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We are getting what we pay for in health care

We are getting what we pay for in health care

Last updated on: July 28, 2009 at 5:30 am by Gene Veith

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We are getting what we pay for in health care 2009-07-28T05:30:11-04:00 Gene Veith

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We are spending more than ever on health care. But we are also getting better health care than ever. As has been said, we are spending more on other kinds of technology–entertainment systems, cell phones, computers–than we did a few decades ago, but few people think it’s not worth it. And the progress in health care over just a few years ago, thanks to new technology and new medicines, has been stunning.

Contrary to political rhetoric, that health care is so expensive is not primarily due to waste and inefficiency, which, though it exists, is quite minor; rather, most of the expense is due to sophisticated high-tech treatments that work dramatically well. The question is, can such medical progress be sustained through the new universal health care plan? Consider the information in this Washington Post article, As Health-Care Quality Rises, So Does Price:

The fight against heart disease has been slow and incremental. It’s also been extremely expensive and wildly successful.

In the 1960s, the chance of dying in the days immediately after a heart attack was 30 to 40 percent. In 1975, it was 27 percent. In 1984, it was 19 percent. In 1994, it was about 10 percent. Today, it’s about 6 percent.

Over the same period, the charges for treating a heart attack marched steadily upward, from about $5,700 in 1977 to $54,400 in 2007 (without adjusting for inflation).

The treatment of coronary heart disease — of which heart attack, or acute myocardial infarction, is the most significant component — this year will cost about $93 billion. It’s a huge contributor to the $2.3 trillion annual bill for medical care in the United States. Cardiovascular disease is responsible for 35 percent of deaths in America and has been the leading cause of death every year since 1900, except 1918, the year of the Spanish flu epidemic.

The evolution of heart attack treatment over the past three decades is a story of doing more things to more people at greater expense with better results. It is a portrait in miniature of medicine in the United States.

Although inappropriate care, high administrative costs, inflated prices and fraud all add to the country’s gigantic medical bill, the biggest driver of the upward curve of health spending has been the discovery of new and better things to do when someone gets sick.

“Money matters in health care as it does in few other industries,” wrote Harvard University health economist David Cutler in 2004. “Where we have spent a lot, we have received a lot in return.”

Beyond heart attack treatment, similar stories can be told about cancer, premature birth, arthritis, HIV infection, mental illness and innumerable other common conditions. The trend in all of them toward more intensive, expensive and better treatment is not likely to change with health-care reform, however constituted.

A universal health care system worth having would give everyone access to such care. But that would cost a lot of money. Instead, advocates of the proposed changes are talking about using a universal health care system as a way to decrease costs. But wouldn’t that, by definition, prevent people from getting access to this level of care? And if doctors, hospitals, drug companies, and technicians are not allowed to charge what it takes for the new treatments, won’t this shut down medical progress at the very time it is taking off? Any suggestions?

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