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One of the ways lawmakers had hoped to save money as part of the overhaul was by emphasizing prevention and wellness. Getting people to lose weight, stop smoking or detect disease earlier seemed like a sure bet to bring down health care spending.
But as NPR's Julie Rovner reports, budget scorekeepers don't see it that way.
JULIE ROVNER: Almost every time President Obama talks about the health care overhaul, he talks about prevention. Here's how he put it at a forum this afternoon before the AARP.
President BARACK OBAMA: So that instead of just spending billions of dollars on costly treatments when people get sick, we're spending some of those dollars on the care they need to stay well, things like mammograms and cancer screenings and immunizations - common sense measures that will save us billions of dollars in future medical costs.
ROVNER: Common sense maybe, savings of billions of dollars, not so fast. According to the Congressional Budget Office, the prevention programs included in the House and Senate bills it's reviewed so far won't save any money for the federal government. In fact, CBO says that'll actually cost money.
Joe Antos of the American Enterprise Institute is a former CBO health analyst. He says it's unfortunately true that many preventive health services simply cost more than they save. Widespread disease screening for things like cancer is a good example.
Mr. JOE ANTOS (American Enterprise Institute): Because you screen literally millions of people, sometimes at fairly high costs per screen. You'll pick up some true positives, people who really have the disease, you'll pick up some false positives.
ROVNER: And in both cases, he says, the medical system will spend more money to see if those people really do have the disease.
Mr. ANTOS: So, by the time you're all through, and studies have demonstrated this time and time again, screening as a preventive health measure, by and large, doesn't work unless you can narrow it down to roughly the right patient population.
ROVNER: Emory University health economist Ken Thorpe agrees that some types of prevention programs don't save money. But he says other types of prevention programs can.
Dr. KEN THORPE (Health Economist, Emory University): The type of prevention that does save money, that we don't talk as much about, are preventive initiatives designed to avoid disease in the first place, get people to stop smoking, lose weight. We have effective programs that do that. And, yes, those interventions can save money.
ROVNER: Unfortunately, says Thorpe, the prevention portion of the bills in Congress aren't as broad as they could be. But other advocates for preventive health say the CBO isn't giving a fair shake to the programs that are in the bills, like programs to urge people to stop smoking. The nonprofit Partnership for Prevention, for example, looked at 25 separate preventive services recommended by government experts, said President and CEO Rob Gould.
Dr. ROB GOULD (President and CEO, Partnership for Prevention): And we found that indeed six of the services did save money and 12 were highly cost effective.
ROVNER: By highly cost effective, he means it cost less than $50,000 to add one year to a patient's life. By contrast, it can cost nearly a million dollars to keep a heart failure patient on a mechanical pump for that long, so he takes issues with CBO's findings about prevention costing money.
Dr. GOULD: Prevention ends up being very, very cost effective. And it's not just because we say so, it's because we studied it.
ROVNER: Then there's another reason budget estimators say prevention doesn't pay, precisely because it helps people live longer.
Dr. GOULD: They have warned us that living longer would cost the government more money because people would be using additional Social Security and Medicare payments. So, if the answer to the question is that it's a problem that people are living longer, healthier lives, then you're asking the wrong question.
ROVNER: But the question CBO is paid to answer is how much a particular bill will cost the federal government. Not whether helping people live longer and healthier lives is a worthwhile goal. So lawmakers may well include lots of prevention and wellness proposals in a health overhaul bill, they just can't expect those changes to help pay for the rest of the measure.
Julie Rovner, NPR News, Washington.
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