The problem with prevention
Blue Cross and Blue Shield of North Carolina, and groups funded by the insurer, like to claim that wellness will save our health care system. Politicians also love this line. State lawmakers are so convinced that wellness will save money — without any evidence to support their position — that they might yank the coverage of overweight and smoking state employees and leave them and their families uninsured.
But the truth is that prevention is only a small piece of the health reform puzzle. Some types of prevention are cost effective — like some smoking cessation programs and vaccinations for children. Other types of prevention probably don’t save much money but add to quality of life, or, in some cases, save lives, like flu shots for adults, Pap smears for cervical cancer, and colon cancer screenings.
If we can keep people at a reasonable weight and stop them from smoking then it will certainly improve public health. But wellness can’t be the cornerstone of cost control in health reform. Of course, Blue Cross and elected officials don’t want to deal with the hard work of actually controlling costs. Controlling costs will upset powerful special interests like insurance companies, drug companies, doctors, and hospitals.
The truth is that a small percentage of the population eats up a huge percentage of health care spending. About 20 percent of the population accounts for 80 percent of spending, and about 5 percent of the population accounts for almost half of health care spending.
Expensive patients usually have multiple chronic illnesses. Some of those illnesses could be prevented by jogging and eating more vegetables, but many are the result of aging. Dying in the United States is expensive and involves many stays at the hospital and many specialist visits. No amount of wellness will change that fact.
Instead, if we want to start saving money in health care we will have to get more efficiency from hospitals and doctors. We will have to get more coordination of care. We will have to offer competition for private insurance companies to reduce administrative costs.
And we will absolutely have to improve end-of-life care.
So when you ask a politician or insurance company spokesman about controlling costs in health reform and they start talking about prevention, start asking more questions. Wellness is a dodge, not an answer.