An article by the Washington Post described a pilot program for patients with “pre-diabetes.” Older patients at risk of developing diabetes were offered lifestyle counseling and encouraged to eat well and exercise. In announcing that this type of program may be something Medicare could pay for in the future, the Secretary of DHHS estimated that it could save Medicare $2,650 over 15 months per beneficiary. That sounds great…if that number is accurate. These kinds of things are notoriously difficult to estimate with precision, in part because there are so many variables and moving parts.
However, even if it didn’t save Medicare any money at all, there’s another argument to be made, namely that helping patients with pre-diabetes to lose weight and reduce their changes of developing diabetes has intrinsic value, both in terms of these patients’ quality of life, and in terms of indirect economic costs associated with any family members who would potentially end up as (at least partial) care-takers. These family members, when caring for an elderly loved one with diabetes, would likely need to take time off of work for doctors appointments, filling medications, and other care-taker duties. Individuals’ health impacts not only their lives, but the lives of those around them as well, and there are costs associated with all of it. More than the direct “cost” or “savings” to Medicare, any preventive model should involve a conversation about the larger impact.