Organizing for America | Steven Beller's Blog: The dangers of preventative care

The dangers of preventative care

By Steven - Aug 21st, 2009 at 11:55 pm EDT

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Tags: Betsey McCaughey, CNN, Health care costs, health care reform, insurance mandate, Kitty Pilgrim, life expectancy, Lou Dobbs, preventative care, Sally Pipes

The dangers of preventative care

You do get some fascinating arguments from the opponents of health care reform. There is, if you have not already seen it, Betsey McCaughey’s priceless discussion with Jon Stewart about the Democratic plot to pull the plug on grandma:

http://www.thedailyshow.com/But almost as good is Sally Pipes’s argument about the dangers of preventative care. Tonight (August 21) on the Lou Dobbs Show on CNN (Kitty Pilgrim hosting), Sally Pipes was arguing that there really is no need for covering the uninsured, because there are really only about 8 million of them, not the 47 million the US census bureau thinks there are. That is highly contentious, but leaving that aside for the moment, I really have to admire her remarkably purist argument about why there was no need for the uninsured to be insured and her satisfaction, one might call it insouciance?, that if these people eventually needed treatment for a condition that could have been solved at an earlier stage but now had become life-threatening, they could just turn up at emergency rooms. Countering an argument from the sane representative of the need for everyone to have insurance, who reasoned that receiving preventative care for conditions before they became life-threatening was, in the long run both better for the person concerned and also for the system, because of the avoidance of the extra-high cost of emergency treatment, Ms. Pipes refuted this by citing what she said was a CBO claim that paying for preventative care created no savings for the health care system, but, on the contrary, was actually more expensive in the long run than the alternative of relying on people letting things develop into life-threatening crises.Now, this is in many ways a brilliant, if somewhat elliptical argument. On the face of it, this idea that preventative medicine is more expensive than waiting for medical conditions to become critical, might appear an odd claim. Intuitively, we would think that if you can catch a remediable medical condition early, like various cancers for instance, or diabetes, one can either cure the condition or provide medicine or treatment that avoids the worst consequences of the disease. Hence the expensive procedures of emergency treatment are avoided, the patient can live a healthier life, a less stressful one, because he or she is not burdened by the fear of not knowing what is wrong with him/her but afraid or unable to go to the doctor to find out and get reatment because of a lack of insurance, and is therefore happier as a result. Health and happiness, and avoidance of serious illness, usually, on average, also result in longer life, which one assumes is a good thing, right? But here is where the brilliance of Pipes’ argument comes in, no doubt backed by the CBO’s number crunchers, because if someone lives longer, and are not killed off by untreated, chronic conditions and the stress that goes with this situation, they have a higher likelihood of contracting other diseases associated simply with ageing. These old(er) people, according to the Pipes/CBO logic are now costing more than they would have done if they had not received preventative care in the first place! How inconsiderate of them, according to Pipesian logic! They are living longer and causing more cost, when they should have been dead by now, if only they had not had health insurance and preventative care foisted on them!In other words, the extra cost of preventative care must arise from the fact that it actually succeeds, statistically at least, in leading to a healthier populace and hence higher life expectancy, more old people to take care of. Now, a compassionate person who was really against “pulling the plug on grandma” and wanted, in fact, grandma to live to a ripe (and relatively healthy and happy) old age, might welcome this result of the provision of preventative health care as provided by (mandated) universal health insurance. It is true, it might cost more in the very long run, but are we not interested in health care reform that can actually make people healthier and extend their productive lives? Those, therefore, who argue against universal health insurance and the institution of universal preventative health care, on the grounds of ideology or just plain cost (like Ms. Pipes, apparently) are, when it comes down to it, wishing for grandma to die just a bit sooner so she does not cost so much to the system. These very same people, or their allies, are casting the Democrats as the one’s wanting to pull the plug, but their whole approach, their willingness to quote the CBO on this point of the “cost” of preventative care, appear to me, following this logic, to want grandma never to get to the point where there is a plug to pull in any case.

Am I being cynical, or is Ms. Pipes? Or, as I suspect, a bit like Ms. McCaughey, is she just too ideologically driven and short-sighted to see what she is actually saying? She might be aghast at this conclusion—but then she should not be quoting CBO figures whose (inhuman) objectivity, as with so many statistics, completely ignore the human, the moral, dimension, and the higher purpose of health care in the first place.

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