Here’s the headline:
WASHINGTON — The Obama administration is examining whether the new health care law can be used to require insurance plans to offer contraceptives and other family planning services to women free of charge.
The article by Robert Pear is more about the continuing and hypersensitive debate over contraception than anything else – but there’s another issue.
According to the Patient Protection and Affordable Care Act, insurers must cover “preventive health services” and cannot charge for them. Without getting into the myriad and highly political issues surrounding contraception, an obscured, undiscussed but highly important question relative to the PPACA is – just what is “preventive medicine?”
With dynamic advances in diagnostics, we can now determine (with ever-greater degrees of accuracy and certainty) if someone, say, is prone to develop Alzheimer’s Disease. A recent article in the New York Times, “Two Tests Could Aid in Risk Assessment and Early Diagnosis of Alzheimer’s,” discusses a diagnostic scan that can help physicians determine whether a patient’s dementia is actually Alzheimer’s – allowing earlier and more aggressive treatment. The article also points out that, “… a large study sponsored in part by the National Institute on Aging is scanning healthy people and following them to see if the scans predict the risk of developing Alzheimer’s disease.”
If such a predictive test does become available, would this fall under the codicils of the PPACA’s call for “no-cost preventive screenings?” The impact on payers would be significant. Such a diagnostic would cost significantly more than a prescription for the Pill. And if Alzheimer’s was indeed the diagnosis – treating it is expensive.
The question then arises, is it cheaper to identify and aggressively treat a patient in the early stages of Alzheimer’s (even before there is a significant manifestation of symptoms) or to wait until the late stages – where the real costs lie not only in therapeutics, but in the related expenses of care-giving?
As the Center for Medicine in the Public Interest demonstrated in the paper, “Alzheimer’s Disease and Cost-effectiveness Analyses: Ensuring Good Value for Money or Indirect Price Controls”, early intervention saves significant dollars over the course of the disease – even by delaying disease progression. This is a crucial point as there is, at present, no “cure” for Alzheimer’s Disease.
Where you stand often depends on where you sit. Will the PPACA demand that insurance providers provide free “preventive care” for a drug that doesn’t lead to prevention of a disease (like Alzheimer's) but delays its progression (like Aricept)? What about diagnostic screenings that can significantly lower the long-term costs of a non-preventable disease? If you are a payer, it’s a question of short-term costs versus long-term savings. And then, of course, whether the disease state is Alzheimer's Disease or breast cancer -- there’s what’s best for the patient.
And that’s a consideration particularly germane for our nation’s largest payer – Uncle Sam.
