“It depends” is all too often a means to drown an argument with minutiae. “Preventative health-care is cheaper than emergency care” is not a scientific hypothesis subject to a “false in one, false in all” refutation; it’s a statement of general principles and even if we accept the fact that it might not be cheaper in particular individual circumstances, that does not refute its overall accuracy.

That can be illustrated with your own example:

from a pure dollar perspective the unexpected heart attack at 58 looks better than a decade of diabetes taking you out at 72

Perhaps – IF that heart attack kills you instantly. If it doesn’t, if you get EMT care, ER care, emergency surgery, a hospital stay, that is going to cost you one hell of a lot more than a lifetime of a heart condition found early and managed with medication and diet.

Five years ago, before we were married, my wife had an MI. She had an emergency triple bypass and later had a defibrillator implanted. The total cost was well over $100,000. It was mostly paid by insurance but she wound up bankrupt anyway. There are other personal details I have no intention of sharing, but if the question is asked if her condition could have been found and treated sooner, could her heart attack have been avoided at a fraction of the cost, the answer is yes.

As for the “friggen brainstem,” while some of the folks you mention are just an unnecessary drag on the ER’s resources, a goodly number of them are there either because they don’t know where else to go, they have nowhere else to go, they have no insurance, or they have insurance that only covers emergencies – so they avoid getting care for which they can’t pay until it either is or at least feels like an emergency. (And to establish my bona fides on this, I’ll mention that my first wife was and still is an ER nurse in the second busiest ER in the state, and I’ve heard all the stories.)

Elaine

Isn’t preventative health-care much cheaper than paying for emergency care?

Depends on how you define costs, and how you measure preventative health care against emergency care.

Finding and treating a mild skin rash in January is, obviously, much less expensive than dealing with a massive infection in July. That’s rather self-evident.

Finding and diagnosing a flu in January, however, as opposed to dealing with the symptoms until February, is not cheaper. There’s no real treatment available, and thanks to the wonder that is human psychology, you’re actually going to feel worse than otherwise.

Finding and diagnosing small-cell lung cancer in January sucks. Even if you catch it early and treat it as completely as possible, we’re talking on the order of all die of something, eventually, and from a pure dollar perspective the unexpected heart attack at 58 looks better than a decade of diabetes taking you out at 72. It’s the non-dollar incentives that make the latter preferable.

It’s almost impossible to say where these become cost-effective, and the answer is almost certainly based on your opinion of the procedures, and of the value of improvements to quality of life.

That’s also before we get to the part about how you plan to make people go to the doctors to get that preventative care reliably.

I sure don’t want the emergency room to be overcrowded with people who wouldn’t be there if they had received treatment sooner.

Frustratingly, a lot of the stuff that ERs (and their foreign equivalents) do is preventative care, or care which could not be provided earlier. If you’ve got a real problem, the only thing that goes before you is people who have a bigger problem, or need tests done to make sure they lack a lethal problem. It’s triage, not first-in first-out. Chest pain means you go in first and take up a lot of time. It does make things more problematic for those nibbly little problems like a couple stitches or stomach pain slower, though.

The remainder isn’t so much preventative care as simple education and a friggen brainstem. Look at the multitude of ER nurse and doctor bloggers. There’s a lot of low-priority garbage that goes around at the ERs, but trying to move it around is probably not going to help much for the crowded 10 PM – 4 AM rush that seems to always be the ER’s busiest time. Even in states where late-open urgent care units treat patients better and faster than the local ERs for what conditions they’re equipped to deal with, you still see people coming in the ER for pregnancy tests, with teething children, drunks, and newly frustrating colds.