Or…it’s complicated.

The New York Times today published a story titled, “No, Giving More People Health Insurance Doesn’t Save Money.” A piece of the argument is, as the author Margo Sanger-Katz puts it, “Almost all preventive health care costs more than it saves.”

What do you think? What’s the evidence? Leave aside, for the moment, the “big duh” fact that at least in the long term saving people’s lives in any way will cost more, because we are all going to die of something, and will use a lot of healthcare on the way. Leave aside as well the other “big duh” argument: It may cost money, but that money is worth it to save lives and relieve suffering. Leave that argument aside as well. The question here is: Does getting people more preventive care actually lower healthcare costs for whoever is paying them?

My thoughts? It depends. It depends on which preventive tests, screens, and prescriptions you’re talking about, and how it is decided whom to help with them. Sanger-Katz’ article only shows that we cannot assume that every preventive screening or test saves money and/or is worth the money spent. Mammograms, for instance, show no benefit (no extra tumors caught, no lives saved) over breast exams alone (Canadian Breast Cancer Study, n=89,000 per 25 years).

This is true of many preventive items, including the annual checkup — it’s hard to show a true benefit from them. So yes, if you assume that every preventive test, screen, or prescription is worth it, and then you give more people access to those, you’ll end up spending more money. Equally important, the assumption is that you screen everyone, and you do it the most expensive way, like giving older people regular colonoscopies as a test for colon cancer. There are far less expensive ways to pre-screen people for that. This one assumption alone costs an estimated $10 billion per year in the U.S..

The problem is that these assumptions mean giving a lot of medical care, much of it not even effective, to people who are well. There are reasonable ways to narrow the focus of expensive, personal, procedural preventive care and maintenance to the 5% or so who really need it. Find that 5%, give them extra care, and you will save money.