Below The Beltway

One of the central tenants of President Obama’s health care reform plan is the idea that increased spending on preventive care will, in the long term, reduce the overall cost of medical care by reducing the number of people suffering from debilitating diseases like cancer, heart disease, and diabetes. As it turns out, there may be very little savings at all from preventive care:

Using data from long-standing clinical trials, researchers projected the cost of caring for people with Type 2 diabetes as they progress from diagnosis to various complications and death. Enrolling federally-insured patients in a simple but aggressive program to control the disease would cost the government $1,024 per person per year — money that largely would be recovered after 25 years through lower spending on dialysis, kidney transplants, amputations and other forms of treatment, the study found.

However, except for the youngest diabetics, the additional services would add to overall health spending, not decrease it, the study shows.

“There’s no free lunch here. Prevention will not pay for everything. But it’s not as expensive as it looks at first blush,” said Michael J. O’Grady, a senior fellow at the National Opinion Research Center at the University of Chicago, and one of four authors whose work is being published on the Web site of Health Affairs, a leading journal of health policy research.

And the same appears to be true of other diseases:

In its own analysis of preventive care, CBO said earlier this month that the cost of making cancer screening, cholesterol management and other services broadly available is likely to far outweigh any savings ultimately generated. The new study looks at a more narrow population — people already diagnosed with diabetes — and projects the cost of providing them with a very specific regimen of frequent checkups and diagnostic tests that has produced predictable results in clinical trials. (Treatment for other forms of disease may vary in their costs.)

For diabetes patients, only about two-thirds of that cost would be recovered in the first decade, when fewer complications materialize, and more than three-quarters would be recovered over 25 years, the study found. Only for the youngest patients, those aged 24 to 30, would spending on preventive care wind up producing a net savings: the study calculates that $21 billion spent on younger patients would cut overall spending on their health care by $6 billion over 25 years.

The other economic reality to look at is the fact that the more successful we are at increasing life spans and allowing more people to live into their 80s, 90s, and beyond, the more we’re going to be spending on the type of expensive end-of-life care that comprises such a large part of the nation’s over all health spending.

As the good doctor said, there ain’t no such thing as a free lunch.