No one really knows whether preventive medicine will save money in the long run, let alone free up the billions of dollars a year needed to help pay for universal health insurance. In fact, studies have shown that preventive care — be it cancer screening, smoking cessation or plain old checkups — usually ends up costing money. It makes people healthier, but it’s not free.
“It’s a nice thing to think, and it seems like it should be true, but I don’t know of any evidence that preventive care actually saves money,” said Jonathan Gruber, an M.I.T. economist who helped design the universal-coverage plan in Massachusetts.
...“Fundamentally, if you’re going to control health care costs, it involves denying people care they want — or things they’ve been trained to think they want,” Mr. Gruber says. “There is no easy answer.”
Michael Cannon calls it Kling's Iron Trilemma. We want:
--what I call insulation, where consumers enjoy the peace of mind of having their medical services paid for by a third party;
--unrestricted access, where consumers and doctors can choose medical procedures without bureaucratic interference or government budget limits;
--less stress over rising health care costs.
The trilemma is that we can have at most two out of three. Much of the "reality-based community" (an Orwellian label if there ever was one) denies that the trilemma exists. Gruber does not deny its existence, but he prefers restricting access to reducing insulation. I prefer the latter.