Steve Chapman
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Rutgers economist Louise Russell says that as a general matter, it doesn't save dollars. On the contrary, she noted in a 2009 article in the journal Health Affairs, "prevention usually adds to medical spending." Four out of five preventive options, she says, "add more to medical costs than they save."

But Americans have not learned to accept the word "no" when it comes to health care, and the administration has no desire to teach them. Two years ago, a federal panel dropped its recommendation that all women begin regular mammograms at age 40 (based on risks and benefits, leaving aside costs). In deference to the ensuing protests, the health care plan mandates coverage of breast cancer screening at age 40 anyway.

Consider this a harbinger: Under Obama's program, if patients and doctors demand something, the government will make sure they get it.

Many people, of course, put great importance on prevention. They'd rather get inoculated against the flu or shingles to avert a possible spell of sickness. They'd rather get screened for prostate cancer or cervical cancer if there's even a small chance it will save their lives.

But if they value such options so highly, why is it outrageous to ask them to remit something for the privilege? Letting insurers impose a co-payment or a deductible would have the effect of inducing patients not to completely disregard the issue of cost.

One of the chief ills of our health care system is that it encourages excessive consumption of medical services, which drives up total spending and wastes resources. But the preventive-care provision amounts to throwing a drowning man a hose.

If the goal is to restrain spending and make insurance affordable for all, a health care system has to put at least some direct costs on patients. We can't all live at the expense of everyone else. But we can all go broke trying.

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Steve Chapman

Steve Chapman is a columnist and editorial writer for the Chicago Tribune.
 

 
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