Medicare Will Pay $50k for Your Heart Attack. It Should Pay $100 to Prevent It
Medicare’s willingness to spend tens of thousands of dollars treating heart attacks but not routinely cover inexpensive coronary calcium scans and targeted blood tests highlights a broader skew in U.S. healthcare toward “sick care” rather than prevention. Commenters debate how useful coronary artery calcium (CAC) scans really are compared with simpler labs and aggressive management of LDL, and note that even when preventive tools are cheap, misaligned incentives, insurance rules, and cultural attitudes often keep them underused. The thread widens into critiques of fee‑for‑service medicine, the role of obesity drugs like GLP‑1 agonists, and the political and economic forces that make long-term, preventive investment in population health difficult.
Coronary calcium scans & blood‑based risk tests
- Many commenters like coronary artery calcium (CAC) scans (~$100–$200 self‑pay) as a concrete motivator for lifestyle or statin decisions.
- Others argue basic blood markers (ApoB, Lp(a), hs‑CRP, HbA1c, eGFR) are cheaper, earlier indicators of risk and more actionable.
- Some say: if advice will be “diet, exercise, statins” anyway, why test? Counterpoint: numbers tailor drug choice/dose, detect genetics, and track whether lifestyle changes work.
Limits, risks, and uncertainty of CAC
- CAC shows calcified plaque, not soft/vulnerable plaque; zero score can give false reassurance, and positive scores can prompt anxiety and follow‑up procedures.
- Shared view: CAC doesn’t itself “prevent” heart attacks; it only informs risk and treatment choices.
- Conflicting takes on benefit magnitude: some cite modest absolute risk reduction from statins; others think that characterization is misleadingly low.
Obesity, GLP‑1s, diet & exercise
- Debate over “diet and exercise always work” vs. “biology and adherence make it much more complex.”
- GLP‑1 drugs seen by some as powerful tools for those who cannot control intake; others worry they enable avoidance of lifestyle change and lifelong drug dependence.
- General agreement that exercise has health benefits beyond weight loss and that ultra‑processed, high‑sugar foods exploit evolved drives.
US healthcare incentives & insurance
- Strong theme: fee‑for‑service rewards sickness and procedures more than prevention; prevention may cut revenue.
- Discussion of capitated/value‑based models that pay per patient, not per service—seen as better aligned but prone to care denial and gaming.
- Several note insurers are legally constrained on margins and often do promote some preventive programs, while provider groups drive many cost increases.
Cultural, political & regulatory context
- Multiple comments tie weak prevention to US ideals of individual responsibility, small government, and mistrust of “nanny state” interventions.
- Others highlight systemic racism/class dynamics influencing which health problems get prioritized.
- Debate over deregulation: some want easier direct access to tests; others stress safety regulations and note CAC is already widely available as self‑pay.