CBO Explains Prevention & Wellness Scoring

 The Congressional Budget Office has taken a load of crap from the Administration and Democrats in Congress for its supposed failure to properly recognize savings from expanded prevention and wellness efforts  In a letter to a Congressman the CBO gives a detailed explanation of its scoring rationale in regard to these programs. (CBO Letter)

The CBO is focused on budgetary effects, meaning what would the federal government end up spending and what would it save that it might otherwise spend, and over what period of time.  It looks at both preventive care, which consists of screening, vaccinations and other similar services.  It relies, as it has before, on the actual studies looking at the costs and savings associated with prevention efforts.  These studies indicate that perhaps 20% of preventive services save more money than they cost.  Lack of savings is primarily due to the inherent nature of population-based screenings, which have to be applied to a large population to identify the persons who will actually benefit and also because if a screening, for example, identifies a person with a disease, medical care then has to be delivered. 

The report goes on to make a very important point–whether or not these programs save money doesn’t mean prevention is a bad investment, on the contrary, most prevention is the right thing to do and generates cliinical benefits that are worth the cost.  After all, the point of health care services is to improve a person’s health.  But from a budgetary perspective, expanding federal spending on preventive programs is not likely to save money in the short or long run.

Similarly, wellness programs undoubtedly improve the health of many people but the evidence for overall cost savings is ambiguous at this point.   CBO points out that in some cases, smoking cessation for example, government outlays would likely be reduced, but that is less clear in other forms of wellness efforts.  And it reminds us that the large reduction in smoking which has occurred in the United States took decades to implement.  It posits that addressing obesity is likely an even more complex effort.  It also opines that while there are studies showing savings resulting from workplace wellness programs, for example, it is not clear that more broadly applied programs would see the same results. 

Hopefully, the rational approach of the CBO will quell some of the irresponsible bashing and lead to a more educated discussion of the value of prevention and wellness programs.