Pelosi, Prevention, and PBS

Is Madame Speaker misinformed?

Preventative care saves money? C’est impossible, Madame Speaker! For weeks, we on Campaign Desk have been pointing out this fallacy, but members of Congress seem reluctant to embrace the evidence. That’s a rather strange stance for elected representatives, who’ve been busy telling their constituents that health care costs can best be reduced by evaluating the evidence and paying only for what works. Apparently, evidence is sometimes a good thing and sometimes a bad thing, depending on which point works for your argument. In this case, the evidence is this: Preventative care does not—does not—save money. In fact, it actually costs money.

On the News Hour with Jim Lehrer last night Judy Woodruff interviewed Pelosi at length, mostly about health care—unsurprising, since health reform is currently Topic A. What was surprising was what Pelosi told Woodruff:

One of the challenges we have is, we know that there are tremendous savings in going forward with the preventive piece, hundreds of billions of dollars. The Congressional Budget Office, the accounting office here, doesn’t give you any credit for prevention. But we are so sure about that that I don’t know that we’ll ever even need the pay-fors because the prevention will provide so much saving.

Wow! That’s quite a statement. The Speaker of the House is so sure that preventative care is going to save billions of dollars in medical expenditures that Congress won’t even have to look for other money to cover the costs for subsidies to help people buy insurance. (Remember, the pay-for rules require that every time Congress passes a new program, it must find offsetting revenue from another pot.) Now here’s the problem: What happens when these savings don’t materialize, as the evidence suggests they won’t? Will they magically appear, like the rabbit pulled from the magician’s hat or the ghosts in Harry Potter land? If the billions don’t appear, what trick will Congress use to cover the shortfall—cut benefits for the millions who can’t afford the coverage they will be required to buy?

In June, one of our Excluded Voices interviews featured Rutgers professor Louise Russell, one of the country’s leading experts on preventative care. “It certainly is not the solution to anything in terms of medical costs,” she told us. Russell also said: “It’s so easy for people to misunderstand the issue. I hesitate to think that people who say preventive care saves money are deliberately misleading. I think most of them don’t understand it.”

In a subsequent post, Russell said she agreed with the CBO’s decision not to score or evaluate preventative care savings. “One way to look at the review of studies on prevention,” she explained, is that “for every one preventative intervention that reduces medical spending, there are four that increase it.”

Asked to offer advice to reporters, Russell said that the press should challenge the idea that preventative care saves money. But, last night, Woodruff allowed Pelosi to foster that illusion. By not pushing back on the point in a follow-up question, Woodruff left the impression with her viewers that Pelosi had indeed pulled a rabbit out of the hat. No doubt reporters trailing Congressmembers during the August recess will hear lots about how prevention saves money. When they do, it’s important to remember what Louise Russell said.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.