Was Denis Leary Right About Preventative Care?

Denis Leary had a great line from his Broadway show/CD "No Cure for Cancer".  It goes a little something like this:

"I love these little facts. "Well you know. Smoking takes ten years off your life." Well it's the ten worst years, isn't it folks? It's the ones at the end! It's the wheelchair, kidney dialysis years. You can have those years! We don't want 'em, alright!?

The Leary premise is quality over quantity.  If the late years aren't good ones, the theory goes that you may as well do what you want.  No mention of the cost of health care during the late years.  That doesn't translate too well into comedy, especially the Leary version of comedy.

Not to worry.  Arthur Garson's got you covered in this column from Governing Magazine, where he and Carolyn Englehard argue that preventative care just doesn't pay out:

"If you're among those who think prevention saves money, and will help reduce the overall cost of medical care, you're not alone. But while an apple a day might keep the doctor away, at least for awhile, it also might cost more than you think. Preventive medicine can help avoid costly illnesses earlier in life, only to increase the population of elderly and infirmed people who will most likely require expensive treatments for other illnesses later.

Even worse, unhealthy habits such as tobacco smoking may actually save money in the long run as people who smoke die earlier and use fewer health care dollars. "This doesn't make sense," you say, "Smokers are less healthy than nonsmokers." That may be true, and smokers do use up to 40 percent more medical care while they are alive. A recent study from Holland showed that, on average, smokers die at age 77 and save $100,000 in lifetime medical care costs compared with non-smokers who die at 83.

The same is true for people who are obese. While obesity-related conditions such as Type-2 diabetes, high blood pressure and heart disease are associated with high medical expenditures, the costs that are saved by preventing obesity will only be offset later in life by diseases unrelated to obesity that accompany living a longer life. In the Dutch study, obese people die at 80 and save $50,000 compared with non-obese people who die at 83."

Wow, there it is.  It's cheaper to allow people to make their own decisions about lifestyles because we don't have to spend money on them once they're gone - it's cheaper overall to let them do what they want. 

What the column doesn't explore is ramifications of preventative care for employers.  The ten years at the end are largely funded by the government.  What about the 5/10 year ROI scenario for employers that invest in programs that get people to stop smoking or drop their blood pressure.  Is the ROI there for the companies that choose to do that?

That's the million dollar question (literally) for employers in America.

Comments

[Tanya]

There is actually a fairly decent amount of information on the excess cost of certain conditions and the cost effectiveness of treating those conditions. One thing that always surprises people is that some studies show treating smoking and alcohol may not actually have ROI.

People who smoke and drink or have drug addiction tend also not to use much (preventative) health care right up until the point where they get really sick and die. Whereas, helping someone quit smoking is energy and resource intensive (especially since it can take up to 7 attempts before a smoker has success in quitting) and they may still develop medical complications as a result of their past smoking.

So....for some behavioral risks it is true that the "return on investment" may be less clear cut. Maybe Arnie has the right idea and we just legalize vice and tax the hell out of it? Ultimately these decisions are difficult to quantify in a clean, economic model with few variables. As societies we make many decisions that might or might not be economically optimal based on how the calculation is made.

[Tanya]

Oh and one other thing, we know that people with fewer socioeconomic resources have less opportunity to improve their health and access prevention, so part of the reason they delay care is because they have no coverage. Is it fair to simply "let them eat cake" and then suffer the consequences? An important social equity question that the numbers don't easily show.

[Nelliebear]

Wow. So people are just reduced to a dollar figure and it boils down to some measurement of payout? No acknowledgement of how the conditions addressed by preventative care feed into how people think and can contribute. Healthier workers THINK better....make better decisions, problem-solve and learn faster. This translates into huge ROI.

Rarely have I seen such crap trotted out. Makes me think of Bernard Madoff....it's just about the money folks.

[Mike Lee]

Yes, quite disturbing perspective, hopefully presented with the same intent as Leary.
70% of illness is preventable, healthcare is bankrupting our society.
According to a 2002 US Department of Health and Human Services report, work sites with physical activity programs have:
Reduced health care costs by 20-55 percent
Reduced short term sick leave by 6-32 percent
Increased productivity by 2-52 percent
Who is responsible for this Blog, the tobacco industry? Do some ROI research.

[cai]

Wow, so I am healthy...and I'll be a drain on society if I get to live a long and happy life. So much for taking care of myself!
Perhaps we have been against the big evil tobacco companies for no good reason. Let's just hand out cigarettes in kindergarten and we can start weeding people out a little sooner.

[Ralph]

Something else to take into consideration that I have not read yet - Morbidity Compression. This is the reality that a healthy person stays healthier longer and as age sets in, the length of time a person is "sick" is less and then the person dies. The length of time a person is "morbid" or sick is compressed or shortened, thereby costing the system less and maintaining a high quality of life for a longer period of time.

[Terri]

Another view is how this passes down to the next generation. If we can get the 1st generation to maintain healthy lifestyles, presumably the generation below will follow the lead and be healthier. For you ROI types, you will be spending less money on your workforce as the generations repopulate.