Recently this question of great magnitude was posed to me, and being neither up to date with current political perspectives nor well informed on the subject (a state I will remedy in the near future), I was at a loss for a response. Being a medical student only affords one with a minimal microscopic perspective on the issue, and asking me for my opinion on the subject is akin to asking a lowly foot soldier his thoughts on how to end the war in Iraq. After much contemplation, I decided to take a step back and tackle the problem from a more theoretical and philosophical approach. What follows may seem like the rantings and ravings of an uninformed man who loves to hear himself talk, and while that may not be too far from the truth, I maintain there is yet some shard of relevance and truth in the verbal diarrhea to come.
The biggest problem facing healthcare is its rising cost. Now, that may not seem like a very insightful or profound statement, so let us try and break it down into smaller, more palatable chocolate chip pieces. And for the record, when I use the word “cost,” I am referring to all of healthcare as an overarching entity, including private insurance organizations, government programs and assistance, individual out of pocket expenses, and any monetary expenditure related to medical care. We can go on a liberal tirade about the black-hearted HMO’s and their passion for high profit margins and baby seal clubbings, but that would not be completely relevant to the discussion, as private insurance company profits are not at the core of the rising costs problem.
At a superficial glance, it is obvious that there is a lot of money and resources simply falling through the cracks, not reaching the consumer (the consumer in this case is the sick patient seeking medical care.) These dollars are being drained by inefficiencies in our lumbering dinosaur of a medical system, inefficiencies like unnecessary middlemen, poor communication, overlapping services provided, imbalance in regional supply vs. demand, and so forth. Thus there is significant room for streamlining and maximizing efficiency to help cut a moderate percentage of current healthcare costs. However, I believe there is a greater more fundamental problem, one that the short term bandage solution of maximizing efficiency will not be able to cure, a plague that claims the majority of responsibility for our rising costs. Who is this evil mastermind?
In no other aspect of life do we as Americans have an innate expectation for deserving “the best.” If you made $50k per year and demanded to drive a Ferrari, people would think you were insane. If you made that much money and demanded to live in a mansion with a 100ft yacht, people would know you were insane. Yet if you made that much money and one day got cancer, you would expect to be guaranteed the best available healthcare. We as Americans feel obligated, and perhaps rightfully so (an ethical debate reserved for another day), to the best healthcare regardless of the cost. And therein is the dichotomy - only in healthcare do we expect and receive the best. If an MRI shows even a marginal advantage over traditional Xrays for confirming a diagnosis, the patient will receive the costly MRI. If surgery is the indicated treatment for a disease never will the patient only be given medications and sent home. If the man earning $50k per year requires procedures and hospital stays costing over $200k, he will receive the necessary care. We find it so ethically and politically incorrect to set financial limitations when providing for the sick, and yet as a society we have a finite financial capacity. But it gets worse.
To compound the issue, technology will only serve to drive costs even higher. Healthcare cost was not an issue back in the days when leeches and holy water were mainstays of therapy. When MRI machines were not available, people did not have that high cost alternative as a management option. As technology advances further, the “standard of care” will continue to rise because we are all, afterall, deserving of the very best care. If in the future reliable artificial organs were invented and everyone currently on an organ transplant waiting list could be fitted with new livers and kidneys, can you begin to imagine the spike in associated healthcare costs?
To make matters worse, the United States is even more susceptible to rises in healthcare costs because we are at the forefront in medical technological advances. Not only do we deserve the best, but we must also be the best. The Da Vinci Surgical System, which costs $1.5 to $2 million per unit for hardware and installation alone, was invented here in the US in 1999. We were the first to implement and utilize this expensive new technology, and by extension incur the associated high costs. A large number of major hospitals across the country own one of these systems now, showing its pervasive (and expensive) penetration into our medical system. In comparison, there are exactly three Da Vinci Systems in all of Taiwan, and I would wager probably not many more than that in all of Africa. As you can see, it’s an expensive endeavor to stay ahead of the curve.
Unlike Alanis Morissette’s misuse of the word “ironic,” there is some real irony in the rising cost of healthcare. As medical technologies improve, people will survive once fatal diseases and live longer. Americans will have more time to subject their bodies to unhealthy practices like smoking, drinking, drugs, and chocolate chip cookies. Longer life expectancies without healthier lifestyles will naturally result in more medical care. When people used to die at the average age of 35, healthcare costs were not an issue. Now that people are living well into their 80’s and 90’s, we are beginning to see more and more expensive acute and chronic diseases emerge in our elderly population. It’s like microphone feedback static, the cycle keeps magnifying itself indefinitely, until you blow out a speaker. Isn’t it ironic, don’t you think, that the more diseases we cure the worse our economic burdens become.
So we are guaranteed the best, the best continues to get better, and we continue to require more of the best. Yet we as a society are not able to increase our overall productivity to compensate for this increased expenditure. The elderly population that we have managed to keep alive, while bountiful in elderly wisdom and delicious home-baked chocolate chip cookies, are not capable of maintaining a minimal level of productivity for society. If we as a country are limited to a certain percentage growth in GDP every year, and medical costs in the country continues to grow at twice the rate (these are hypothetical values) then naturally there will be a growing deficit. Even if we manage to maximize the efficiency in the system, eventually down the line, unless some unforeseen increase in economic productivity occurs, we will run out of money. We as a society will no longer be able to sustain our demands for the very best.
I am in no way suggesting some sort of senior citizen genocide, nor am I suggesting we shift to a completely capitalistic system of healthcare (ie: the Asian grocery store system – you touch you buy! Cash only!) I am simply pointing out a trend, albeit from a somewhat conservative perspective. Yet part of me knows the dangers of focusing solely on economic concerns, since reality and ideality are in such conflict when human lives are at stake. Watching patients wither away in the hospital, you can’t help but forget "all about the Benjamins" and focus solely on improving their health by whatever means necessary. In the operating room, you don’t see a homeless man with no money addicted to cocaine and alcohol, you see multiple fractures and a ruptured spleen in a human being who got hit by a bus. So perhaps the biggest problem facing American healthcare is also the biggest strength of our healthcare, because at the end of the day, we still care enough to give and be given the best.
