2661

There will DEFINITELY be less of them. You’re being disingenuous to suggest otherwise.

2662

True now, but if preventative care actually becomes an across-the-board practice, all insurers will see ROI in more or less equal amounts, benefiting from each others’ previous clients and so forth.

2663

It didn’t end up in the bill. The new exchanges are state wide.

2664

Ok, then there will definitely be less of them. But there will also definitely still be some of them, which is all I said, geez.

2665

Conversely, wouldn’t they see benefits from preventive care paid for by their competitors? In other words, they do see a overall ROI from preventive care in general even if people do not stick with the same provider their entire life.

2666

Except that the medical evidence is pretty firm that preventative care doesn’t save costs. Preventative care may reduce costs for 1 person. But all the additional screenings to find that one case add substantially to the cost. If you look through this post’s history, you see that most analysis of preventative care shows it’s not a money saver.

The savings from this bill comes from ending Medicare advantage and reducing payments to providers in the belief that they will become more efficient.

I also think this legislation ensures that there will be a VAT will be strongly considered if the Dem’s have a majority in a few years. The revenue shortfalls will be very signficant.

2667

Doesn’t that depend on the kind of preventive care? Some things like mammograms seem to have diminishing returns for younger women, for example, based on that recent study but surely there are less expensive examples where an ounce of prevention really is worth a pound of cure.

2668

I’d like to see links that show that preventative care doesn’t work, which is what you are basically saying. I don’t know if you are discussing a specific illness or set of illnesses, but it seems obvious that things like vaccines do in fact have an ROI, because even if you assume a .0x percent failure rate with them, the amount of care that someone who has received a vaccine is going to be a lot less than someone who gets the disease that the vaccine would have prevented. And I’m only talking about vaccines, there are a number of other preventative medicines and treatments that obviously reduce the cost of treating what they are preventing.

It’s interesting also that you are claiming that the ‘revenue shortfalls will be significant’ since the Congressional Budget Office found otherwise.

2669

Mammograms are damned near obsolete at this point, FYI. After a few decades of being overprescribed, the numbers work out against doing them at all. Same with prostate exams, the false positives are so frequent that they’re doing more harm than good.

H.

2670

Let’s be careful to separate out cost savings from health benefits. My understanding is that preventive care “works” in that it improves outcomes. I don’t know the economics of whether particular interventions produce cost savings, I could see it go either way. When people die earlier, you save on the health care costs after they’re dead, so does the 20 days in the ICU end up costing more than the extra 10 years of life on oxygen? I don’t know.

The CBO evaluation, as I understand it, pretends that Congress will not reverse the mandatory medicare reimbursement cuts already scheduled. Right now, a 21% cut in reimbursement scheduled for March 1st, has been postponed to the end of March. Every year Congress has voted to reverse these cuts, because decreasing the rates will cause providers to stop seeing Medicare patients. This falls particularly hard on primary care practices, who already have very narrow margins on Medicare, much less Medicaid patients. I think wahoo’s skepticism that Congress won’t stick to these cuts is pretty well founded.

2671

Back by popular demand, studies on why preventive care doesn’t work.

As for the CBO score…CBO score is full of a bunch of tricks/gimmicks. Like a bump up on Doctor pay that only gets scored for 2 years and then Medicaid drastically cuts spending on primary care physicians. The idea that these cuts to Doctor’s pay will actually happen is absurd given the AMA deal on the bill.

2672

No, in fact if preventative care actually saves money over the long term the winner will be the US government because the end destination insurance plan for all of us is Medicare.

There is actually the possibility that preventative care increases costs if it increases lifespan during the time that people are on medicare and experiencing chronic diseases but either way it’s one of those right thing to do decisions.

2673

I could be wrong, but I think the preventative care debate is less about vaccines and more about checkups and screenings.

2674

First, that applies only to those people in the individual market (which most forget to mention), not the people covered under their employer’s plans. Second, there will be sliding-scale subsidies for everyone up to (according to the reconciliation bill, IIRC) 400% of the poverty level.

2675

That’s the rub, exactly what is preventative care? I was thinking about this while eating breakfast :)

I mean I realize you could argue that everyone should get all kinds of screening tests all the time. I guess I wasn’t thinking of screening tests necessarily being preventative care, although I can certainly see how they are. And that’s a whole other discussion because as we have noted before, there is a lot of disagreement about what screenings are necessary when.

And wahoo, I always find it interesting when Republicans poo poo whatever facts a non-partisan accounting office comes up with. If the CBO had come up with facts that supported the Republican position then they’d be absolutely adored. It’s utter bullshit since the CBO is in fact non partisan and in fact has real accounting professionals doing the work.

2676

That’s what he’s referring to, I think. I believe the top end of that scale (400% of the poverty level, as you say) covers insurance costs above 9.4% of your gross income.

2677

Yeah, it’s a little counterintuitive because you’d think vaccines would be the very definition of “preventative care,” but for the purposes of this argument, people are really talking about the kinds of preventative care that don’t normally get done either because they’re too expensive or because people don’t feel like it and don’t see the immediate benefit; essentially, this means checking people out in various ways to find out if they have a disease that they don’t know about yet.

2678

Can someone out there give us an idea of how the reconciliation bill fight is going to play out in the Senate? Is there a good chance that the majority can reject all of the endless amendments that the minority is going to try to append to the bill?

2679

Logically I would think there would be a reduction in the severity of incidents by covering more people, if they are covered then they’ll go get the nasty cut cleaned up and stitched rather than waiting for it to fester into a serious infection. Logically, mind you, I have no data to back this up.

H.

2680

From the NYT article:

No one really knows whether preventive medicine will save money in the long run, let alone free up the billions of dollars a year needed to help pay for universal health insurance. In fact, studies have shown that preventive care — be it cancer screening, smoking cessation or plain old checkups — usually ends up costing money. It makes people healthier, but it’s not free.

As Dr. Mark R. Chassin, a former New York state health commissioner, says, preventive care “reduces costs, yes, for the individual who didn’t get sick.”

“But that savings is overwhelmed by the cost of continuously treating everybody else.”

The actual savings are also not [QUOTE]as large as might at first seem.
Even if you don’t develop diabetes, your lifetime medical costs won’t drop to zero. You might live longer and better and yet still ultimately run up almost as big a lifetime medical bill, because you’ll eventually have other problems. That would be an undeniably better outcome, but it wouldn’t produce a financial windfall for society.[/QUOTE]

No one except the NYT is asserting that preventative care will eliminate the cost of healthcare. What I’m saying is that it’s still cheaper to prevent illnesses than it is to treat them. Also the NYT article assumes that doctors will be doing the preventative care, something that I don’t find to be true at Kaiser Permanente. None of the preventative care that I get is done by doctors; that’s one of the benefits in fact that nurses and physician assistants can do this kind of stuff. Unless you are going to a very small clinic, there’s no reason for doctors to be doing preventative care in any insurance coverage.

From the New England Journal article:

Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs. For example, screening costs will exceed the savings from avoided treatment in cases in which only a very small fraction of the population would have become ill in the absence of preventive measures. Preventive measures that do not save money may or may not represent cost-effective care (i.e., good value for the resources expended). Whether any preventive measure saves money or is a reasonable investment despite adding to costs depends entirely on the particular intervention and the specific population in question. For example, drugs used to treat high cholesterol yield much greater value for the money if the targeted population is at high risk for coronary heart disease, and the efficiency of cancer screening can depend heavily on both the frequency of the screening and the level of cancer risk in the screened population.

There is no question that a lot of attention needs to be paid to preventative care through screening. For example, men can get breast cancer, but the percentage of men who get breast cancer is not great enough to justify screening them. But some men may demand the screening anyway, and then you have a problem that can’t easily be solved through quantitative analysis. And this is the thicket that healthcare, insurance companies and politicians are going to have to continually navigate.

I answered your CBO assertions in my previous post.