An Apple a Day? Sorry, Prevention Is Just Too Expensive

As discussion of healthcare reform begins to get louder, we have to separate the accepted truths from the real truths. Not because we will be healthier, but because we can't afford them.

Prevention is one of those accepted truths. We hear about it everywhere. The promotion of wellness through healthy eating, good exercise, weight reduction, no smoking, a better night's sleep, life balance, zero trans fats, all those good, healthy, preventive activities -- they are not only supposed to help us escape disease and live longer, but they are now embraced by those who pay for our healthcare as a panacea for costs, too.

Employers build gyms in the workplace. State government provides quit smoking programs. The county subsidizes healthier food for the poor in an attempt to curb obesity. The idea is that a healthier workforce or group of citizens will reduce healthcare costs.

But does prevention really reduce those costs? Turns out that in the long run -- no -- it doesn't.

Froma Harrop, who writes for the Providence Journal, pointed this out in her recent column about prevention and costs. She's actually quite blunt about it: the longer someone lives, the more their healthcare costs. Therefore, since prevention programs help people live longer, prevention actually costs us more money in the long run. She draws her conclusions based on a book called Healthcare Half Truths, by Arthur Garson, Jr. MD.

Everyone dies eventually, says Harrop, and the sooner they do, the less it costs the rest of us. For example, the man who avoids a fatal heart attack at age 70 because he exercised and didn't smoke, will go on to require more healthcare services for those extra years, including extra CT scans, hip replacements, drugs or more before he dies, maybe 10 years later.

It makes perfect sense, actually. Live longer = cost more.

In his book, Garson cites a Dutch study that showed that the medical spending on smokers who died at an average age of 77 was $100,000 less than non-smokers who were thin and died at age 84.

I've seen it described other ways, one based on the 80 / 20 rule. On average, 80% of the total cost of one's lifetime of healthcare is spent in the last 20% of life. If life is shorter, then that 20% of time will be shorter, too, and the money for care will be paid out for a younger person for a shorter period of time. OR, of course, if life lasts longer, then more money will be paid out over a longer period of time.

Why does this matter? What conclusions can we draw as individuals?

It actually matters more to us as taxpayers than patients. When people are encouraged to be healthy in the workplace, they live to retirement. As they age into Medicare, which is offered to those who are 65 and older, much of their care cost becomes our tax burden. Granted, they/we have paid into Medicare all our working lives, but we've all heard the nightmare predictions that Medicare funds will run out in 20___. (name your year here.)

So we have to ask ourselves... do we really want all those OTHER people to be so healthy that they cost US money or use OUR money up before we get to use it?

I say -- prevention may be the last revenge. I've paid into Medicare, Medicaid, employer sponsored programs, even government healthcare at one time or another throughout my working life. I'm going to go out and prevent everything I can! I just really want to get my money's worth by the time it's all over.

So perhaps that's our takeaway for today. Prevention may be more expensive in the long run, but it's definitely an investment that lets us reap the benefits of not only better health, but our earned share of the government healthcare pie, too.
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