Preventive care is one of the magic formulas often invoked in discussions of so-called health-care reform. Dont worry about the apparent costs of reform, were told, because were going to save a ton of money with fanfare preventive care.
To listen to this promise, youd think no one would get sick if the government created the right incentives to avoid disease.
John Goodman, who, as president of the National Center for Policy Analysis, understands health-care economics better than most, points out that there are literally hundreds of studies from over the past 40 years that show preventive medical services usually increase medical spending. For instance, a review of nearly 600 studies published between 2000 and 2005 found that fewer than 20% of preventive services ... were cost saving 80% actually increased the total costs of care.
Preventive care costs money in itself. And being spared from one disease could let you live long enough to contract something more costly.
Theres no guarantee that money will be saved.
That doesnt mean people shouldnt look after their health, and in a free market some lifestyles would net lower insurance premiums than others. But prevention is no solution to high costs, and it wont bail us out of the expensive plans theyre cooking up on Capitol Hill.
Do we really want government meddling in our lives this way?
Under various reform ideas being tossed around, the government would determine what is and what is not an acceptable insurance policy. If you have an unacceptable one, you'll be fined by the IRS. The House bill is vague on what would become of existing policies. It seems to grandfather them in, but any change would require compliance with the new standards. So the aim is to push everyone into a one-size-fits-all policy, regardless of your health or the hardiness of your stock. Part of this standard, universal policy would be various "incentives" related to prevention that would determine how doctors are reimbursed for their services.
So, in the name of preventing disease, government will make many decisions for us about medical care and health insurance. How else will the politicians and boards of experts tilt the system in the direction they want?
But thats not all. We can expect intensified campaigns against unhealthy lifestyles. If you think government has already gone too far in this direction, you aint seen nothing yet. Get ready for the super-stigmatizing of those who smoke, drink, or overeat.
The impetus for this new round of social control is the need to control health-care costs. The government has decided we spend too much on medical services. Its professed concern would be more persuasive if it proposed to undertake an audit of all the ways it makes those services artificially expensive. The list is long on the supply side:
licensing, patents, accreditation, certificate-of-need rules, FDA requirements, and more; on the demand side: Medicare, Medicaid, and a tax system that rewards employer-based first-dollar insurance coverage.
But government does not accept the blame for how much we spend. On the contrary, everyone but the government gets the blame because its government that is going to save us.
If all the reformers wanted to do was lower the countrys overall medical bill, theyd end these government interventions. But thats not what they want to do.
Someone should ask President Obama at his next news conference, Why do you care how much we spend as a society on our health? Hed probably say what he said at his last news conference: [T]he biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid. An enterprising reporter would then follow up with, But thats a collective problem only because Medicare and Medicaid are tax-financed government programs. So instead of controlling spending, isnt the solution to privatize it and leave people alone?
Indeed it is. Its no business of the governments how much you and I spend on medical care. The reason we have these problems is that government made medical care its business long ago. The laws of economics avenge themselves. Now we can have government rationing and regimentation.
Or we can have freedom and market-based medical care.
We dont need reform. We need repeal.
Sheldon Richman is senior fellow at The Future of Freedom Foundation, author of Tethered Citizens: Time to Repeal the Welfare State, and editor of The Freeman
magazine. Visit his blog Free Association at