If there’s one thing that both sides of the congressional aisle seem to agree on, it is that health reform based on increased medical prevention and the adoption of electronic medical records(EMR) will save us all a lot of money. Unfortunately, they won’t do any such thing.
The enduring prevention myth emerged during the 1960s and became an anchor tenet of the government’s major push into HMOs in the 1970s. It followed the common-sense notion that preventing a disease is a lot cheaper than paying the horrendous costs of treating it later. However, in reviewing the extensive four-decade literature on the subject, the journal Health Affairs recently conceded:
Hundreds of studies have shown that prevention usually adds to medical costs instead of reducing them. Medications for hypertension and elevated cholesterol, diet and exercise to prevent diabetes, and screening and early treatment for cancer all add more to medical costs than they save.
There are two major reasons why prevention has failed to contain costs. First, you have to screen and treat an awful lot of people in order to prevent a relatively few diseases. Second, much of the money spend on medical prevention is wasted by patients who don’t fill their prescriptions, take their drugs, lose weight, exercise, stop smoking, or moderate their drinking. There is very little that half-hour doctor visits can do to prevent diseases when confronted with patients’ self-destructive 24/7 lifestyles.
As for EMR savings, no less an authority than Peter Orszag (Obama OBM director and former CBO director) has concluded that EMR alone is “generally not sufficient” to reduce costs. The reason was provided in 1987 by Nobel economist Robert Solow with his observation that “You can see the computer age everywhere but in the productivity statistics.” Information technology has indeed allowed us to do things never before imagined, but the financial returns from such high-tech investments have taken decades to emerge. Electronic medical records may indeed expand our knowledge and our capabilities, but we shouldn’t expect any payoff in cost savings for decades yet to come.
There are indeed effective means for dramatically reducing health care costs, but medical prevention and EMR are not among them. Any government health reform plan that depends on them will fail.
1 Robert Solow, New York Review of Books, July 12, 1987