to decrease their risk of cardiovascular disease. If you target the right people, you could actually save money and make people's health better.

But only 19 percent of the preventive interventions you looked at ended up saving money. Some cost a lot more.
NEUMANN: One example is prostate-cancer screening. It seems to be inefficient.

You have to spend a lot to catch the few cases that threaten people's health.
NEUMANN: And you might intervene medically when it wasn't necessary. So you get better health at very high costs, or you possibly get even worse health.

COHEN: Savings claims for smoking cessation programs are also controversial.