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A Quick Shot of Healthcare, Part 1 – When Progress Hurts

By Brian | August 10, 2009 | Share on Facebook

I’ve been watching the current healthcare debate with great interest, and have a lot of opinions on various aspects of the matter, but can’t seem to consolidate them all into a single blog post. Instead, I’m queuing up a list of “quick shots” – thoughts on particular aspects of the debate – which I hope will spur some discussion

Remember, when Barack Obama first took office, how he vastly expanded federal spending for stem cell research? As he did, he spoke inspirationally about the potential benefits from this kind of research – possible treatments or cures to everything from Alzheimer’s Disease to heart disease to neural/muscular disorders. There was even some talk about growing replacement organs in patients where the originals were failing.

Now that we’re talking about healthcare reform and ways to keep healthcare costs under control, it occurs to me – what happens if this stem cell research succeeds? To be sure, medical breakthroughs can sometimes reduce overall costs. I don’t know what the polio vaccine costs per patient, for instance, but I’m guessing it’s cheaper than the series of wheelchairs, braces, and physical therapy sessions that once guided a polio patient through many painful years until the disease overtook them.

But then there are diseases like cancer. Certain types of cancer used to be death sentences – if you contracted them, your life expectancy could be no more than a few months. Today, while there are still no cures, there are surgeries, preventative drugs and monitoring techniques that can remove the cancer, minimize the risk of recurrence, and catch it if it does come back early enough to effectively treat it again. Lacking the actual data, I can only imagine that the total cost of these treatments far outweighs the costs we used to pay for end-of-life care for these cancer patients.

So what of stem-cell research? Surely we’re all rooting for the kind of success that the President and others have boldly predicted. But what if the resulting therapies, drug treatments, or surgeries far outweigh the costs of treating these diseases today? And even if not, we should consider that people who don’t die from heart disease, ALS, or the like will live long enough to die of something else. So even if the cost of treatments were a wash, overall health care costs would still go up.

My point is this: the President’s recent claims that health care reform will be cost neutral seem like disturbingly short-term thinking. His own initiatives seem to be (rightly) shooting for new, innovative treatments that will likely increase the cost of healthcare, along with the benefits it provides.

It seems to me that our true goal isn’t cost control at all, but rather the reduction or elimination of inefficiency and fraud, so that we provide the highest possible benefit at the lowest possible cost. As the benefits increase (through technological advancement, for example) costs should go up, just not excessively.

I don’t hear anyone talking about this concept these days…

Topics: Political Rantings | 2 Comments »

2 Responses to “A Quick Shot of Healthcare, Part 1 – When Progress Hurts”

  1. Jeff Porten says at August 10th, 2009 at 10:56 pm :
    It seems to me that our true goal isn’t cost control at all, but rather the reduction or elimination of inefficiency and fraud

    Well, here’s the essential problem. If you state the issues in terms of cost and financing, then you come up with conclusions which are inimical to health issues. I’d argue that the problem is that we’re spending too much time on the former, and not nearly enough on the latter.

    If your goal is perfect efficiency, there’s an existing model: Logan’s Run. Boom, no gerontological or end-of-life care, and your public system only mostly has to handle accidents and prenatal care. (Can’t remember if Logan’s society had regular babies, or decanted them.)

    On the premise that both of us have had some societal value since 1999….

    One way to square this circle is to pay attention to cost-increasing dynamics generated by the free market system. Let’s say you’re a pharmaceutical company: what’s your preference, to come up with a drug which treats a chronic, incurable symptom, or a drug which cures the underlying disease? Answer is likely to be the former unless you can get away with charging the lifetime cost of the treatment drug in one fell swoop for the cure.

    My guess is that 99.9% of the researchers and doctors in the industry are assiduously seeking cures in preference to treatment, but they’re going to go where the research money is.

    Stem cell research falls mainly in the latter category; presumably, if you can monkey with faulty genetics, you can both cure disease, and prevent it permanently before it occurs. It also raises interesting possibilities in terms of susceptibility: right now, I know that I’ve got a 1/3 chance of premature death from smoking. If there was some way to know, now or back in 1991 when I started, that I was definitely the one in three, I’d have probably picked something safer, like heroin. (Likewise, tell me that I’m in the other two, and both me and Philip Morris will be happy campers.)

    Seems to me, the happiest outcome of both health and costs is a society which promotes perfect health, long lifespans, and dropping dead quickly afterwards. You tell me — do you think we’ve built a society which promotes these goals? Seems to me that we spend a lot more on getting people sick.

  2. Brian says at August 11th, 2009 at 11:22 am :
    I’m fairly certain that there’s plenty of money in curing cancer, just as there’s plenty of money in treating it. Furthermore, I’m not sure the line is as bright as you’re implying that it is. Stem cell research, for instance, could just as easily provide treatment that keep a disease at bay rather than eliminate it…

    But my point is not what we spend the money on. My point is that, under certain circumstances, an increase in the cost of health care is a good thing, that is, when an increase in the benefits accompany it. Or, to use your words, “a society which promotes perfect health, long lifespans, and dropping dead quickly afterwards,” except that perfect health gets more perfect, and long lifespans get longer as time and technology marches on.

    What do you think will happen if such advances (in both care and costs) happen while the federal government is responsible for some percetage of the cost? Will we raise taxes? Increase deficits? Call the pharaceutical companies “greedy and incompetent” for making profits while the government is struggling to balance the budget? None of the above would be unprecedented with this administration…

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