Edwards: Mandating preventive visits

I wonder how he can enforce this?

Democratic presidential hopeful John Edwards says his universal health care proposal would require Americans to go to the doctor for preventive care . . .
. . . He says if Americans are going to choose to be in the healthcare system, they can’t choose not to go to a doctor for 20 years. He says they need regular checkups.

Comments

Mike
He’s mentally impaired. We allow people to smoke, drink and eat unhealthy garbage. We allow people to work as coal miners, depsite the untold risks. We let people skydive, ride motorcycles, bungee jump, etc. We allow people to sunbathe without sunscreen, even though skin cancer can be deadly.
Will he next forbid these things as well? It makes no godly sense. Especially since the anti-primary care weirdos on this site keep proclaiming that preventative care is useless and not proven to do anything.
The Democrats seriosuly need help. Lobotomies all around I say. (For Guiliani too, since he thinks a 25,000 dollar deductible is a good idea)
Throckmorton
We tried very had in the VA system and the military healthcare system to establish routing health checks. For active military we were able to orden them to come in. The VA patients were a different matter. With no way to hold them accountable, they did not come in.
It is unfortunate that preventive care is not more widely appreciated or payed for. The main problem remains that people do not want to go to the doctor when they feel well, rather they want to come in when they dont.
I have found that generally the Democrats are proponents that no one should be accountable for their actions and that the government should be parental in all matters of life. Edwards seems to be toting that line.
Happyman
edwards is a self-absorbed goofball whose only exposure to medicine was in inflicting undue suffering to OB/GYNs based on junk science.
he has about a 0.1% chance of becoming the next president, and I hope he’s proud of what he’s putting his wife & kids through with his campaign at such a time.
Alla
throckmorton, going to the doctor only when you feel sick is a perfectly valid and reasonable decision. You may disagree with it, but it is really none of your business as you are not paying for it and in fact you are saving money: preventive care is expensive. If you don’t believe me, pick your favorite preventive measure and look up some studies on cost-savings. Don’t confuse it with cost-effectiveness that is measured with the cost of QALY, but actual savings. You’d be surprised.
Have you ever bothered to look at NNT/NNS for most popular (primary) preventive measures? For an individual the probability of benefitting of routine preventive care is very small. The risk reduction of bad things happening is no greater than that of abstaining of some risky activities, like those mentioned by Mike. In some of these measures there is cost and risks involved (e.g. overdiagnosis in screening or side effects of preventive drugs — remember HRT?).
I am amazed that people who want to force people to participate in preventive care using phantom cost-savings as justification have never bothered to look at whether there actually are cost-savings. I wonder if some of them can even spell NNT.
Mike
Alla, do you just cut and paste the same comment about “doctors need to look up about NNT” every time preventative care is mentioned? Becasue as I said before, it DOESN’T APPLY to people who have family histories, elevated risk factors etc etc. And it DOES SAVE MONEY overall.
But just pick whatever test you want, convince yourself that it isn’t “cost effective”, and then tell everyone to just stay home until they get sick enough to go to the hospital. That will save LOTS of money.
Anonymous
Edwards is also the guy who wants to ban smoking in public places nationwide…he’ll deal with the constitutional problems later.
He reminds me of an assertion I heard from a lawyer once that they ones who make the most money aren’t the smartest. Winning the trial lawyer game requires a certain self-righteousness most easily mastered by the simple-minded.
Do you think he knows that Cuba is a communist country now?
Alla
Mike.
First of all, let’s not confuse cost-effectiveness and cost-saving. Cost-effectiveness generally means that the cost of QALY is under 50K. While this is important, it is not the same as actual savings.
1. Becasue as I said before, it DOESN’T APPLY to people who have family histories, elevated risk factors etc What is your definition of high risk? If 100% – sure, but 10% is usually considered high risk. If someone’s 10-year risk of, for example, heart attack is 10% and you are reducing it by, say, 50%, it still means you need to treat 95 people out of 100 for 10 years. This may or may not be cost-saving. Look for example at this study of two preventive measures in diabetics, one is cost-saving, the other is not. Yes, this is only an example, but counter-example has always been a valid way to dispute validity of a claim. (Remember math? If you want to prove that something holds for all cases i.e. all high-risk people, example is not enough; but if you want to show that something doesn’t hold in all cases, counter-example is fine)
2. Aren’t you guilty of the same thing you are accusing me of – picking a subset of measures that validate your argument? You say that some preventive measures for a small subset of symptomless individuals are cost-saving. From this you are concluding that preventive measures are cost-saving overall. How does one follow the other?
3. Some preventive measures in some subgroups are cost-saving. Other preventive measures in larger section of the population are not. If you want to show that preventive care in general and annual physicals that Edwards wants to mandate in particular are cost-saving overall you have to show that the savings achieved for cost-saving measures are higher than costs associated with non-cost-saving measures. Do you have some data on that?
Alla
Just a correction — it was too late at night here on the East Coast.
In the above when I said “If someone’s 10-year risk of, for example, heart attack is 10% and you are reducing it by, say, 50%, it still means you need to treat 95 people out of 100 for 10 years.”, I meant you wouldn’t see any benefit or savings for 95 people out of 100. I.e. you’d need to treat 100 to prevent 5 heart attacks (NNT=20). This is actually a pretty good NNT, but unless you have studies that calculate total cost you don’t know if it is really cost-saving.
Here is by the way an interesting paper on the cost of primary care, the difference between cost-effectiveness and actual cost savings and how some seemingly cheap measures may actually be expensive. It concentrates on cost-effectiveness more so than on cost savings, but it gives an idea about the actual cost when everything is taken into account.
Again, let’s not confuse discussions about cost with discussion about benefits to one’s health or life-saving potential. These are apples and oranges. Also, since plans like that of Edwards don’t only affect high-risk individuals, it is not valid to use “but it is cost-saving for high risk individuals” as a proof of overall cost savings.

Edwards: Mandating preventive visits

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