the basic premise it rests upon — shifting from reactive to preventive medicine — is the only way we will ever gain control of health care costs.
Although I agree that a switch to preventative medicine is desirable, I disagree that it is a substantial factor in controlling health care costs (I also disagree that this is a “basic premise” of the ACA — — rather, I’d say that the ACA provides some light incentives for the providers to work more proactively — — but let’s not digress.)
From birth to age 50-ish, our health care expenditures per capita are about the same as any other developed nation. 80% of the total expenditures in those age groups are for congenital diseases. You can nibble around the edges of that a bit, because a portion of it is obesity related diabetes, but preventative medicine doesn’t help somebody with Lupus.
So, 80% of those expenditures are not significantly addressed by preventative medicine. And, 80% of our TOTAL expenditures occur during end of life treatments, or expenditures made within the last few years of life. Those expenditures are relatively immune to preventative concerns as well.
So, where is the big “preventative” silver bullet that could lower our overall costs vis a vis care delivery? Obesity. And that’s not really something that’s addressed with preventative medicine, either; it’s lifestyle, a function of our pedestrian-unfriendly existence.
Uninsured, unhealthy people cost taxpayers a lot of money.
They do. But this was the ironic part of the ACA. The “fix” to this actually ended up increasing the % of GDP contributed by health care, rather than decreasing it.