Reader Lynn comments on High Deductible Health Plans:

Would not preventive care available at zero deductible cover the problem of under utilization of preventive care with high deductible insurance?

Which seems about right if you are speaking English and adhering to the rules of common sense. Alas, things are quite different in health insurance land.

To a health insurer preventative care is limited to diagnostic testing and checkups for people who have no symptoms. A woman with normal breasts can get a mammogram for free on a schedule determined by her health plan or some learned body of medical research. Tests and so on are only preventative if there is no diagnosis that would indicate that tests are needed. If the patient or doctor has any reason to suspect disease then the tests are diagnostic and not covered under the preventative benefit.

If that woman finds a lump during self examination or even if she has a family history of breast cancer then she has a diagnosis and a mammogram becomes a diagnostic test so she pays.

Huge areas of health care - for example diabetic education, dietary programs and blood sugar monitoring, asthma treatment, cancer follow ups and so on - that the lay person would consider preventative are not, thanks to the magic of health insurance contract writers.

Besides, Wonks Anonymous can think of many areas where seemingly minor symptoms or "lifestyle" problems are signs of serious conditions. When we keep parents from taking their children to a pediatrician for a bad case of the flu we increase the chance that they will show up in the ER with a dying child.

Early signs of many diseases, tiredness, headache, even impotence seem trivial to those who sit in judgment of our medical utilization. They often are trivial and can be cured by simple lifestyle changes but you never can be sure of that until you actually seek professional advice.