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Yet another installment of everyone's favorite topic: health care reform ideas!
In this installment we focus exclusively on medical technology. Why? Simple: not only is it incredibly complex, but it can form the basis of both our potential salvation and our potential undoing.
The Upside of Medical Technology
Advances in health care technology have revolutionized the cost of treating chronic and fatal illnesses over the last hundred years. A century ago the standard treatment for Polio was a iron lung machine. Aside from the cost of the machine itself, there were the 2-4 people required to run it. Were we to apply these costs to a modern disease using our current insurance system, it would quickly bankrupt it.
Luckily a bright guy named Salk did an end run around the problem and invented the Polio vaccine and changed the entire paradigm. The cost today: about two bucks.
Fast forward eighty years and we are have that modern version of Polio: we call it "Diabetes". Care for Diabetes patients consumes about thirty percent of the Medicare budget. We have an opportunity for another spectacular win should some bright scientist come up with a silver bullet for this dreaded condition... or a budget-crushing loss should we fail to get these costs under control -- regardless of how we reform our health care system.
What is at Stake
This example clearly illustrates what is at stake for our costs, our potential to save lives -- and our potential to lose all this if in our current zeal to reform health care we get it wrong.
It is no secret that the profit motive in our health care system has caused it to evolve in a perverse manner: our system has grown to treat illnesses, not cure them, because this is where all of the incentives are. Cui Bono: to whom the profit? Healthy people provide no revenue to health care providers, pharmaceutical companies and medical device manufacturers.
At the same time, there is the basic argument that profiting off of human sickness and disease is simply immoral. Thus, we see there will be tremendous pressure to remove the profit motive from medicine. While this can be done in many areas without adverse effect, in the area of research and innovation it could be disastrous.
Any reforms in profit taking must take into account that future innovations will likely be produce incredible cost savings and life savings. While there are several ideas out there for how to do this, perhaps the strongest one is to simply provide a cash bonus to researchers and device manufacturers based on demonstrated savings. For example, the team that came up with a Diabetes cure could collect a portion of that 30% mentioned above -- and that's a tidy sum.
Perhaps the best method is to simply leave it alone and let them take whatever profits they can. In the end we have bigger fish to fry in terms of cost savings, and there is tremendous danger in whatever reforms we attempt.
The Downsides
The downside to our reliance on technology can be illustrated by comparing our system to Canada. A 2006 study found that the US performed 172.5 CT scans per 1,000 patients, while in Canada the number is less than half this -- 87.3 per 1,000 patients. A CT scan can cost up to $8,000 each. At the same time, Canada performs far better in the overall outcomes. They use far fewer CTs, and yet get better results. One can only come to the conclusion that we in the US perform far more CT scans that are actually necessary... and there is an obvious explanation.
It is no secret that doctors in the US practice defensive medicine, and one of the ways this ends up costing a lot of money is the overuse of CT scans "just to be sure"... or rather "just to be safe from a lawsuit should that upset stomach turn out to be appendicitis -- even though the odds are very long".
In summary, when we cross the average sue-happy American with the sue-shocked doctor, we have a prescription for the over-use of expensive machines... and we all end up paying more for less.
Another important downside is the attitude that results from our amazing technology. Americans love their instant gratification, and health care is no exception. The problem is that for many things we simply don't have any instant gratification in the cupboard, yet we act as if there is. The obesity epidemic is a perfect example. We neglect our most basic health care responsibilities of reasonable diet and exercise and then expect some magic pill or machine to instantly cure us when the inevitable heart attack comes knocking.
In the end, our attitudes are unrealistic, and produce not only more adverse-outcome lawsuits, but an epidemic of Diabetics requiring chronic care... and we all end up paying a lot more for less.
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