Friday, August 14, 2009

An ounce of logical prevention...

I've been, over the past several months, been engineering a new personal political equilibrium, that is something at odds with my traditional knee-jerk libertarian instinct. It's not a rejection, per se, but an accommodation of certain physical and political realities. I realized that I'm willing to make compromises on certain dogmatic fronts in order to weakly achieve Pareto improvements. It all really started with an NPR interview with Doug Holtz-Eakin a while back where he actually made some sense on these kinds of tradeoffs Republicans have to be willing to make. A full response to him has been in the works for some time, and some day will appear here.

For now, I just want to ask the obvious questions begged by this Charles Karauthammer column. He writes:
This inconvenient truth comes, once again, from the CBO. In an Aug. 7 letter to Rep. Nathan Deal, CBO Director Doug Elmendorf writes: "Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."

Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.
Clearly. But then isn't the correct adjustment to at least fund population-wide preventive care for those diseases where the benefits outweight the costs? That is, fund the screenings for diseases that occur with higher frequency and also have sufficiently high late-stage treatment costs. Maybe there are none that meet this criteria - I dont know. But an out-of-hand dismissal seems, well, dismissive. From CDC and private research, we have a pretty good idea of how common various conditions are in a given population.

Also, if preventive care is instead restricted to sub-populations (maybe this is unacceptable to some people), then we can increase the positive/population ratio by selecting into higher risk populations. We do this informally by telling women there's no need to get a mammogram until your 30s (at least) because occurrence of breast cancer is so low among teens and young adults. In the same way, we could fund heart disease preventive care for say those over 40 (or 30 if you have a family history of heart disease), but not 20-year olds with no known risk factors.

I would think somewhere in either of those criteria would be a preventive care regime that passes the cost-benefit muster. Maybe the data says otherwise...

1 comment:

Rob said...

If this is a readjustment of your sense of the world, I'd be interested in hearing what's changed about your view. Is it that the old you would have been with Krauthammer in dismissing preventive care as a waste of money?