No one is disagreeing with you about the efficacy of preventative measures. The concern is more practical. 1. For instance, an immediate switch to preventative measures does not help people who have already developed a disease as a result of several decades of previous poor lifestyle. That is, let's grant your (questionable) scenario that after funding support for preventative measures, no one should be covered for conditions related to their obesity, etc, since there would be proper support for eating and living healthy. Fine. What about all the people that didn't have that support before, and lived the entirety of their life with the McDonald's fast food dollar menu as the most economic way to feed themselves? Should be denied assistance in the same way as someone who had the nutritional counseling, medical support, healthy food subsidies, and convenient exercise centers that your new preventative programs would presumably provide? 2. Really, no one should be treated if they can be held even partly responsible for their condition? Because I'm fairly certain that every sports-related injury ever could be avoided by simply not playing the sport in question. And children wouldn't get sick so often if they would have better hygiene and be more cautious about sticking things in their mouth. Do neither of these two situations deserve any help? 3. How do you account for the fact that our knowledge of disease processes grows and changes over time. How long was it before the link between asbestos and mesothelioma was well known and established scientific fact? Smoking and lung cancer? If someone does something that seemed innocent at the time they did it, but was later discovered to be a major risk factor for causing a disease, are you still going to deny them coverage? 4. Because these are long term processes, changing your lifestyle can help (in terms of preventing things from getting worse) without really improving your condition. In that sense, do you think it's really sensible to consider it "encouraging poor lifestyles" to tell someone who stopped smoking cigarettes 20 years ago but still developed emphysema that they don't deserve any help? Etc The point being, you are grossly over-simplifying here. You are also making a false choice. Supporting preventative care programs does not mean we have to cut funding for acute care, nor vice versa. Your position is also unrealistic. While, yes, it would be more cost-effective for people to live better, that's not what they actually do. If your goal in healthcare reform is to reign in costs, you have to focus on things that actually change people's real behavior, not figure out which plan would work in an ideal world where people are already competent and responsible.