Prevention Isn’t Profitable

“If you look at every medical drama on TV, who gets the hero buttons?” Julia Hubbel asks. Answer: “The ER doc who saves the victim, the guy who let a disease progress way too far.” It’s true: Healthcare has incentive problems. And though ego boosts and savior complexes might only make a small portion of doctors act against their patients’ best interests, money interests everyone — and that holds even more of the same power.

If big pharma succeeded in curing every disease, what would big pharma do afterwards? From a profit-perspective, it’s better to just sell drugs treating symptoms, because symptoms can continue to be treated as long as the patient remains sick, which, if that’s all you do, they certainly will. Despite the obvious flaw in its setup, this is not an easy problem to fix.

Imagine the government offered a reward of $1,000 for every person who never gets diabetes. That sounds lovely, but it pales in comparison to tens of thousands of dollars of insulin payments. Plus, you’ll have to wait for them to die to arrive at your conclusion. And which company gets the money, anyway? Prevention is the most efficient medicine, but unfortunately, it isn’t all too profitable.

In healthcare, this dynamic affects millions of people, and you’d think that’s bad enough. When it comes to the climate, however, it affects literally everyone — yet here, too, we seem to insist the heart rate monitor go flat before rushing to…where exactly, actually? That’s climate change’s unique problem: There won’t be an ER to stitch up the planet in by the time it goes into cardiac arrest.

Carbon credits are the 21st century’s letters of indulgence. “We’ll pay someone else to offset our emissions” sounds like a nice idea, but if the ultimate goal must be to reduce the totality of our carbon wastage, it’s simply a paid permission to pretend to hand off a responsibility that, in the end, no one can get rid of. Every company is passionate about reducing all emissions but their own. “Ours are special! Important! Necessary!” Even if the certificates are costly, they’re not exactly existential motivation to think about better ways of operating. But if we don’t all come up with those ways soon enough, eventually, our carbon sins will be impossible to pardon. If only the church sold a letter guaranteeing our entry into heaven…

Planting trees is a better, albeit still too run-after-the-bus solution, for it comes with a 40-year-delay we might not be able to effort. By the time each new tree absorbs enough CO2, we’ve long produced a thousand times the emissions. Let alone will we find the time and space to each plant 200 trees per year.

When prevention is the only thing that works yet not well-incentivized, perhaps it is easier to bring sexier incentives to the task than to try and force productivity despite their absence. If Tesla can make electric cars cool and desirable, surely someone else can do the same for solar modules, green production, and living without grid reliance.

As for being healthy? That’s always been cool — and so is telling people how to brush their teeth correctly, make a habit of light exercise, and eat well enough to avoid insulin injections. If you’re one of the few renegades taking extra time to do so after you’re done writing prescriptions, drawing blood, or changing a patient’s pillow: Thank you. Thank you for your service.

And if you’re “just” one of all of us affected by the dilemma, know it’s never too late to take the first step into the right direction. Prevention might not be profitable, but if money was all we sought, humanity would have gone extinct a long time ago. Let’s choose kindness one more time, and see where it leads.