Prevention: The real and the imaginary

I have always privately thought that the only real solution to the healthcare crisis is prevention. By that I have meant exercise and sensible eating---or, as Michael Pollan put it in his book In Defense of Food: "Eat food. Not too much. Mostly plants."

The third leg of President Obama's healthcare vision is also "prevention." By that he means free mammograms and checkups. I don't think it would be a bad idea, in principle, to get free mammograms and checkups. But in the real world, there are two things going against it. One is the surprising finding, by the Congressional Budget Office, that this second kind of prevention, rather than saving the system money as the president had hoped, would actually make healthcare more expensive.

CBO director Doug Elmendorf said, "Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."

It's complicated. It's counterintuitive. It should have worked. But the problem has something to do with the fact that in order to head off one person's cancer, "it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway," said Elmendorf. So what happens is we spend a lot of money---money that we wouldn't have spent---to catch a few cases here and there.

But the second reason that prevention (in Obama's, not Michael Pollan's, sense of the word) would not work is one gleaned from elementary observation of human nature's proclivity for self-deception. Our little yearly scheduled visits to the clinic for checkups would fast become our new false security, as we continued to indulge in Big Macs to our clotted hearts' content. "I'm good! I'm living responsibly! I'm doing something for my health!" we would tell our crooked little hearts. "I go to the doctor's for regular stress tests; leave me alone," we would say, and pop another potato chip.

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