At a meeting we attended about health reform the other day, one side of the room was saying of course prevention saves money and the other side was saying with equal certitude that of course prevention doesn't save money. (Forget the irony that we were having this discussion over a pizza lunch. With no salad.) A lot of other people are having this debate, and we attended a helpful panel discussion recently sponsored the Alliance for Health Reform.
We'll grant that if you look, you can find good solid economic arguments that prevention (depending on how it's defined, but more on that in a minute) doesn't save money. At least it doesn't save money in the five- or 10-year budget windows that Washington is used to talking about (and which legislation must be measured against). Economist Louise Russell has been writing about this for years, and her widely cited article earlier this year in Health Affairs (and a shorter version on the Hastings Center blog) makes that argument. Note she is not saying prevention isn't a good thing; she's saying it isn't a "money-saver," strictly defined.
But you can find good solid arguments, too, that prevention and wellness does save money, and can save it quickly. A number of major corporations—Intel, Pitney Bowes, IBM, to name a few—report a high return on investment within a few years (sometimes sooner). They have taken a variety of steps—incentives for diet and exercise, tobacco-counseling, health screenings, no-copay screenings—that are producing a healthier workforce at lower cost.
As they say on Facebook... It's complicated. Let's break it down.