Rouse on Transformation

Last August, the Director of the Congressional Budget Office (CBO), Douglas W. Elmendorf, sent a letter to Congress informing them that most preventative health interventions tend to expand utilization of services with costs that far exceed the eventual cost savings due to avoiding disease or detecting it earlier.  In other words, he reported that prevention is not worth the investment.

I considered immediately stopping exercising and not worrying about trying to eat healthy.  Based on the CBO’s sage advice, I now knew that it was not worth it.  The money spent on the exercise club and Whole Foods produce would not provide a return on this investment that would exceed the costs.  I even entertained stopping eating because it just increases food costs.

Then it struck me.  The CBO had attached no value to healthy, productive people.  People who are healthy, educated, and productive, and thereby increase GDP and tax revenues, have no value to Congress.  The CBO only counts what matters to Congress – how tax dollars are distributed, not how these dollars are secured.

Of course, as I indicated in an earlier post, another problem is that the “return” on prevention primarily occurs in later years.  No one in Congress owns the future, 5, 10, or 20 years from now.  Thus, despite the fact that relatively small investments in prevention now will contribute to a healthier and more productive workforce in the future, Congress is not concerned with the GDP and tax revenues these people will generate many years from now.

If you and I were to adopt the philosophy that Congress embodies, we would not save for our children’s college education.  We would not pay the exercise club dues or waste time on after dinner walks.  We would avoid expensive broccoli and whole grains and, instead, consume a lot of tasty but poor quality food, made cheap by government corn subsidies.

However, we do attach value to being healthy, educated, and productive.  We also probably attach value to other people being healthy, educated, and productive.  We would like a society where as many people as possible are healthy, educated, and productive.  We know that prevention is worth it, just like we know that eating is worth it, even if it does increase food costs.