A pound of prevention barely worth an ounce of cure

Michael F. Cannon has a blog post at Cato.org about preventive medicine.

While I've always thought that prevention of disease would be less costly than treatment, that is only true, when we stop to ponder it, when the total cost per person treated with some preventive measure is less than the savings in cure costs. That means that the total cost per person treated or per preventive measure would have to be lower than the difference between the cure expenditure with and without prevention. Furthermore, those costs have three categories: direct costs, indirect costs, and abstract costs.

You there at the back! Please don't yawn unless you've got enough for the rest of us.

Where was I? Oh, yes. The direct costs are the costs of shots, educational materials, and so on.

The indirect costs include the time off work going to get some preventive treatment, the loss of efficiency when some supposed safety control is implemented, and the added bureaucratic sludge that happens whenever we try to prevent something bad by changing the behavior of everyone.

Abstract costs include the loss of freedom for the individuals who are given the prevention.

Nestled invisibly between the indirect and abstract costs of preventative medicine is what it does to people's opinion. Much of preventative medicine consists of "raising awareness" of the problem, so that people can avoid stepping into open pits and so forth.

But if told too many times about an open pit, or a hot stove, or dangerous intersection, people will be filled with thoughts only of safety and precaution, aftraid to risk opening their eyes lest ultraviolet radiation damage their unprotected corneas. They exist only to be safe.

Alternatively, the more preventive measures we implement, the more jaded the people become and the more difficult it becomes to raise their awareness to a preventive level.

But the key problem is that for prevention to work, the pool of those treated with the preventive measure must be larger than the number cured, in many cases far larger. Taken together, and since prevention must be applied to the wider pool while remediation only to those affected, the cost of the prevention must be very low, and its effectiveness very high, for prevention to make sense.

Depending on the depth of the pit and the type of snakes at the bottom, it may be more cost-effective and indeed more humane to wait for someone to step into the pit and throw them a rope. Put a sign on the pit perhaps, but don't develop a slick ad campaign to tell people to avoid the pit, which will likely draw more people to it anyway.

This all yields the best quote ever on socialized medicine:

The point of the medical-care system is to serve people. It is not the point of people to serve the medical-care system.
-- Louise B. Russell

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