Preventative care does not save money

Back when I was just a wannabe health care wonk, I regularly made the mistake of arguing that providing more free/low-cost preventative care would actually lead to less overall health care savings.  Talk about a win-win.  Alas, I (like many others) was wrong.  But, you know what?  That’s okay.  Some things are worthy society spending on.  And preventative health care is surely one of those things.  Aaron Carroll:

The idea that spending more on preventive care will reduce overall health care spending is widely believed and often promoted as a reason to support reform. It’s thought that too many people with chronic illnesses wait until they are truly ill before seeking care, often in emergency rooms, where it costs more. It should follow then that treating diseases earlier, or screening for them before they become more serious, would wind up saving money in the long run.

Unfortunately, almost none of this is true.

[Nice summary of studies of all kinds of health care showing this]

But money doesn’t have to be saved to make something worthwhile. Prevention improves outcomes. It makes people healthier. It improves quality of life. It often does so for a very reasonable price.

There are many good arguments for increasing our focus on prevention. Almost all have to do with improving quality, though, not reducing spending. We would do well to admit that and move forward.

Sometimes good things cost money. [emphasis mine]

So, yeah, let’s keep making arguments for government doing more to make preventative care affordable and accessible.  Let’s just be honest– it’s worth paying for.

The memo

Atlantic’s David Graham with about the most succinct explanation I’ve seen on how stupid the whole Nunes memo is and what it is really all about:

The central accusation, based on what’s known, is that the Justice Department improperly signed off on an application to a Foreign Intelligence Surveillance Act judge for a warrant to surveil Page. The application (the memo contends) was based on information from a dossier compiled by Christopher Steele, a former British intelligence agent who was researching Trump for a company paid by the Democratic National Committee.

As I have reported, and as Orin Kerr also writes, this is dubious. First, it’s doubtful that the warrant application would have been based solely on the Steele dossier. American intelligence agencies had long had an eye on Page, who they believed was subject to recruitment as a Russian agent as early as 2013. Second, even if the dossier was part of the application, the fact that it derives from opposition research wouldn’t bar the FBI from using it unless the bureau had reason to believe it was false and used it anyway.

Still, imagine for a moment that it is true that the FBI used only the Steele dossier to apply for the Page warrant, and that it acted improperly. Certainly, as I have noted elsewhere, this would not represent the first case of intelligence overreach in American history. That would be great news for Page’s defense, but it is hard to see how this would solve Trump’s broader problems. Page claims he was a bit player anyway. He also doesn’t make for a great political cause, given his peculiar and sometimes contradictory answers to questions from the House Intelligence Committee.

Moreover, the Page warrant has no bearing on the larger questions of whether the Trump campaign, or Trump himself, was colluding the Russians, and whether Trump obstructed justice by trying to hobble the investigation into collusion. [emphases mine] It would not do anything to undermine George Papadopoulos’s guilty plea, or his conversations with Russians, or his boasts to an Australian diplomat that the Russians had dirt on Hillary Clinton. It would not invalidate Michael Flynn’s guilty plea and cooperation with Mueller. It would not erase the June 2016 Trump Tower meeting, or the questions over a statement about that meeting he dictated in summer 2017. It would not throw out Trump’s attempts to pressure James Comey, nor his firing of the FBI director and explanation that he did so because of the Russia probe. It would not efface Donald Trump Jr.’s DMs with Wikileaks.

Of course, actually rebutting this extensive set of stories is not what Trump means when he says he hopes the memo will undermine the Russia probe…

The goal is simply to spread confusion and create fog that might give the impression that the Justice Department is unreliable and that the investigations into Trump are politically motivated by opponents who inhabit the same moral plane as he does. 

And, Drum, on how the media has been completely played by Nunes, who has repeatedly shown himself to be a person singularly lacking in integrity and honesty.  Drum:

You have to give Republicans credit: as political theater, the Nunes memo has been sensational. If Devin Nunes had just written his memo and released it, no one would have cared. Adam Schiff would have gone on TV to denounce it, and by the next day it would have been forgotten. But no. That’s not what happened. Here’s how the launch plan has marched forth:

  • Nunes writes memo.
  • But it’s based on classified info and “can’t be released.” Everybody loves secrets, so that gives the memo an extra cachet.
  • Nunes makes it available for reading, but only to members of Congress and only in a secure location. Ooh!
  • Lots of Republicans read it, so it generates lots of chatter—and a few carefully calibrated leaks so the press will write about it. The Washington press corps absolutely can’t resist a leak.
  • Needless to say, Fox News is giving the memo 24/7 coverage throughout the entire marketing rollout.
  • Trump starts tweeting about how the memo will blow the Russia investigation out of the water.
  • Nunes threatens to release the memo regardless of whether it’s officially declassified. This naturally provokes a partisan fight, and just as naturally that has to be covered. It’s news!
  • Adam Schiff is provoked into writing a dissenting memo.
  • Republicans vote to release the Nunes memo regardless of its sources.¹ This is the first time any intelligence committee has done this, so naturally it’s news.
  • The vote leaves the final decision on release up to President Trump. He has five days to decide, which means five more days of news.
  • Then we get the usual Trump show. Will he release it? Or won’t he? Has he tweeted about it? What did he tell that congressman, anyway? All the world wants to know.
  • The FBI chimes in. The memo is shoddy and wrong. News!

And that takes us up to today. Presumably Trump will release the memo, but if he doesn’t it hardly matters. Someone would just leak the whole thing to make sure it gets into the press. In fact, it might even be more newsworthy if Trump pretends to withhold the memo because it’s based on sensitive intelligence. That would add to the memo’s authority and whet the public’s appetite even more for the eventual leak.

All of this for a memo that’s a nothingburger. What’s more, I’ll bet everyone in the DC press corps knows it’s a nothingburger. They already know roughly what’s in the memo, and they also know that Nunes is a singularly untrustworthy actor. But there’s nothing they can do about it. They know they’re being worked, but they go along anyway. We are all lemmings.

Photo of the day

Oh my, so many good choices in this “Animals on the Playing Field” gallery in the Atlantic.  Couldn’t resist the very last one.

A group of langur monkeys lounge in the spectator stands as they watch a practice session of the England cricket team in Ahmadabad, India, on October 27, 2006. 

Gurinder Osan / AP
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