post by Bill Gardner
I'm thinking more about the Health Affairs article by Bobbie Milstein and his colleagues (my summary here). They used a simulation to estimate the costs and lives that could be saved as a result of three strategies for improving US health.
- Extending Health Insurance to Universal Coverage.
- Delivering Better Preventive And Chronic Care.
- Enabling Healthier Behavior And Safer Environments.
What they found was that the most cost-effective way to save lives was to promote healthier behavior and get toxins out of the environment: that is, stop disease before it starts. Next best was doing a better job at preventive and chronic care: that is, treat diseases before they get worse. The least effective, by a wide margin, was universal coverage.
Now, you may reject those conclusions. But for a moment, let's stipulate that the authors are correct, and think about what the implications are.
Progressives: We have spent generations fighting for universal coverage. Was this the right hill to die on? Sure, universal coverage and health behavior change + environmental protection are not mutually exclusive. Nevertheless, winning a political battle requires concentration of force. Why was universal coverage more important than strategies that would save many more lives?
Fiscal conservatives and libertarians: We are committed to reducing the dead weight cost of governmental health care expenditure, but we do not want to ration care. You do not need to pay for care -- or ration it -- if it isn't needed because people are not getting sick. Shouldn't health behavior change + environmental protection be the foundation of our health policy?
We are spending too much time fighting about how to pay for disease, instead of how we can promote health.
Read this. I have heard about this program, but not at this level of detail. Wonderful, and speaks to above beautifully:
http://opinionator.blogs.nytimes.com/2011/07/28/treating-the-cause-not-the-illness/
Brad
Posted by: Brad F | 07/30/2011 at 09:09 AM
Thanks, Brad.
Posted by: Bill Gardner | 07/30/2011 at 09:39 AM