The role and scope of preventive care in our healthcare system has been a perennial issue for decades. Emily Willingham raises the issue and its role in healthcare reform and are larger healthcare system in light of a recent encounter on Facebook and more:
I received a Facebook invitation today to join in signing a petition to require insurance coverage for genetic testing for breast cancer. According to the petition, insurance companies might cover such testing if three people in a family have had breast cancer, but if “only” one person has, then no dice. I did some quick Mendelian math and cannot understand how three vs. one in terms of heritability makes a difference in individual risk. If your mother carries the BRCA allele, whether your sister or your aunt does has no influence on whether or not you do. If you inherit BRCA1 or BRCA2, your lifetime risk is up to 80%.
The invitation was timely because I’d already been mulling the relevance of prevention in the context of national health care. It is an enormous logical disconnect not to provide coverage for all standard preventive care, including vaccines (we once had insurance that did not cover vaccines). We’ve got another irrational disconnect on our hands if companies refuse to cover tests for at-risk people and introduce an irrelevant “three-person” rule into the heritability calculus, one that is not even within the National Cancer Institute’s guidelines for “significant family history” of breast cancer. Surely the costs of such preventive interventions in at-risk populations are less than the costs of treating related acute or chronic diseases, even if broader screening across a population regardless of risk is not. That math can be worked out. A breast cancer allele, on the other hand, cannot.
The breast cancer petition is just one example. In our discussion of national health care, there ought to be a strong emphasis on coverage for standard preventive care. We should also consider encouraging covered individuals to meet benchmarks for regular checkups and immunizations (with the usual exceptions). Expenditure of tax dollars on a person’s health could at least warrant emphasis on prevention adherence in maintaining good health. The cost savings in the long run are measurable in terms of economics. In terms of lives, they have no price.