Sachs Support Occupy Wall Street Movement; Goldman Pissed

[Aeson]

I am essentially agnostic on policy (though PPACA was a ****ty law), because it's not clear how well market mechanisms work here.

...

"The idea that preventative health care reduces total healthcare consumption is one of the greatest feel-good lies the left tells itself. More preventative care almost always increases consumption, not reduces it. Sometimes (but not always) it also improves outcomes. The improved outcomes may be worth the extra resources, but they are not cost-saving measures in any way."

I am talking about the study you sourced. Do you think that the study you sourced is valid and we should implement the preventive care measures they found to reduce costs?

As for your claim that that is what you have been saying all along, I find it very hard to believe given that you still won't come out and plainly admit that there are preventive care measures that reduce costs. The fact that you deflect the direct question and instead talk about your suspicions as to whether government could provide cost cutting healthcare measures that insurance companies don't or won't either shows you don't believe such a thing (and as such, were probably not claiming it all along as you claim), or speaks volumes about how intellectually dishonest you are being about this discussion.

Your reply about government/insurance also ignores that government could be providing this preventive healthcare to people who do not have insurance at all or are on medicare/medicaid and thus could be a reasonable avenue for cost cutting.

[Kuciwalker]

I am talking about the study you sourced. Do you think that the study you sourced is valid

I don't know if it's valid, it was the very first result for my Google search. That study's conclusion is one that is widely affirmed in the literature, it's not some unique result.

The result is, of course, just as widely ignored by the left, because it's inconvenient.

and we should implement the preventive care measures they found to reduce costs?

How would "we" do that? In a system where pre-retirement health expenses are overwhelmingly paid for through private insurance provided by your employer, and that private insurer has substantial discretion as to what treatments it will and will not cover, there is no "we". You need to posit some sort of substantial government intervention, that may be inadvisable for reasons completely unrelated to the question of these particular preventive measures.

You would also need to explain why the private insurers would not decide to offer the cost-saving treatments at their own discretion. There are a number of plausible explanations, but you can't just hand-wave it away.

As for your claim that that is what you have been saying all along, I find it very hard to believe

I QUOTED THE LITERAL TEXT OF MY OWN ****ING POST, moron. The literal reading of it is exactly compatible with the conclusions of the study NYE posted.

given that you still won't come out and plainly admit that there are preventive care measures that reduce costs.

You mean, apart from the fact that my very first statement on the topic directly admitted so?

The fact that you deflect the direct question and instead talk about your suspicions as to whether government could provide cost cutting healthcare measures that insurance companies don't or won't

This is a strawman. I claimed, precisely, that I don't think the government is identifying cost-cutting preventive care that private insurance is not providing. You have to address the question "if it cuts costs, and we know it cuts costs, why aren't the insurance companies providing it?" In some cases there may be a simple answer (e.g. the cost savings are realized after the employee is on Medicare). In other cases there may not be one.

I don't address at all the government's ability to actually provide care.

or speaks volumes about how intellectually dishonest you are being about this discussion.

You are the one who is attacking the broad general claim "most preventive care doesn't save money" (which is A TRUE CLAIM that has been validated by ever piece of evidence posted here) on the grounds that "well, some small proportion of them might! what about those huh?" It's an irrelevant sideshow and typical of your own dishonesty.

Your reply about government/insurance also ignores that government could be providing this preventive healthcare to people who do not have insurance at all or are on medicare/medicaid and thus could be a reasonable avenue for cost cutting.

That only works if the uninsured would otherwise receive the treatment being prevented.

[notyoueither]

http://www.huffingtonpost.com/chris-fey/rebutting-the-cbos-preven_b_270450.html

Rebutting the CBO's Preventative Care Cost Analysis

Chris Fey
CEO, U.S. Preventative Medicine
Posted: August 27, 2009 02:43 PM

On August 7, 2009, the Congressional Budget Office (CBO) published a letter to the U.S. House of Representatives Committee on Energy and Commerce, Subcommittee on Health. The letter summarized a CBO analysis of potential reductions in federal costs from health improvements gained through preventive medical care and wellness services.

While the report recognized that most preventive care is "cost-effective," meaning that the costs are considered "reasonable relative to their clinical benefits," it concluded that "providing preventive care represents a net use of resources rather than a source of funding for other activities." We consider that assessment inaccurate because it rests on the premise that "expanded utilization leads to higher, not lower, medical spending overall."

The disciplines of wellness and preventive health care are based on the principle that improving health-related behaviors, detecting conditions at earlier stages and slowing the progression of chronic conditions will save lives and reduce health care costs. Today's clinically-based preventive health care programs reduce, not increase, utilization and can potentially save billions of dollars in health care costs.

Clinical prevention, as defined by the American Medical Association in Clinical Preventive Medicine by Richard S. Lang and Donald D. Hensrud, includes primary, secondary and tertiary prevention. Primary prevention, also called wellness, identifies risks and recommends behavior changes, such as healthy eating, exercise and immunizations, to reduce those risks. Secondary prevention detects diseases in the earliest stages when treatments are more effective. Tertiary prevention encourages adherence to recommended treatment and promotes specific lifestyle changes, such as healthy eating and exercise, to slow or even reverse the progression of an existing disease.

The CBO analysis and many legislative approaches to prevention focus on secondary prevention with subsequent medical interventions. They do not address primary and tertiary prevention, which represent a significant portion of health care cost savings.

The main challenge to secondary prevention has been widely discussed and provides the basis for the CBO assessment. The report states, "to avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway." We agree that some early prevention efforts, while effective at improving outcomes, were cost prohibitive because they produced widespread screening for multiple diseases. However, the discipline of preventive health care has progressed beyond its early stages to incorporate risk-based targeting and clinical recommendations. Programs such as The Prevention Plan™ combine simple blood tests with online health history and lifestyle questionnaires to identify each individual's top risks and then recommend an action plan to address only those risks. The CBO report states that preventive care "can have the largest benefits relative to costs when it is targeted at people who are most likely to suffer from a particular medical problem." These capabilities are available in the marketplace today, but not included in the analysis.

It is also important to note that the CBO report excludes the entire spectrum of wellness services from its calculations, citing that "evidence regarding the effect of wellness services on subsequent spending on health care is limited." In fact, studies have documented the benefits of wellness programs. "An Unhealthy America: The Economic Burden of Chronic Disease" by the Milken Institute estimated that modest reductions in avoidable factors -- unhealthy behavior, environmental risks and the failure to make modest gains in early detection and innovative treatment -- will lead to 40 million fewer cases of illness and gain over $1 trillion annual in labor supply and efficiency by 2023." This represents a 27 percent reduction in total economic impact.

Studies by Dr. Dean Ornish with Mutual of Omaha and Highmark Blue Cross Blue Shield have shown that people with severe coronary heart disease can stop or reverse their condition without drugs or surgery by making healthy lifestyle changes. Almost 80 percent of patients eligible for bypass surgery or angioplasty were able to safely avoid it by making lifestyle changes, saving almost $30,000 per patient in the first year. In a second study, lifestyle changes reduced total health care costs in coronary heart disease patients by 50 percent after one year and by an additional 20 to 30 percent in years two and three.

To achieve these savings, however, the United States must look beyond the current model of health screenings and medical interventions. We must develop comprehensive programs to change behavior. Preventive health care entrepreneurs have taken up the challenge. The same American ingenuity that brought us the airplane and the artificial heart is now focused on helping people lead longer, healthier lives. These programs are designed to complement, not duplicate, current health care services. The CBO report cautions, "a new government policy to encourage prevention could end up paying for preventive services that many individuals are already receiving -- which would add to federal costs but not reduce total future spending on health care." Programs such as The Prevention Plan, however, are designed to assess risks and make recommendations while members' regular health care providers administer screenings and treatment. This third-party approach provides a model for increasing preventive health care while avoiding duplicated services.

The United States can no longer afford a system where 70 percent of deaths and nearly 80 percent of health care costs stem from the same preventable chronic conditions. At this crossroads in health policy, the United States government has a rare opportunity to nurture a movement that can save hundreds of billions, make our workforce more competitive and improve the quality of our lives. We commend the CBO for its thoughtful analysis of this important issue and encourage further exploration to incorporate both recent advances in risk-based targeting and the role of wellness programs in reducing health care costs.

Christopher T. Fey is chairman and CEO of U.S. Preventive Medicine, a global prevention services company.

[notyoueither]

I beat high blood pressure, and the consequences, through regular access to healthcare. Every time I saw a doctor since I was around 17 I was told my BP was a bit or quite high.

Repetition (and age) led me to pay attention and seek ways to reduce my BP. I modified my diet and began spending a significant amount of time on fitness. My BP is now at the high end of normal.

The cost savings to the system from me not developing a chronic CV condition is totally ignored by the CBO.

[Aeson]

I don't know if it's valid, it was the very first result for my Google search. That study's conclusion is one that is widely affirmed in the literature, it's not some unique result.

So your claim is that it is widely affirmed by studies that there are preventive care options which reduce cost? Yet you distrust those findings because for some reason insurance companies aren't offering to pay for medicare and medicaid patients, as well as uninsured, to have this care available?

The result is, of course, just as widely ignored by the left, because it's inconvenient.

Red herring. "Look, the left is as bad as I am..."

How would "we" do that? In a system where pre-retirement health expenses are overwhelmingly paid for through private insurance provided by your employer, and that private insurer has substantial discretion as to what treatments it will and will not cover, there is no "we". You need to posit some sort of substantial government intervention, that may be inadvisable for reasons completely unrelated to the question of these particular preventive measures.

I am obviously talking about the large portion of Americans who don't receive preventive treatments simply because they don't have insurance. This should be abundantly obvious since I've told you that 2 times already. You keep pretended that there are no healthcare costs from uninsured people or those on government provided healthcare.

You would also need to explain why the private insurers would not decide to offer the cost-saving treatments at their own discretion. There are a number of plausible explanations, but you can't just hand-wave it away.

You're the one hand-waving. Obviously insurers don't pay for avoidable costs that medicare or medicaid are covering. They also don't directly pay for avoidable costs that some poor sap incurs in the emergency room. While those costs probably do get passed onto the insurer to some extent by hospitals, much of that gets passed onto the consumer. How much would be debatable, but surely the cost to the insurance agencies is less than the cost of the insurers insuring everyone who can't pay just to avoid it.

I QUOTED THE LITERAL TEXT OF MY OWN ****ING POST, moron. The literal reading of it is exactly compatible with the conclusions of the study NYE posted.

u mad?

It was not compatible with the claims you made about it in response to my questioning. You claimed that you had been saying that there were preventive healthcare which reduces costs all along. Yet when directly questioned on it, you still won't say that "yes, there are" or even "no, there aren't." You could of course claim ignorance on the matter. That is acceptable. But in response to others in the thread and even myself you seem very sure about the results of these studies you are referring to.

You mean, apart from the fact that my very first statement on the topic directly admitted so?

You keep trying to play it as "increase costs" but worth it for the benefits. I want you to flat out say that there are preventive care options which actually decrease costs if that is what you believe, or that there aren't if that is what you believe. You seem terrified of taking a stand on this for some reason. (Yet backed with the exact same evidence you have no qualms about making definitive statements as long as they are derogatory of preventive healthcare.)

You keep claiming you've done it, but the reality is you keep falling back to a statement which was about health benefits being worth increased costs, while pretending it was about actually reducing costs.

This is a strawman. I claimed, precisely, that I don't think the government is identifying cost-cutting preventive care that private insurance is not providing.

Yes, when you did so it was a strawman since the question was about the study's findings, not the government implementation of whatever they are working off of. I am glad you can admit to the fallacy of your argument.

You have to address the question "if it cuts costs, and we know it cuts costs, why aren't the insurance companies providing it?"

Because insurers have no incentive (or at least far less than their incentive not to) to insure people who can't pay, or who the government pays for.

I don't address at all the government's ability to actually provide care.

"Just to make sure... You admit that we should add some preventive healthcare to reduce costs?" - Aeson

"I am essentially agnostic on policy (though PPACA was a ****ty law), because it's not clear how well market mechanisms work here. However, I am deeply suspicious that the government is reliably identifying cost-saving preventive healthcare that the insurance companies don't cover or wouldn't cover." - Kuci

You responded to my question with some irrelevant hodgepodge of suspicion of government and your dislike of a specific law. Neither of which concern the question of whether or not you think that there is preventive healthcare that should be implemented because it reduces cost.

Now, if you had just come out and say you think there aren't preventive healthcare that reduce costs, then it's easy. Or if you say, yes, there are some preventive healthcare which reduces costs that's fine too. You however have thrown up strawman after strawman to avoid answering the question. It's very simple question. It doesn't rely on whether we will do it right or not. Just if it should be done in whatever way you think is right. It's about your opinion. Do you have one?

You are the one who is attacking the broad general claim "most preventive care doesn't save money" (which is A TRUE CLAIM that has been validated by ever piece of evidence posted here) on the grounds that "well, some small proportion of them might! what about those huh?" It's an irrelevant sideshow and typical of your own dishonesty.

I do take exception to you claiming that most preventive care doesn't save money, yes. Because you are the one who brings up the counter claim so that you can attack it. It is a fallacious argument on your part.

You're allowing your partisanship to get in the way here. You keep attacking the "left" and these ideas espoused by "the left" rather than simply address what is being said in this thread. Some of which may qualify as "the left" no doubt. But my statements can hardly be construed that way so it's disingenuous of you to keep bringing them up in response to me.

As for the question of what about the ones which are cost effective (according to your source), they are hardly irrelevant. They are very relevant as if you'd get your head out of your ass (or rather, partisan people like you who actually have power would get their head's out of their ass) this would be one area where essentially everyone could agree on something we could do to cut costs without providing less healthcare.

Perhaps that's the thing you are so afraid to admit, because so many of your arguments in this thread have been based on a dichotomy you've formed in your mind that you can have less health care, or more costs.

That only works if the uninsured would otherwise receive the treatment being prevented.

You are aware that when patients show up to emergency rooms they are required by law to be treated? You are aware that there is lots of money spent on medicaid and medicare? Please tell me you are just being intellectually dishonest here to try to promote the idea that these costs won't ever need to be paid...

[Kuciwalker]

I beat high blood pressure, and the consequences, through regular access to healthcare. Every time I saw a doctor since I was around 17 I was told my BP was a bit or quite high.

Repetition (and age) led me to pay attention and seek ways to reduce my BP. I modified my diet and began spending a significant amount of time on fitness. My BP is now at the high end of normal.

The cost savings to the system from me not developing a chronic CV condition is totally ignored by the CBO.

The CBO is just one group that has studied the issue. The finding that preventive care usually does not reduce costs is widespread.

[Kuciwalker]

Aeson's going back on ignore for the extreme level of dishonesty in his posts. It's just not worth bothering anymore.

[Kuciwalker]

God ****ing dammit why is Aeson an admin?

[Kuciwalker]

Now I remember why I didn't have him on ignore before this.

[Aeson]

You should sign the petition I have going around to have me removed from staff. Someday we'll have enough support to get this thing done!

[Fake Boris]

Kuci, there are a lot of reasons why insurance isn't providing preventative treatment, and it's not just because it doesn't work. Amongst other, "reaction" treatment means more money for everyone (except the patient).

[Dinner]

The CBO is just one group that has studied the issue. The finding that preventive care usually does not reduce costs is widespread.

Yeah, I'm sure catching cancer early doesn't decrease costs (you still have to treat the cancer where as if you didn't catch until the terminal phase the person would just die thus saving money) but it sure as **** improves out comes for people. In a totalistic view having adults survive treatable illnesses so they can go back to work and pay taxes again is probably the better way forward for society as a whole. Sure, telling people who are sick to just die fast saves money but not in a totalisti sense since it means a lot of trained workers would die prematurely.

[Kuciwalker]

Kuci, there are a lot of reasons why insurance isn't providing preventative treatment, and it's not just because it doesn't work.

I agree, I even provided one example. Many of those reasons, though, are situational.

To clarify my position in general, I don't believe that healthcare markets work. But I don't believe that they don't work, either! I'm agnostic. Markets have an extremely strong presumption in their favor, because of experience elsewhere; that markets work in general may be the most thoroughly-proven claim in all of sociology. We've even performed the closest thing to a true experiment as exists in sociology, multiple times - take one country, split it in two, give one half markets and the other communism - and the answer came out the same every single time. But with healthcare there is a mountain of evidence that in this specific case markets don't efficiently allocate resources. The rational Bayesian looks at those two things and concludes "I don't know". I also conclude that neither you nor HC actually know the answer either.

Amongst other, "reaction" treatment means more money for everyone (except the patient).

Why do you think this?

[Kuciwalker]

Yeah, I'm sure catching cancer early doesn't decrease costs (you still have to treat the cancer where as if you didn't catch until the terminal phase the person would just die thus saving money) but it sure as **** improves out comes for people. In a totalistic view having adults survive treatable illnesses so they can go back to work and pay taxes again is probably the better way forward for society as a whole. Sure, telling people who are sick to just die fast saves money but not in a totalisti sense since it means a lot of trained workers would die prematurely.

I agree (though in some cases preventive care really is just useless even after you try to look at the health benefits; see mammograms for women under 40). If we think that we actually have to cut costs, though, this isn't going to do it and we need to look somewhere else to reduce expenses.

[Tupac Shakur]

Aeson's going back on ignore for the extreme level of dishonesty in his posts. It's just not worth bothering anymore.

Cut him some slack. It's really not his fault.