The CBO admits that prevention doesn’t lower costs.

Preventive medical care includes services such as cancer screening, cholesterol management, and vaccines. In making its estimates of the budgetary effects of expanded governmental support for such care, CBO takes into account any estimated savings to the government that would result from greater use of preventive care as well as the estimated costs of that additional care. Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.

By now this is may be received wisdom among those looking at health care issues. However, when I first starting pushing this six years ago many were shall we just say, less than receptive to the idea. How can you possibly speak ill of prevention? Do you like to see women die of breast cancer?

The take home now should be that health issues – at least as much as economic issues, if not more – can be deeply, deeply counterintuitive. They are counterintuitive largely for the same reason, which is that you have a complex dynamical system that is “trying” to reach an equilibrium you don’t necessarily like.

Every human body is dying. This is fundamental and it will impact everything you do.  So every investment you make has to be with the knowledge that this is a temporary patch not a solution. Even if you prevented all cancers, the would-be cancer patients will become fatally ill with some other disease. This reality makes everything less cost effective than it seems at first.

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