US cities pay too much for buses

It's even worse, I will use my healthcare just because it is free. I would feel like a moron not get my free physical, bloodwork and other labs every year. If it was $20 I wouldn't bother but its almost obligatory to take something "because its free".

Once I learn something is free it is like I already own it, so now I don't get it if I take it, I lose it if I don't.

Preventative care is free because it saves a tremendous amount of money for the insurance company and physical and emotional hardship for yourself by catching bad things early.

Your view is a commonly-held one, and makes a lot of sense; unfortunately there is very little support for it. One data point to the contrary is the Oregon Health Care Study, which showed that 'free' preventative care increased healthcare spending, but did not improve lifespan or reduce long-term cost.

I'm not sure they determined that it did not improve lifespans. Here's some snippets from the Wikipedia article (https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim...):

> On average, Medicaid coverage increased annual medical spending by approximately $1,172 relative to spending in the control group. The researchers looked at mortality rates, but they could not reach any conclusions because of the extremely low death rate of the general population of able-bodied Oregon adults aged 19 to 64.

> In the first year after the lottery, Medicaid coverage was associated with higher rates of health care use, a lower probability of having medical debts sent to a collection agency, and higher self-reported mental and physical health. In the 18 months following the lottery, researchers found that Medicaid increased emergency department visits.

> Approximately two years after the lottery, researchers found that Medicaid had no statistically significant impact on physical health measures, but "it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."

But it only looked at two year outcomes, yet you made a claim about long-term health and cost outcomes.

For example, it found that diagnoses and medication increased. If you are diagnosed with heart disease and you begin an intervention, you probably see no change in mortality in two years especially since it took decades for you to progress to that point in the first place.

Such a counterintuitive study, when there are highly motivated political actors trying to deprive people of social benefits, makes me highly skeptical. Catching bad things early is almost always better. Diabetes, cancer, heart disease, etc, cost hundreds of thousands to millions of dollars to treat caught late and prevent people from working or doing things they like to do, and mere thousands to treat early while preserving their quality of life.

Cancer, in particular, can be practically free to insurance if caught early. Colon and skin cancer are the poster children. Colon cancer can be treated in the process of doing the screening when caught early. And skin cancer is a pretty minor "just lop off that mole" procedure that also ends up being the treatment.

Letting it grow and catching it when symptoms arise is terribly expensive. The chemo, surgery, scans, and frequent doctors visits are all crazy expensive.

About the only way I could see preventative care not costing less is if you just let the people die and call it god's will rather than calling it a death that could have been prevented.

Anecdotally, if I hadn't gotten tested as part of a long term physical I wouldn't know about stuff that would cause my body to fail much younger than it would otherwise and lead to an early death.

So hey, at least in my case, it worked as the commonly held belief states.

And that study doesn't look at multi-decade long term effects like diabetes, etc. where you need it for a decade (or longer!) untreated (or poorly managed) before it kills ya. But it still kills ya years early.

So even the "raising rates of diabetes detection" in combination with your belief from that study proves you incorrect when people talk long term.

It’s not fee though is it. How many hours does it take do go somewhere and have a checkup? Almost certainly more than $20 worth.

Another variation of this are GLP 1 drugs.

Obesity costs USA $1.75T (https://milkeninstitute.org/content-hub/news-releases/econom..., grossed up for inflation)

Number of people that are obese: 100M

Annual economic impact from obesity per person: $17,500 per year

GLP-1 "For All": $6,000 per year (assuming multiple vendors, and some will be over vs under)

Savings: $11,500 per year per person.

Economic impact: Around $1T

This should free up around 3% of GDP for better uses of money rather than just fixing up people.

Obviously, the devil is in the details, but the potential impact is so massive that it should be deeply studied.

These free things are preventative. If you take them, the insurance company expects you to need less healthcare in the future, so actually this is a good thing (and not a problem as in the op)!

In two years maybe you have a different insurance co though.

Otoh this is why we invented reinsurance

It's usually cheaper to die

The study is looking only at healthcare spending and two-year outcomes, so it doesn't really address people's intuition that healthcare spending is lower in the long term with preventative care.

That said preventative probably does result in more dollars being spent on healthcare; presumably significantly, if not completely, offset by economic benefits like increased productivity and quality-of-life benefits. Analyses that only look at the cost side of the equation IMO are unhelpful.

Could US gov just buy out one the patents and make it free for all?

The challenge is that we have a rapidly evolving GLP/GIP/Other landscape being developed. In other words, you take a risk that the government buys the wrong thing. However, I think with a little push, you could have a highly competitive field to lower the federal cost, and the ROI should be easy to plot.

Actually, you don't need to do everybody all at once. Target the biggest (no pun intended) opportunities first.

Only if nobody does anything to help you. Truly LBJ's "Great Society" That also completely discounts the value (economic, social, and moral) of human life and all the attendant problems a dying person creates.

The Oregon Health Care Study followed patients for 2 years initially, then it was expanded out to 3 years. That's an absurdly short interval.

The idea is that increased primary care services will have benefits 10 or 15 years down the line by preventing chronic disease from reaching a critical state. For example, preventing prediabetes from reaching diabetes and then diabetic end stage renal disease (which would require dialysis at a cost of 5 figures per person per month). You're not going to see that over 2 to 3 years.