There’s been a lot of talk about the AHCA, the new healthcare bill that was passed in the U.S. house and is currently being worked through the Senate as the BCRA. A lot of people have focused on how it’s going to kill millions of people, because obviously that’s a pretty big problem for people’s health.
But let’s for a second ignore the fact that the decrees about the BCRA from its authors are based on what could be politely termed imaginative fantasies about how the world works, and assume that against all evidence that the main provisions repealing Obamacare will somehow save money without killing people. Let’s assume that 22 million people aren’t going to lose their insurance so that a few rich people can save some tax dollars.
This is a pretty huge assumption, but for the sake of argument let’s say that it’s true.
What happens then? In short, the bill is still going to cost the country billions, because the group of partially sentient thumbs who wrote the damn thing know about as much about how health works as I do about theoretical quantum physics.
Actually, scratch that. At least I can spell theoretical quantum physics.
If you have a look at the AHCA, and now the BCRA, amidst the paragraphs taking money away from the poor and handing it wholesale back to the rich, there’s a section called “THE PREVENTION AND PUBLIC HEALTH FUND”
What it’s basically saying is that the commitments that Obamacare made to the Prevention and Public Health Fund (PPHF) are going to be cut from the end of the 2018 fiscal year, which is in about 12 months time.
If you haven’t heard of it before, the PPHF was established as part of Obamacare, and provides preventive and public health service funding to a wide range of programs. The services covered range from preventing young people from killing themselves to helping people with diabetes manage their illness.
And it’s all going to stop in just over a year.
Now, this program costs a fair bit—almost $1 billion a year. If the BCRA gets through, overall the funding cut will be about $4 billion in total — not a massive amount as far as the federal budget goes, but a decent chunk of money.
The problem, as any health economist will tell you, is that these simple, easy preventive healthcare programs save a lot of money.
Here’s how the PPHF saves you healthcare dollars:
Smoking Prevention, $125 million: The ACA provides $125 million a year to smoking programs that aim to raise awareness about the harms of smoking in areas with high rates of tobacco usage. This makes perfect sense, because smokers cost untold billions in healthcare and related costs each year. Evidence from the U.S. and internationally has demonstrated that every dollar spent on smoking prevention programs saves between 2 and 55 dollars, which means that cutting this vital program will cost somewhere between $250 million and $6.9 billion dollars a year to the healthcare system.
Diabetes Prevention, $72 million: I work in diabetes prevention and management, and I can tell you: it is bloody expensive. Some recent analyses have shown that diagnosis of diabetes costs somewhere between 15–25 thousand dollars a year, which over the life of the disease can end up being in the millions. For every dollar that we spend preventing diabetes, we expect to see around $3 of savings, which means that cutting this program will cost a cool $216 million a year.
Immunization, $324 million: With the hefty price tag, you better believe that the spend on immunization is cost-effective. Vaccine-preventable diseases are often incredibly expensive, whereas vaccines are notoriously cheap. So cheap, in fact, that immunization programs (even including administration costs) save about $10 for every dollar spent. That makes the cost of cutting this program about $3.2 billion. A year.
Falls Prevention, $5 million: When you’re young and healthy, falling down is an unpleasant but not particularly worrying experience. You trip on the cat, slip in the bathtub, or get tangled in your computer’s ethernet cable, take a tumble, and maybe get a nasty bruise. But for old people falls are a really serious problem. Broken bones and nasty infections are just the start: it’s no exaggeration to say that falls are one of the biggest issues for people over the age of 65. The plus side is that preventing them is often remarkably cheap, with programs usually involving simple risk assessments and the occasional visit from a physio or occupational therapist to make peoples’ homes safe. International evidence indicates that every dollar spent on preventing falls in the elderly saves between $1.27 and $5, which means that cutting this program will cost $6–25 million dollars a year.
Heart Disease, $72 million: Heart disease is a complicated one, because the range of prevention efforts is so broad. There are so many things that cause heart disease, and so many ways that we try and prevent it, and all of these have different costs and benefits. That being said, the American Heart Association estimates that simple public health programs in the community and workplace save as much as $5.60 for every dollar spent. That means that cutting the heart disease prevention funds from the PPHF will cost a disheartening $403 million dollars a year.
Chronic Disease Self-Management, $8 million: Getting patients to better manage their own chronic disease is the no-brainer of 21st century medical research. It’s one of those things that just seems so obvious to anyone with half a brain: teach people how to make themselves not die, and they’ll happily do it.
Luckily, it’s also super cheap.
For every dollar invested in chronic disease self-management, evidence indicates you’ll see a $2 return, which means losing this program will cost the U.S. health system around $16 million.
Lots Of Money
The list goes on. The PPHF covers another 20 or so areas, all of them saving money on health interventions. And if you take a look at my short list of six, you’ll see there’s a potential $10.8 billion dollars in yearly healthcare savings that has been thrown away just through these few programs, and a total savings from the cut of only $600 million.
That’s at least $10 billion dollars a year wasted in the name of saving money on health. Probably far more.
These costs might not be borne by the federal government. They probably will, because ultimately a lot of the money ends up being paid from government coffers regardless, but they will equally be felt by the people who would’ve been helped by these vital programs.
The newborn who will miss out on vaccinations.
The 85-year-old who will fracture her hip and die in hospital of pneumonia because no one checked if her bathroom was safe.
The man with diabetes, lying in a coma on the floor of his kitchen because he miscalculated his insulin dose.
I’ve been talking about money, because money is what this healthcare bill is built on. The empty rhetoric is all about saving money and making people responsible for their own costs, because the tepid pond of curdled milk that is the Republican Senate has only the faintest understanding of what the words healthcare and costs mean, never mind long words like personal responsibility.
But while it’s not even true that the bill will end up saving anyone any dollars — the new healthcare bill will likely cost an enormous amount morefor the average American — it’s easy to forget that the costs aren’t just monetary.
We are talking about people’s lives.
And here we are, back at the sordid truth of this healthcare tragedy. We know that free-market economics makes healthcare more expensive. We know that cutting preventive healthcare will lose far more money than it will save.
We know millions of people are going to die to save a few tax dollars for the ultra-rich.
So fight back. Resist. Call your senator and protest this gross idiocy that will cost everyone so much money and so many people their lives. Send them an email, or even better a signed letter.
Because this will cost staggering amounts of money.
And also kill people.
Gideon is a health nerd and epidemiologist (public health person) working in chronic disease. He writes about how simple health science really is, how we get it so wrong and why being terrified of that New Scary Study is usually a bad idea. If you want to get in contact, he is shamefully addicted to Twitter and would love to hear from you!