Is preventive care cost effective? Of course it is. How else could France, Britain, and even Cuba achieve better health outcomes than us at a fraction of the cost? The irony in this debate is that the question only makes sense in the context of the enormously inefficient and pricey American healthcare system.

When healthcare costs have been driven through the roof by an inherently flawed reimbursement structure, Krauthammer and the rest can plausibly make an argument against screening and prevention. But in doing so, they reveal their myopia. Rather than seeing this as the indicator of systemic flaw that it is, anti-reformists attempt to play both sides of the debate. They oppose reducing healthcare costs through the intervention of a public option, and yet they also oppose reducing costs within the current system through rethinking our delivery of care model.

The existing fee-for-service model has incentivized the most radical, invasive, and expensive procedures because they’re the most profitable for hospitals and physicians. But when public health professionals discuss preventive care, we mean targeted cost-effective interventions for at-risk populations. For example, a school nurse could provide nutrition counseling to obese students, or a university clinic could screen each student for tobacco addiction and offer low cost cessation medication to smokers. The problem is that “preventive care” has been defined by our broken system. Ask an American cardiologist what preventive medicine means, and she’ll likely answer that cardiac stress tests for those aged 55+ are the way to go. Ask a British physician, and she may start with blood pressure screening.

Consider screening for colon cancer. Gastrointestinal docs tout the benefits of colonoscopy, which involves visually inspecting the colon for polyps or cancerous lesions. But much cheaper, less invasive fecal occult blood testing (FOBT) has been shown to be highly effective as well. But FOBT has encountered resistance from GI physicians who stand to lose a major revenue stream if colonoscopies are phased out and replaced with this cheaper alternative.

For preventive care to really be cost-effective, we need to realign the incentive structure in medicine. Fee for service medicine has resulted in care that’s administered for exactly the wrong reason (reimbursement) and with exactly the wrong outcome (endlessly increasing healthcare costs). Fee for service must die.

That’s one area where the Congressional Budget Report on cost-effectiveness of preventative care got it wrong-their calculations assume the perpetuation of what most of us now recognize to be a flawed system for the provision of medicine. But even CBO Director Elmendor does concede that preventive care is cost-effective when clinical benefits are considered. In other words, critics who claim that preventive care will cost us more are neglecting to mention that preventive care will undoubtedly make us healthier. Because these health benefits span the lifetime of an individual, the 10-year CBO projections barely even incorporate the fiscal benefits of good health in a population.

Health care reform is about making a flawed system better, and making our sick population healthier. Yet critics still stand on the sidelines, blocking reform with ever more creative criticisms that always boil down to the same conclusion: let’s retain the status quo. Problem is, most Americans are sick of the way things are, and some Americans are sick because of the way things are. The status quo won’t work for them.