“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.”
– Thomas Edison

Mr. Edison, if he is watching over us, must be sadly disappointed.

The provocative idea of making cancer centers obsolete might sound extreme, but it underscores a critical vision for health care—shifting from reactive to preventive treatment. Envision a future where advanced cancer cases are so rare that specialized cancer centers are no longer a necessity. This scenario isn’t just a fantasy; it’s a feasible objective, achievable through existing yet underutilized preventive measures that encounter significant systemic barriers, primarily due to the economic strategies of health insurance providers.

Preventive health care encounters significant setbacks due to insurance policies that fail to cover crucial evaluations and procedures. This systemic flaw affects various aspects of health care, from minor to severe conditions, with insurance companies often prioritizing short-term cost savings over long-term health benefits. Allow me to expand on the ridiculously flawed approach to common ailments that insurance companies continue to use.

Esophageal cancer

21,000 cases annually. Almost all are caused by gastroesophageal reflux disease (GERD). GERD is typically managed endlessly with medications to alleviate symptoms, rather than endoscopic procedures that could catch and even prevent the progression to esophageal cancer. This financial decision-making fails to account for the potential future costs and patient suffering that might arise from an eventual cancer diagnosis.

The approach to managing esophageal cancer remains flawed. Patients with acid reflux are at risk of developing this type of cancer, yet preventive endoscopic treatments for its precursors are often not covered by insurance. This gap in coverage persists despite the clear benefits of early intervention in preventing one of the leading causes of cancer deaths in the USA.

Colorectal cancer

153,000 cases a year. Almost all are preventable and yet illustrate another missed opportunity for prevention. Despite the potential to reduce both the incidence and mortality of colorectal cancer by up to 90 percent and 50 percent, respectively, through regular colonoscopy screenings, these programs are not fully utilized. If fully implemented, such screening could not only lessen the emotional and financial strain on patients and their families but also significantly decrease national health expenditures related to this cancer.

Breast cancer

300,000 annual cases. Its prevention strategies also suffer from economic short-sightedness. The protocol of following up suspicious mammograms with ultrasound and, if necessary, biopsies, represents a proven method to detect and treat breast cancer at its earliest stages. However, the incremental approach to diagnosis and treatment is often stymied by insurance policies that do not cover all the necessary steps unless cancer indicators are unmistakable.

Cervical cancer

14,000 cases a year. The replacement of traditional Pap smears with HPV genetic testing and the subsequent use of colposcopy for detecting pre-cancerous changes in the cervix are critical advances in preventive care. These are outpatient procedures that could drastically reduce cervical cancer rates, yet they, too, face coverage inconsistencies.

Prostate cancer

288,000 yearly cases. And yet, the situation is no better, where preventive screenings like the PSA blood test could significantly improve long-term outcomes. Despite its benefits in detecting prostate cancer early, particularly in asymptomatic men, such screenings are often underutilized due to coverage limitations and perceived cost implications.

And finally, for the most malignant of them all:

Obesity

40 percent of the country is obese. 25 percent of all deaths annually are from health care afflictions directly caused by obesity. And yet, the treatment and management of obesity demonstrate a glaring oversight in preventive care. Obesity, a significant risk factor for various diseases, including heart disease and diabetes, is still not recognized adequately as a medical condition deserving of treatment. Procedures like balloon gastric placement or gastric sleeve are overlooked by insurers, who deem them unnecessary or elective, ignoring the substantial long-term health benefits and cost savings they offer.

More recently, medications like Mounjaro and Ozempic represent a beacon of hope in the fight against obesity, offering what many see as a potential national solution to this widespread health crisis. These drugs, which have shown promising results in not only managing diabetes but also significantly aiding weight loss, could be pivotal in reducing the extensive health care costs associated with obesity-related ailments. However, despite their potential, there remains a significant barrier in the form of insurance coverage.

Insurance companies, often driven by immediate cost considerations rather than long-term health outcomes, have been reluctant to include these medications in their coverage plans. This decision seems penny-wise but pound-foolish, considering the billions of dollars spent annually on treating conditions linked to obesity, such as heart disease, diabetes, and joint problems. By investing in preventive measures like these medications, insurers could reduce the overall burden of obesity-related health care costs.

This reluctance may stem from the high initial prices of these drugs or from the insurers’ calculations about long-term profitability and risk. Nonetheless, the debate continues about the role of health care insurers in preventing diseases by supporting not just traditional treatments but also innovative medications that tackle the root causes of obesity. This issue highlights a broader discussion about health care economics and the prioritization of immediate costs over long-term health benefits, which is critical as we consider the future of health care policy and the role of preventive care in sustaining public health.

The overarching theme in these failures is the prevailing “not our problem” attitude among insurance providers, which shifts the cost burden onto patients, their families, and eventually the government once these individuals age into Medicare. This short-term cost-saving approach reflects a deeper systemic negligence and a national shame: allowing our health care system to overlook preventive measures that could spare millions from suffering and save countless lives. Our current practices not only burden the health care system but also underscore a moral failure to prioritize the well-being of our citizens.

As Warren Buffett said, “Someone’s sitting in the shade today because someone planted a tree a long time ago.” It’s time we started planting.

Shakeel Ahmed is a gastroenterologist.