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Wednesday, June 24, 2009
David Harsanyi :: Townhall.com Columnist
Preventive Care Is a Sick Idea
by David Harsanyi
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Will the Dems' health care Christmas Present to America be an improvement or detriment to our health care system?


Despite the extraordinary energy exerted in trying to delay the inevitable, the inconvenient fact is we all die.

So it is no surprise that "preventive" health care, that game-changing fix to policy trotted out relentlessly by both Democrats and Republicans, is so appealing. And like many cure-alls, it's a myth.

Surely, for some, preventive health care is worthwhile. And no one is stopping you from eating an apple. But unless policy changes have the power to stop the Grim Reaper -- rather than only postpone his arrival -- it will make health care more expensive.

Let's begin with the morbidly obvious. The longer people hang around the longer they utilize the health care system. End-of-life care is often the most expensive. Old folks just love doctors. (I know I plan to unleash septuagenarian fury on physicians regularly.) As studies on Medicare have proved, easy availability to services at the tail end of life translates into lots of needless services.

Second, a government policy that prods people into incessantly visiting medical offices for checkups, screenings and tests will only raise costs even further. According to studies, preventive medicine thwarts little, though it does mean early diagnoses for relatively harmless ailments -- and treatments for them.

As H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy, contends: "Recent expansions in the definitions of diabetes, high cholesterol and osteoporosis defined millions more as suddenly needing therapy. A new definition of 'abnormal bone density' … turned 6.8 million American women into osteoporosis patients literally overnight."

There is another vital aspect of preventive health care that many health care professionals and bureaucrats simply refuse to accept: Some of us can't be helped.

A few years ago, I heard a highly educated and successful author maintain that a life without cigarettes and copious amounts of alcohol is a life not worth living. There exists no warning label, no bone-chilling study, no crafty public service announcement that is going to separate me from my sour cream- and cheese-infested burrito.

At this point, anyone who doesn't comprehend that french fries aren't a suitable vegetable substitute will not be aided by preventive health care -- unless it includes the cost of a cerebral transplant.

There are also potential consequences to "prevention" policy.

For instance, you can "persuade" people to care by coercing them. Increasingly, elected officials are warming to the idea.

We've seen an explosion of intrusive legislation around the nation -- sin taxes and ingredient bans, to name two. The more we collectivize health care policy the more your comrades will make it their business to demand preventive health calisthenics.

In a recent, amazingly uncritical article about preventive care in Time magazine, titled "This Doctor Does Not Want To See You" -- because, as we all know, most doctors yearn for pervasive sickness -- we read this pronouncement: "Ours is a system that rewards pills and procedures and nurtures a clinical culture in which the goal is primarily to fix what goes wrong."

You've got that right. Millions of Americans are now alive, living without excruciating pain, engaging in healthy sex lives, avoiding suicide, etc., because of pills and the clinical culture that many preventive care proponents like to denigrate.

It's one thing to blow off steam about corporate America, insurance companies and overpriced drugs but quite another to undervalue technology. The idea that jumping jacks can take the place of pharmaceuticals is a dangerous one.

Moreover, diverting dollars from the "clinical culture" into programs that try to persuade me to get more colonoscopies would be a serious waste of time.

Very much like the entire institutionalized "preventive care" racket.

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About The Author
Brilliant!
You are exactly right. The Veterans Administration system, which would be the prototype of socialized medicine with preventive health emphasis, spends so much time and money documenting "health check" screenings, that patients rarely get to tell their physicians what is ailing them. One VA emergency room did not let doctors begin life-saving medication administration for heart attacks until all the "health screen" questions were addressed in the electronic medical record. Beware this! You do not want this type of health care. The emphasis on preventive care is the first step to moralizing approval or disapproval of what kind of illnesses it's OK to have. That, in turn is the first step to assuaging our collective consciences when we do not treat certain conditions. After all, if that sick person had availed himself of "preventive care," he wouldn't be sick, now would he?

The world according to Liberals..

In order to gain public Support Obama says healthcare for everyone.

Then we find out 19 million will still not be insured.

So who will this 19 million be that is not insured?

They are not saying but from past experience I can tell you it will be working middle class who can not afford high premiums but will be forced to pay taxes so others will have healthcare.

Liberals are great at creating programs that taxpayers don't qualify for.

You guys sound like 20 something ...
Obama drones ...'cause you're making a great case for rationing of health care. And I suppose for you guys, older people (past 25) are an inconvenience ... if only they would die and get out of the way.

I don't claim to know how (or even if) our health care should be reformed, but certainly treating people like so many pounds of meat ain't the way.

a complicated topic
An interesting counter-perspective on the much- vaunted value of preventive health care.

I heard yesterday that 50% of health care dollars are spent on 5% of the people... this might be because we too often pointlessly spend so much (ICU) on the last couple of months of life-- ergo, subsidizing failure!

An inconvenient truth--> the M. Deities would simply have to make less and hospitals do fewer money-sourcing procedures to cover "free" care for ILLEGALS and others. More guvment involvement will make things WORSE from a cost perspective-- simply more paperwork and bureaucracy.

Federal workers make TWICE what the rest of us make... and they would keep their OWN better health plan (which WE all pay for) for themselves! And we already pay a lot more for health care than elsewhere with no greater life expectancy. Hmmm.

What a mess!

It's a ruse.
All the talk about "preventative healthcare" is nothing but buzz words in Obamacare. It's their strategy to convince people they will get more and better healthcare so they tout "preventative healthcare" while the man behind the curtain is taking a hacksaw to lifesaving, effective, higher costs medical diagnostics, treatments and pharmaceuticals that will disproportionately effect the seriously ill and elderly.

Meanwhile, Obamacare plans to seriously limit access to diagnostic imaging. See the Senate bill outline--plan is to set up regional imaging commissions. I knew this was coming last year when you started seeing articles in the paper about exposure to radiation from CT and MRI scans--propaganda to get people to accept less diagnostic imaging. It works like this. If you control and delay access to imaging, you control and delay access to diagnosis, then treatment--result--medical costs "saved". It works for Canada.

So all the talk about preventative healthcare is disingenuous. While people may get an annual physical, those in need of cancer diagnostics and the like will find their access limited. The goal is to spread healthcare dollars as thinly as possible so that people feel they are getting "something" while those with high utilization will get less.

Prevention
Early detection is a good thing, but it is not prevention. The only investigation that I can think of is colonoscopy. If a polyp is found and removed, it can prevent colon ccncer from developing in that polyp. Of course, one could say that was also early detection.
I was an active doctor for fifty-one years and practiced internal medicine in kingsport, Tennessee for forty-five years. I am locally noted for pushing prevention, but my experience shows me that most people will not be led to change their life style by information, exhortation or even legislation.
MY longevity and good health at eighty-seven is the result of heredity, luck and maybe a little due to life style.
Prevention can delay suffering, disabiltiy and premature death-my principle goals for my patients throughout my practice life. Early deaths would actually help the Social Security system. Some wags have suggested that smokers should get a reduction in their conributions to the Ponzi scheme that is the Social security system since many smokers will not live to collect benefits even though they may qualify tor "total and Permnanent" disability benefit for a while.
However, when society undertakes to clean up after self promoted illness then that society gets a stake in regulating the behavior promoting the illness.
People want to have their cake and eat it too. They want to behave in unhealthy ways but have someone else pay for the consequences.
I have rambled on, but maybe there is some sense in this piece.
Donald W. Bales

some GREAT research and analysis
...from the Heritage Foundation... really worth a read


http://www.heritage.org/Research/HealthCare/wm2448.cfm
http://www.heritage.org/Research/HealthCare/bg2267.cfm
http://www.heritage.org/Press/FactSheet/fs0032.cfm
http://www.heritage.org/Press/FactSheet/fs0033.cfm
http://www.heritage.org/Press/FactSheet/fs0029.cfm

Of course, the goal is to live forever!
For people who have no confidence in God and Heaven - their goal is to live forever. Relatives complaining that the elderly relatives are all being diagnosed with Alzheimers. Duh - they're all over 90 - the previous generation died before 90, and therefore did not have time to either develop this problem, or be diagnosed with it. M-i-Law is diabetic, almost blind....her top of the line assisted living and health care costs $80,000 a year - It might have been better for her and Dad to stay in their home, rather than forcibly be moved to Assisted living, and pass away naturally. Certainly the family members who were counting on an inheritance won't see one now! It's all spent.

thanks
preventative medicine has it's place; colonoscopies and probably breast examinations, but the rest is pushing a good thing too far.

Longevity is basically hereditary. Most of the diseases that get you in your old age are simply your genetic susceptibility. there are exceptions like smoking (lung) and abusing alcohol (liver) but for the most part diet is out of the equation.

There is a prejudice against fat people. Because of that we tend to believe that they are that size because of their lifestyle. No one takes into consideration that it is genetics.

Oh, by the way BMI is a crock. Look at most world class athletes and they are either overweight or obese. It is simply the gullibility of the masses that makes them think that the US is fat. BMI simply measures weight vs. height. IT HAS NOTHING TO DO WIH FAT.

Donald
I have a feeling you were the type of doctor that practiced medicine when I was a child and young woman. A lot like the one we had for over 20 years who retired because the malpractice premiums were killers. He wasn't a mechanic, giving us 5-10 minutes in the clinic setting, but in his own office practice; and he took the time to care about our concerns. My doctor is part of a clinic and I HATE going there, it's so impersonal and cold. That fact and the fact when my husband lost his last job prior to retirement, we were forced to go for fee for service and it was the best thing that ever happened for us. It got us back in control of our own health, i.e. personal responsibility.

This little quote from the article
sums up the irrelevancy of Harsanyi!

"And like many cure-alls, it's a myth.

Surely, for some, preventive health care is worthwhile."

You write it both ways! It's one or the other bubba!

You're claiming preventive health is a myth! Stick to that and be an idiot. Don't fence ride and add "Surely, for some,...."!

You're wrong about preventive health care being a myth. This is misleading for the dilweed crowd!

Yuh getting all hot and bothered dilweeds?

Preventive medicine
David may or may not be correct in concluding that a substantial number of old folks will abuse the medical system if it's taxpayer funded, but I've had access to both military and V.A. medical care since released from military hospital in late 1970 subsequent to being WIA in Viet-Nam and I seek medical care as infrequently as poissible.

If one assumes that the V.A. & military medical syatems are representative of what nationwide socialized medicine would look like, I cannot recommend the notion. On the other hand, I've survived all these years relying upon those medical systems.

I was VERY happy
to see someone broach this subject. I said exactly the same thing a few days ago, only not as well. Preventive care sounds good on the surface, but a closer examination makes it obvious that there are serious problems with this approach.

Young people today have been so bombarded with the notion of exercise that a lot of them think if they exercise and eat right, they will escape the effects of aging. It is going to come as quite a shock to them when they find out they can’t control the inevitable.

An emphasis on preventive care will translate into getting everyone to cut their cholesterol (an idea that even some medical experts view with skepticism as preventative) losing weight, cutting out sugar, smoking cessation, taking vitamins and exercise. In other words, healthcare on the cheap. Not to mention this will give government what they have always wanted most, an excuse to control every detail of our lives.

But anyone who actually gets sick and needs help will be viewed with contempt (he must not have taken care of himself) and will likely be discriminated against. (He is costing the rest of us large amounts of money). In short, it will be a system that rewards the young and healthy and penalizes the elderly.

If all this sounds vaguely familiar, it’s because this is the same idea promoted by Hitler under his Nazi government.

Harsanyi has it right
Do we ever get the sense that more and more folks are so worried about living, that they stop living? And that would be ok with me, if they didn't demand that I do so as well.

How many times do these 'health' people have to go out of their way to inform us all about what they eat and don't eat? And Lord help if they workout as well -- they have to continually let us know about their 'workouts'.

Folks like me don't go around trying to force everyone to drink beer, eat lasagna and get the combination platter once a week at our favorite Mexican restaurant. And it sure would be nice if the health-nuts could just do their thing and not demand that the rest of us comply.

french fries aren't a suitable vegetable
"anyone who doesn't comprehend that french fries aren't a suitable vegetable substitute will not be aided by preventive health care -- unless it includes the cost of a cerebral transplant."
Since the school system recognizes french fries as a vegetable does that mean that dieticians will be getting cerebral transplants? I hope so.
The medical profession knows nothing about true perventive medicine. Mammograms increase the risk of breast cancer. Cholesterol meds do nothing to prevent heart attacks, etc.
I got rid of severe heart arrhythmia, rheumatoid arthritis, psoriasis, sinusitis, etc. by changing my diet, supplementing missing nutrients and some exercise. At 65 I now plan on dying healthy without bothering the corrupt medical profession. I have two brothers who are doctors and who have come to me asking what truly works.
Americans are eating and entertaining themselves to death with no help from our government. Some of the above are doing the same and will not listen until they hurt bad enough and then will still die at their doctor's command." Go ahead and laugh. After all these years I now feel quite well and am active again without troubles that I have had most of my life. Die healthy!

A Great Solution!
If the Federal govt really wanted to reduce healthcare costs, they could pour ten or twenty billion into a massive program to train doctors and nurses. Since most people would pay to receive this type of training, I suspect it would cost a lot less than expected.

They could pass laws allowing nurses to treat minor injuries and people with headaches, etc. and foster greater competition for healthcare dollars, and finally, they could pass tort reform.

But then, the govt really doesn't care about that. They just want power.
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