POLICY/THE INDUSTRY/QUALITY: Why health care costs so much, reason #498

Two angioplasty procedures on a 93 year old in one week.

Former President Ford underwent his second heart procedure in a week at the Mayo Clinic when stents were placed into two of his coronary arteries to increase blood flow, his spokeswoman said Friday. The angioplasty procedure on the 93-year-old Ford was successful and he was resting comfortably in his room at the hospital in Rochester, spokeswoman Penny Circle said in a statement.

Oh, and this was at Mayo, the bastion of low cost conservative medicine. So if you’re keeping score using the Dartmouth stats that means that if he’d have gone to New York University Hospital, he’d have had EIGHT procedures this week!

10 replies »

  1. re: “Real numbers” – you make my point exactly, Matthew. With wild, exorbitant “discounts” such that almost no one pays actual charges, the true “cost” of any given health care service isn’t necessarily known (hence my less-than-perfect use of the word ‘apparent’), and institutions who have done the calculations are unlikely to publish them. All we really know is $50,000 discounts skew reality, and health insurance premiums keep rising, of which a good portion goes to overhead, not care. Which leads to unaffordability . . .
    Peter’s Aug. 30 comment above about aligning costs and prices & limiting discounts warrants serious consideration and leads to thoughtful and productive debate. And yes, Peter, the 46.6 million uninsured, the use of full chargemaster prices to charge those without health insurance, and medical-related bankruptcies are indeed shameful situations in this country. Did you submit your stories/recommendations to the Citizens’ Health Care Working Group? (See links at http://www.consumerhealthratings.com as necessary)
    PS – some hospitals have moved away from charging the uninsured “full” undiscounted prices.

  2. “is it worth it spending tens of thousands of dollars keeping him live a little longer?”
    Well, I suppose Ford prefers to keep live a little longer, so he might well answer “yes”.
    But, maybe, do ya think he actually has a duty to die now, and save the rest of us some money? What is the annual Medicare tab again? Mightn’t all that money be better spent to pay 100% of the cost of routine health care services for the young & healthy, rather than paying for the expensive care of people who are all going to die soon anyway?

  3. Barry–I dont know the specifics but at least the UK has got a body (NICE) which actually does look at the QALY scores for interventions and decrees which ones are worth it or not.
    The hard question is, given that Ford is 93 and even if he is healthy will likely die within 2-5 years anyway, is it worth it spending tens of thousands of dollars keeping him live a little longer? It’s the same question as the one you posed regarding cancer patients, those with dementia, etc.
    It may well be that the answer for Ford is that he is worth the money! For those others, they may not be. But the problem is that we cannot as a society ask the damn question!

  4. Matthew,
    Would cardiac stents be made available at taxpayer expense to a 93 year old in Canada, UK, Western Europe, Japan, or Australia?
    In President Ford’s case, if he is otherwise reasonably healthy for his age, he might be able to pass UK’s QALY metric. I actually have less of a problem with this then providing ultra expensive drug treatments to Stage-4 cancer patients or expensive surgery to elderly dementia and alzheimers patients or kidney dialysis to those who have lost much of their cognitive ability.
    We need to focus on reducing utilization, especially with respect to these end of life situations and bring our practices into closer alignment with those in the other developed countries, in my opinion.

  5. Posted by: Gretchen Dahlen | Aug 29, 2006 9:20:07 AM
    “…apparent high cost of health care.”
    Does that comment align with the “apparent” number of people who can’t afford insurance, or the “apparent” number declaring bankruptcy for medical bils, or the “apparent” practice of hospitals using the “Charge Master” rates for the uninsured?
    “What would happen if Medicare was limited to the amount of discounts it was able to take, and there was closer alignment among prices, costs and payments by all payers?”
    Sounds like universal healthcare to me.

  6. Gretchen–no one pays charges. Come back with some real numbers!
    The real question is why all private plans dont just pay at the Medicare rate. If I was a private insurer I’d be pushing for that, and ammassing as much market power as I could to do so.

  7. Medicare Cost-shifting contributes “nicely” to the apparent high cost of health care. FY 2005 Angioplasty with drug coated stent (DRG 527) shows national average charges of $43,096, but Medicare payments averaging just $14,047 (meaning 67% of charges are shifted to other payers). Pacemaker implant (DRG 116) also shifts 2/3 of its average $42,462 charges. Heart bypass surgery (DRG 109) reports over $51,000 per case on $75,536 average Medicare charges goes UNPAID. What would happen if Medicare was limited to the amount of discounts it was able to take, and there was closer alignment among prices, costs and payments by all payers? Medicare report linked at http://www.consumerhealthratings.com under General Costs of Medical Care (in Cost/Prices category)