Reporters from the New York media, take note! It’s time to tell your state’s senior senator (and the people he represents) the facts about preventative care—that elixir every politician believes will magically reduce health care costs. The other day, Sen. Charles Schumer did not seem eager to believe the Congressional Budget Office’s assertion that health care legislation winding its way through Congress would actually raise health care costs, not reduce them. Schumer called the CBO scoring “a little bit wacky” because it doesn’t account for savings from preventative care and efficiencies in the system. “They are not quite fair because they don’t measure the cost savings down the road, just the immediate spending,” he said.
Schumer isn’t the first member of Congress to put blind faith in the preventive care solution for America’s medical cost problem. Several weeks ago, California Sen. Barbara Boxer said that if the CBO did not give the Senate the numbers it was looking for, she, for one, would not follow its advice. Said the senator: “We’re going to look at OMB and CBO and make our own decision as to who is right.”
We don’t know about the efficiencies that Sen. Schumer is counting on, which may or may not materialize. But we do know about preventative care. In June, I sat down with Rutgers professor Louise Russell, one of the country’s leading experts on the subject. She told me that, contrary to widespread belief, preventative care does not save money. “Prevention has contributed to our rising medical costs,” she said, citing the example of statins—drugs to lower cholesterol—that are widely used for millions of people. In an e-mail this week, Russell said that she agrees with the CBO. One way to look at the review of studies on prevention, she said, is “that for every one preventative intervention that reduces medical spending, there are four that increase it.”
In the interview, Russell pointed out that the U.S. may not be spending its prevention dollars wisely. She said that America may already be doing more preventative care than other countries—but, clearly, more prevention has not reduced health care costs. For example, New Zealand, Australia, the U.K., and Canada spend less of their GDP on medical care and have longer life expectancies. Those countries emphasize more cost-effective interventions like flu shots, instead of annual Pap smears, which are popular in the U.S. but far less cost-effective.
We also asked Russell which interventions are worth doing and which ones are not. Smoking cessation programs and flu shots, she said, were great. So are statins for high-risk patients. But statins for people at a low risk for heart disease may not be worth it, Russell explained—at least not until other, more cost-effective interventions have been done, such as giving diuretics for high blood pressure.
After the June interview, Russell sent along another study from the Annals of Internal Medicine, showing that statins could reduce medical spending if they cost less than ten cents per pill. But an informal survey conducted by study researchers showed that costs ranged from seventeen cents per pill for a generic purchased at a large discount chain to five dollars per pill for a name brand purchased at a retail pharmacy chain.
Russell said that a cap on total spending would really help control medical costs: “We have to decide how much we are going to spend as a country and then stop when we reach that point.” That’s just what Schumer, Boxer, and other members of Congress want to avoid—so instead they peddle other nostrums that sound good, but offer little evidence that they work. So, Sen. Schumer, the issue isn’t so simple. Myths die hard.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.