Health Care Conundrum: Quality, Cost, Longevity, Goals

Unfortunately no one has tackled the problems Arthur raised in his post above about getting out of socialized medicine. Other things that no one has honestly dealt with are the problems of transitioning into a socialistic system as seen in Europe or as proposed by the Democrats.
This weeks New England Journal of Medicine has this article explicitly attacking private health care. It’s free on line.

“U.S. health care expenditures rose 6.7% in 2006, the government recently reported. According to the Centers for Medicare and Medicaid Services, total health care expenditures exceeded $2.1 trillion or more than $7,000 for every American man, woman, and child. Medicare costs jumped a record 18.7%, driven by the new privatized drug benefit. Total health care spending, now amounting to 16% of the gross domestic product, is projected to reach 20% in just 7 years.

http://content.nejm.org/cgi/content/full/358/6/549

Relentless medical inflation has been attributed to many factors — the aging population, the proliferation of new technologies, poor diet and lack of exercise, the tendency of supply (physicians, hospitals, tests, pharmaceuticals, medical devices, and novel treatments) to generate its own demand, excessive litigation and defensive medicine, and tax-favored insurance coverage.”

It is fairly easy to explain why healthcare costs are accelerating in this country without a proportional superiority in longevity compared to other advanced countries which spend less. We also have bigger cars, houses and closets full of stuff. This is America, for Christ sake. Just don’t forget that longevity is increasing and new modalities often provide significant quality of life benefits and extend life for individuals even if this not reflected in gross mortality statistics nor are they equally distributed among all people.

Let’s look at an example at the micro level, far from the pontifications of public policy experts. Healthcare for individuals advances in ways that are not publicized since this kind of publicity would do nothing to promote the media’s socialist/ sensationalist agenda. Commercial interests which are ceaselessly pilloried by the media develop these advanced technical methods silently, for profit. This does not mean that corporations don’t have higher missions than just money. It is just that, unlike government bureaucracies, businesses can’t survive without eventually generating profits.

For example manufacturers are introducing super accurate methods of measuring a protein that escapes from the heart that increases if you are getting ready to have a heart attack. Scientists are using the same chemical process to measure the protein that fire flies use to glow in the dark, chemo-luminescence. The chemicals are bound to chemically created “Senso Beads” that glow when exposed to minute amounts of troponin, the myocardial protein in question. If the measured protein is inappropriately high this predicts a heart attack. We can already accurately measure this protein when it is grossly elevated and you already have had a heart attack. If doctors repair your coronary arteries before you have a heart attack it could save your life. Thus commercial companies adapt processes used by insects to develop methods of saving human lives. But for the profit motive would any such thing happen? I doubt it.

Critics of the fee for service medicine would homogenize and “rationalize” medical care. If successful it would depend more on public health measures such as coercive life style and state supported therapeutic regimens to ameliorate chronic diseases. Salaried primary care physicians would work at a more relaxed pace, order less tests, and practice less aggressively. For instance VA hospital MDs, so I am told, see about half the number of patients seen in private practice and get paid about as much. Manpower needs would increase not decrease.

If successful in remolding society to preventing deaths we suffer today this public health effort this would only delay deaths from other forms of decrepitude. This would consist of degenerative joint disease, various forms of organ failure that would not have supervened if one had died earlier. For example dementia, loss of senses such as vision and hearing and advanced forms of degenerative bone and joint disease already loom large in the elderly population. Just how much bionics, custodial care and organ supplementation does the government want to provide for oldsters? The sky is the limit without explicit rationing, which would be a political quagmire. Failsafe procedures, check lists devised by the aircraft industry are now available to prevent oldsters from that one in a hundred “mistake” that might be a friend in disguise that would push the fragile ones over the edge.

Sweeping generalizations are easy but lives are lived and end individually. There will be no lessening of the demand for care in the long run. Americans, many of whom are used to Cadillac care at minimal personal cost will make the system very expensive regardless of what is done. Either way your beloved dog has a better chance of a dignified death than you or your grandma does.

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