CPB and Ricky: Prevention Over Prescription

Why prevention loses to prescription

Chris Brandlin argues that prevention beats another prescription — and, more usefully, explains why the system so rarely chooses it.

His answer is about incentives rather than intentions. Prevention is diffuse, slow, and hard to bill for; a prescription is discrete, immediate, and fits inside an appointment. When reimbursement rewards the second and not the first, the outcome follows the money regardless of what any individual clinician would prefer. That framing is worth noting: he is describing a structural problem, not blaming physicians.

The policy question he raises is what a payment structure that actually rewarded prevention would look like — and how much of that sits with a state legislature versus Washington.

Related: the sick-care system conversation, nutrition training in medical school, and the children's health agenda.

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Nothing here is medical advice.