Why is preventative health care such a bad thing?

I don’t disagree with you. Let me ask you a question. Would you be willing to pay for your own preventative care if everything else was covered?

Most companies I have worked for have implemented some form of preventative health care.

Because they can’t charge you as much for advice about keeping your heart healthy as they can for an emergency bypass operation.

I don’t think preventative healthcare is bad at all. I did just wake up, so perhaps I’m not understanding the question correctly. Are people saying it’s bad because the government is taking part or because one should only get heathcare after one is sick?

It’s not bad but it doesn’t really save money

@sleepdoc: I guess it depends on how one defines preventative care. I eat healthy food and take vitamins. I get a good amount of sleep every night. I exercise. I consider all of this preventative because I am maintaining a good level of health. In that case, yes, I am paying for my own preventative care. :)

@gemiwing: I would hear people saying that the “don’t get sick” policy was just a complete lack of health care coverage which always bothered me. I have always thought “don’t get sick” is synonymous with “take care of yourself.”

Edit to add: @hugofwar: I disagree. As @Lightlyseared pointed out, advice on heart health is much cheaper than bypass surgery.

@KatawaGrey Ahh, gotcha. Thanks.

Well, I think our old system didn’t work because even if you do everything ‘right’ (as it stands with current medical research/advice) you would still be screwed if you did get sick/car accident/cancer etc.

I think that “don’t get sick” is not so much about preventive care, but about the lack of health insurance coverage in this country.

@marinelife: Oh, yeah, I know that. It just seems to me that, universal health care or no, people are not as worried about taking care themselves. I have noticed that people tend to be more vocal about what’ll happen if they get sick but they are not so vocal about preventing that in the first place.

@hug_of_war Of course it saves money – example: cancer patients in Brooklyn show up with more late-stage disease than any other borough in NYC – they’re also notoriously bad about getting screened earlier (we’re also notoriously bad at providing free screenigns as our gov’t is cutting more and more funds from the healthy partnership initiatives) – if they would get screened, their care wouldn’t cost as much because they’d have to go through less surgeries, less chemo and radiation, less end of life care that costs billions of dollars overall.

@KatawaGrey I think that attitude comes from the top. The leaders in this country have been very slow to respond to the obesity and diabetes epidemics. There is little money allocated to health education and preventive care.

The first level of preventative healthcare is keeping yourself fit and healthy by eating right , getting enough regular exercise, avoiding smoking, and avoiding excessive alcohol. These things are not the responsibility of a heathcare system. I support both educational spending and ‘health improvement taxes’ such as cigarette tax, and the proposed excess sugar taxes as a way to help curb supply and demand for troubling behavior.

Once you enter into ‘preventative’ things a doctor can do, you start to quickly ramp up costs with questionable efficacy. I’ll point to two facts to consider.

(a) In 2008, Lipitor is the #1 selling drug at $12.4B. How many of those people would have had a problem without the drug? Certainly not 100%, probably not even 50%. Preventative drugs is a snake oil and fear based market.

(b) One preventative body-scan study (which sadly I can’t find at the moment), found that in their sample preventative full body scans did not change mortality among a test group. They did find some disease early, but they also had patients subjected to procedures because of ‘unknowns’ on the scans which turned out to be benign. The small number of surgeries caused complications, and in the end, different people died, for different reasons, but with the same numbers. Of course this was just one small study, but many people ignore the potential negative effects of trying to detect broad disease early by checking everyone. Targetted and high-risk checks are the ones that work the best.

@Lightlyseared Because they can’t charge you as much for advice about keeping your heart healthy as they can for an emergency bypass operation.

That is huge problem. Gigantic. There is no lobby for preventative care shoveling money into politics and running Harry and Louise commercials.

@KatawaGrey I agree with you that we are all responsible for our own habits. That has nothing to do with healthcare reform. What I am talking about are you willing to pay for your own check ups and such. The reason there is all the debate is some people think it should be all covered. Personally I see check ups like car maintenance. We should pay out of pocket for those.

@sleepdoc: I see what you mean. Frankly, yes, I would pay for my own check ups and exams.

@KatawaGrey cause I think if we all were willing to do this you wouldn’t hear the debate about how it should happen and that there isn’t enough of it.

Surprise. The blame-the-system people are out in full force. How about blame the people?
1. Do you smoke? Try stopping, or else we all pay for your bad decision when you develop emphysema or any number of cancers.
2. Do you drink excessively? Moderate, or else we all pay for your bad decision when you develop cirrhosis, or stomach cancer, or ulcers.
3. Do you eat a 4000 calorie/day diet laden with sodas and processed food? Try switching to vegetables/fish/water, or else we all pay for the consequences of your obesity and diabetes.
4. Are you morbidly obese? Try losing weight and exercising, or else….
5. Do you use recreational drugs, including cocaine, meth, and heroin? Stop…
6. Are you thin, but a sloth? Try exercising regularly to help control your blood pressure and maintaining your bone health (to prevent osteoporosis).
7. Do you avoid the dentist? Go more regularly, to improve your dental health.
8. Do you just love your bacon double cheeseburger? Slow down with the fat and cholesterol, or else we all pay for your heart attack, peripheral artery disease, and strokes.

Etc. etc.

@shilolo I don’t think it’s all about ‘blame the system’ or ‘blam the people’ – it’s both. However, you must know that there are disparities in access to health information, healthy foods, exersize options, etc. according to race and class.

@Simone_De_Beauvoir Yes, I’m well aware of that, but much of this information (smoking = bad, heavy drinking = bad) is not novel. Furthermore, I see many quips up there that in essence say that the system fosters expensive care at the expense of preventative care (i.e. surgery instead of an aspirin). That is rather trite, considering that as a society we’ve decided that quick fixes (bypass surgery, transplant surgery, gastric bypass, liposuction, etc.) are our solutions well after the damage has been done. People have to take stock of their own lifestyles rather than expecting miracle solutions later in life.

@shilolo You take for granted, I think, that this information is not novel – it’s just been a few decades since we’ve managed to not give alcohol to pregnant women to induce labor and to link FAS to alcohol – it’s been even less decades since commercials for cigarettes have been pulled – it’s been merely years since some cities have pushed for banning smoking in restaurants. People know these things are bad for them but we, as public health professionals, also know there are social and behavioral determinants to decisions people make about their health and who is more likely to drink and smoke and eat diets high in fat and that this doesn’t only have to do with personal choices but environment and which communities are targeted by the alcohol, tobacco and fast food industries. I agree with you that people have to be more proactive about their health but it’s not that black and white.

It’s more cost effective to help people lead healthy lifestyles than to wag your finger at them. But some people can’t abide other peoples’ health and happiness.

They see life as a zero sum game, where another person’s benefit must be harmful somehow to themselves.

@Simone_De_Beauvoir Well, I think it is too much of a cop-out to say that people aren’t able to make better decisions because of socioeconomic forces. The fact is that people (on the whole) are undisciplined, and consistent poor decision makers. Yet, when the consequences of those (in)actions occur, they blame the system rather than themselves. It is human nature.

Preventative medicine typically costs much less.
This makes it more difficult for the Fed to hold your health hostage for money by means of a government healthcare system.

@shilolo I suppose (as a future sociologist) I am biased to think that these forces are stronger than many people take into consideration. You’ve got quite a low opinion of people saying they’re ‘undisciplined and poor decision makers’ – would you put yourself in that category? Why not? Is it because of your education/access to internet/etc. that you’re able to make better decisions. Did you become a physician because you thought the sheep needed herding? You have to realize how you come off sounding and maybe it’s okay by you and sure some people are irresponsible but some people eat up the messages given to them by TV and the gov’t (even when they’re always changing and are contradictory) and don’t have the time or resources to figure out where something starts and where something ends. I don’t think people have accurate information – I know they’d be making better decisions if they did – I know this because I work with regular people every day who are not out to ‘leech the system’, who are just people that didn’t know about cancer screenings, that have cultures preventing them from certain patters we take for gratned, that have gendered families where that dynamic comes into play and affects their health, etc. But this q isn’t about all of the above necessarily – this is about whether preventative care is a good idea and I think we both agree that it is.

Of course preventative care is a good idea. My objection was to the numerous quips above (and I imagine we shall see below) that either imply or directly state that a lack of preventative medicine is somehow a conspiracy to keep people sick. That, in a nutshell, is bullshit.

As far as how I sound, I’ve been in medicine now for 15 years. I see, every day, the consequences of poor decision making. The smoker with lung cancer, the drinker with cirrhosis, the morbidly obese with diabetes, etc. etc. Indeed, our society allows and promotes peoples’ free will to make these terrible decisions, and then allows us to pay for other peoples’ mistakes. That doesn’t stop me from caring for people, but it is a fallacy to suggest that these diseases somehow occur in a vacuum.

Clearly, we see things differently. While you may feel like these issues are somehow “not their fault” because of “socioeconomic forces”, I take a more existential viewpoint for all people, rich or poor, educated or not. While any given individual is free to make good or bad decisions, that same individual is also free to experience the consequences of said decisions.

@shilolo In some ways the lack of preventative medicine is about the direction of medine towards specialization and the money to be made from that – no money is made from preventative care even if money is saved. I certainly don’t think it’s a conspiracy to keep people sick but it’s about needing a fundamental shift away from disease to prevention which I think is occuring but not fast enough, for my taste. I am noticing a contradiction in your arguments – you say diseases don’t occur in a vacuum and then you say all people are the same – all people do not have a level playing field, that’s a fact, a well researched fact ( I know I don’t have to post links or anything for you), existentialism or not.

@Simone_De_Beauvoir I disagree that prevention isn’t or hasn’t been available. It is, but not enough people make use of it (or have access to it) as adults. Children get annual checkups, plus vaccines, plus school screening, etc. Yet, young to middle-aged adults routinely avoid the doctor (I’m healthy, dammit!) or go infrequently. Then, around 40–50, people begin to realize that they need medical care, but have bypassed the important times in their 20s-30s and have developed bad habits. By then, much of the damage has been done. If we all lived better between 20–50 (these days, we have to shift that to maybe 10–50 given the high rates of childhood obesity), I dare say we’d have much less cardiovascular disease, stroke, diabetes, hypertension and many cancers (attributed to smoking and drinking). But, we don’t.

I see no contradiction in my terms. Diseases don’t occur in a vacuum. All people (rich/poor, black/white, educated/uneducated) make bad decisions, or forsake exercise for sloth. You tend to attribute this to social forces, while I see less influence of social forces and more on simple human nature. Do some people have greater access to education and medical care? Absolutely. Does that excuse those that don’t (and everyone, in general) from taking better care of themselves. No.

@shilolo All people can take better care of themselvse but your options are limited if you’re poor..let’s look at it this way: we as a family have decided that veganism is healthy, okay…and let’s say there are many cancer patients that I’ve met who are interested in going vegetarian (as recommended by physicians who, for some damn reason, only bring this approach up when a person is about to die)...now it is pretty hard in some areas of Brooklyn to find fruits and vegetables (our health department had to mandate a fruits and vegetables place per block and the project is nowhere near finished) but it’s pretty easy to find KFC, Mcdonalds, White Castle and meat markers in those same neighborhoods – in fact hard not to trip over 3 or 5 of these establishments on the same block…there are no veggie resources for miles around, no books about it in the library (there are no libraries in some places, a couple around my neighborhood have been closed) and these people don’t have internet access at home…there are certainly no vegan stores, whatsoever, we have to travel for an hour to get to Whole Foods in order to get healthy food and that’s us – middle class, white, educated, can afford to go to Whole Foods – ...what can a cancer patient with insurance problems and other co-morbidities do to really change their lifestyle…and really, exersize? what if there is no safe place to exersize? what if kids in certain neighborhoods don’t get exersize in their schools at all due to funding cuts and they cut gym programs – I’ve worked for the health department to remedy this issue as well and I can tell you it’s a damn shame: their parents know it’s good for the kids to exersize but if all the schools in the are aren’t providing that, when will they do this? at night, when it’s unsafe…or on playgrounds that don’t exist and are toxic if they do?

I see what you are saying, but that is a small subset of the population. Moreover, continuing with the theme of prevention, I think it is wrong to assume that people don’t know that McDonald’s isn’t exactly great for you. It’s convenient, and cheap, but that doesn’t make it good for you. Likewise cigarettes, or obesity. Too many people throw up excuses without taking the initiative to take better care of themselves. That is all I’m saying. Besides, medicine can only do so much. Until society as a whole decides that vegetables should be cheaper than potato chips, things like that won’t change.

In any event, my entire point was that while prevention is important, and does work, much prevention should be the onus of the individual, and not “medicine”.

@shilolo You say small – next to what? next to white middle class educated people? Nope, not here in Brooklyn and not here in NYC. I think people think it’s okay for you or why would they continue to feed their children McDs – I don’t think parents would feed their kids that stuff if they knew what it was about because I think most parents operate with care towards their children (am I too naive here?). People do come up with excuses because it’s hard to can those habits and because the industries are exploitative and know very well why it’s hard and who to target. Medicine is not supposed to be the answer – we are looking at an issue that includes economics, culture, race and so at the very least if we can get a person like me (a patient navigator) and a person like you ( a doctor) to agree that those forces matter more than people think and that people should be helped to make correct decisions, we can enact change. I heard somewhere in the million of conferences that I attend that many physicians don’t discuss diet and exersize with their patients – when everyone tells me ‘your kids are vegan..you’re killing them…have you asked your doctor?’ I say ‘why, do they know anything about nutrition?’ and I’m dead on…(and I did ask my doctor who said ‘okay but give ‘em fish’)

who said it was a bad thing?

Chiming in here…

I agree with @Simone_De_Beauvoir in that “the lack of preventative medicine is about the direction of medine towards specialization and the money to be made from that.” Fewer than 5% of all medical school graduates go into primary care fields (e.g. internal medicine, pediatrics, family medicine). In 2008 it was actually 2%. In an ideal world, a primary care doctor would be offering help with prevention (as well as coordinating visits with specialists that were actually necessary).

It’s not an ideal world, obviously. I spend much of my time poring over records after people have seen 5 subspecialist doctors for 5 different organ systems, trying to figure out who did what and what medications the patient is actually supposed to be taking. Prevention? Yeah, right.

@Dr_Dredd I differ in the opinion that prevention requires much medical input. If people were to learn good habits early in their lives, and stick with them over time, that alone would be sufficient to significantly decrease the overall disease burden in our society. As it is, we need more primary care doctors because there is more disease. Give a man a fish and he’ll eat for a day, teach him to fish and he’ll eat for a lifetime.

@shilolo It’s a great “if,” but in today’s society it’s just not the case. Therefore, pragmatically speaking, medical input is needed.

Agree with needing more primary care docs because there is more disease…

@shilolo People depend on doctors and see medicine as a great light of truth of some sort (it’s right up there with god to some) and they look to their doctors for information.

The problem with preventative healthcare, from a political or economic standpoint, is that you cant quantify the results.

@JeffVader No reason to not try it.

@JeffVader: The results may not be quantifiable in the strictest sense, but in a general sense, I think the results are quantifiable. If you exercise regularly, you will be healthier. We may not be able to measure how much, but there is still improvement.

@Simone_De_Beauvoir & @KatawaGrey Absolutely right…. personally I’m all for it, but I can see why it’s difficult to get a political consensus when they cant produce a league table or some sort of statistic to prove value for money.

I don’t know why more people do not consider yoga as a form of preventative health care. It is much better for you than other exercise. There are lots of easy yoga poses that anyone can do.

Who says it’s a bad thing? You should always perform preventative healthcare maintenance. You do it for your car, don’t you? If you keep your body in shape, you can prevent it from having problems later. Even just listening to yoga music can clear your head and relieve you from stress.

I think that everyone should do their part to stay healthier, but I don’t really feel like it is the government or a private employer’s place to force you into certain types of preventative care. The more you try to force something on people the more they will pull away from it.