Similar to the finding that prevention rarely saves money is the calculation that people in good health probably rack up higher lifetime medical costs than their less-healthy brethren.
The reason? Healthy people tend to live longer.
The Framingham Heart Study has followed more than 5,000 people in a town outside Boston since 1948. An analysis published in 2003 found that obese women smokers lost 13.3 years of life, and obese men smokers lost 13.7 years, compared with normal-weight nonsmokers. This loss of longevity can make a big economic difference because people who miss old age miss the high medical costs associated with it.
In the journal PLoS Medicine last month, Dutch researchers led by Pieter H.M. van Baal used mathematical modeling to compare the medical expenses (starting at age 20) of healthy people, obese people and non-obese smokers.
Up to age 56, an obese person's annual medical costs are higher than a smoker's, mostly because of problems that often come along with obesity, such as diabetes, arthritis and lower back pain. Healthy people have the lowest annual cost.
But over a lifetime, the researchers calculated, healthy people incur the most cost, followed by the obese and then smokers, who die the earliest.
Does that mean we shouldn't try to get people to quit smoking or lose weight?
Of course not, says Louise Russell, the "Is Prevention Better Than Cure?" author who is now a research professor at Rutgers University in New Jersey.
"People are important, their health is important, and we want to make their lives better in a variety of ways," Russell said. "The point of the medical-care system is to serve people. It is not the point of people to serve the medical-care system."
Prevention can be a great investment, but it's still an investment. Nothing in the modern health-care economy is cheap.