Preventative treatment for disease is ten, hundred, thousand times cheaper than treatment ex post facto.
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Sounds like a misguided incentive ...
But even with your point, all insurance companies I've ever had cover with in the UK have had some element of support for preventing illness (periodic assessments, support material and trackers) and, at least with people covered under company schemes, they clearly have an incentive to offer more if you are at risk of becoming affected by a preventable illness.
When we were hiring a lot of people out of college, I spent way more time than I expected teaching them about how healthcare works and how to find their own information. We found that a lot of them would build their idea about how health insurance works from years of reading Reddit posts: They thought visiting the doctor was always going to be a $1000 bill or a single accident was going to medically bankrupt them, because those are the stories they saw on Reddit. I would explain things like the free annual physical and many just wouldn’t believe me. It’s really tough to cut through the confusion out there.
As for preventative medical treatment: This one is a difficult topic. There’s a popular misconception that getting a lot of different blood tests and imaging scans is a good idea to identify conditions early, but most people don’t understand that these tests (including imagine) are prone to a lot of false positives. Excessive testing has been shown time and time again to lead to unnecessary interventions, leading to worse outcomes on average. A number of previously routine medical tests are now not recommended until later age or until other symptoms appear because routine testing was producing too many unnecessary interventions, producing a net negative benefit.
It’s a hard concept to wrap our heads around when we’re so attached to the idea that more testing means better information. It’s a huge problem in the alternative medicine community where podcast grifters will encourage people to get various tests like organic acid tests or various “levels” testing, then prescribe complex treatment programs with dozens of supplements. The people chasing these tests then throw themselves far out of balance with excess supplements while sinking thousands of dollars into repeat testing
You only get so many chances to be sick before you can't come back from one, or it alters your life so severely you'd wish you were dead anyways.
I'll opt for paying to stay healthy.
>The reason that the rich were so rich, Vimes reasoned, was because they managed to spend less money.
>Take boots, for example. He earned thirty-eight dollars a month plus allowances. A really good pair of leather boots cost fifty dollars. But an affordable pair of boots, which were sort of OK for a season or two and then leaked like hell when the cardboard gave out, cost about ten dollars. Those were the kind of boots Vimes always bought, and wore until the soles were so thin that he could tell where he was in Ankh-Morpork on a foggy night by the feel of the cobbles.
>But the thing was that good boots lasted for years and years. A man who could afford fifty dollars had a pair of boots that’d still be keeping his feet dry in ten years’ time, while the poor man who could only afford cheap boots would have spent a hundred dollars on boots in the same time and would still have wet feet.
These are items you receive along with your insurance.
They are not insurable events and they are not “covered” like an insurable event.
Predictable, regularly occurring events cannot be covered by insurance by definition. You can’t adjust it, you can’t assemble a risk pool, etc.
We use the word “insurance” to mean “nice things that I like” but I think we’d have more enthusiasm for socialized medicine if we knew how much of “insurance” was nothing of the sort.
Fpr example, paying for a diabetic's insulin/blood sugar testing vs. amputating a limb, with the bonus of a working individual now likely ending up on disability
If you get a high score on that test, what are you going to do? Eat better, lose weight and exercise. So skip the test and just do that instead.
This is why, historically, they were rarely used.
The point I am making is that for the “worried well” (aka “longevity enthusiasts”) you aren’t going to do anything differently based on the result. It's largely a waste of money for the sake of people who want to feel like they're Doing Something (tm).
If you really think about it, you're talking about the extremely marginal case where a) the patient had no prior symptom of an illness; b) the calcium scan is so bad that you'd put the person on a medication to manage a hypothetical future problem; and c) you weren't going to do it anyway based on other tests.
The three things together are vanishingly unlikely. The better argument, mayyyyybe, is that maybe the test is one of those things that motivates a certain type of person (again, the "longevity enthusiast") to do something they otherwise wouldn't do, but that kind of person seems like...the kind of person who wants to do things. So what is the goal?
See also: Vo2max, DEXA scans, and most of the other tests mentioned in the book. Great for nerding out on metrics, but...you aren't going to do anything you weren't already doing if you're the type of person to be getting the test in the first place.
Even if we're just going to say "diet and exercise" it is a privilege to not live in a food desert and have sidewalks. If we are to mention the free yearly physical it's a privilege to have a doctor nearby and be able to get the time off work
So no, I don't think I am the one missing the point
Testing in general gets out of control but we as a medical community also have a problem I think of not identifying certain problems until it's too late. Some preventative testing could be done more, some less.
When you have one organisation responsible for health as a whole rather than just treatment, you can make better decisions. The usual example I give is that it's cheaper to give out the contraceptive pill than deal with pregnancies, but the same thinking applies to broader disease and health.
The primary lesson from this is to ignore stories you read in aerobic sport forums.
This kind of (usually apocryphal) tale is an example of the turtles, rabbits and birds allegory [1]. Testing is like a fence around a farmer's field -- it may catch rabbits, but it's useless for turtles (who will be caught, but move too slowly to matter) and birds (since you can't catch them with a fence). The "super fit person who randomly drops dead" is the very definition of a "bird" -- even if you assume the test is sensitive enough to catch the rare thing before it happens (usually not), you have the dual problems of timing (i.e. are you going to test daily?) and false positives for whatever rate of testing you do choose.
In real life, almost nobody has an illness that moves so quickly that it requires special screening, but so slowly that it can be stopped, or at least, that has a positive risk/reward ratio for the testing required to detect it. It's the fundamental problem of medical testing, and even most of the recommended tests have a very small expected benefit.
No one is saying "all medical issues are more expensive if you're poor" or "it's impossible to be healthier if you're poor." All of that is fantastic, but it in no way disproves the catch-22 that it is often more expensive to be poor, in many ways, including medicine. Particularly in the US with its clusterfuck confusopoly of copayments, coinsurance, deductibles, and so on, so the mere act of going to any doctor is a gamble