OP-ED

Osama and the Cost of Health Care

In the near-decade since the Sept. 11, 2001, terror attacks, the “War on Terror” has cost the United States about $1.3 trillion, according to the National Center on Defense Information.

By comparison, it took just six months for the U.S. to spend that much money on health care, based on the $2.5 trillion spent in 2009.

Why does that comparison matter? Because as health care costs rise, they have begun to crowd out the money available in state and federal budgets for elementary and secondary education, infrastructure and other pressing human needs. The War on Terror isn’t going away and, in fact, may increase in intensity in the short term if fears of Al Qaeda retaliation prove true, so we won’t be de-funding the military to provide to get money to shore up crumbling bridges, roads and schools.

A 2009 report from the Office of Management and Budget put it plainly: “The Federal Government’s long-term fiscal shortfall is driven primarily by escalating health care costs…These growth rates are simply unsustainable and are why slowing the growth in health care costs is the single most important step we can take to put the Nation on firm fiscal footing.”

David Walker, the former U.S. Comptroller General turned crusader for fiscal responsibility, has said repeatedly, “If there’s one thing that could bankrupt American, it’s health care costs.”

Perhaps some of the patriotic unity inspired by the successful operation to kill Osama bin Laden can carry over to the efforts to responsibly control health care costs and preserve what makes America great. Not very likely – but, hey, one can always dream.

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Categories: OP-ED, THCB

34 replies »

  1. I won’t go to the trouble of refuting all of your anecdotal “evidence”

    So when liberals kill our grandparents we shouldn’t be sad becuase its not really grandma and grandpa they are just anecdotal evidence.

    Curious are murder victims just anecdotal? Any crime victim for that matter, they don’t represent every person so you seem to be saying they don’t matter.

  2. Nate,
    You are full of FUD as usual. I won’t go to the trouble of refuting all of your anecdotal “evidence” but there is one fact that is verifiable. The survival rate for babies less than 22 weeks is zero. The UK policy of not putting parents through the false hope of NICU prior to 22 weeks is perfectly reasonable. In the US, of course, hospitals are happy to run up a $100,000 bill on a less than 22 week infant before they inevitably die. Profit before patients.
    Same with terminal cancer patients. The US is happy to bill patients $100,000 for ineffective cancer treatment, putting them through untold agony before they inevitably die.

  3. @Margalit

    The number of docs at a particular facility really doesn’t matter. What matters is having a system to disseminate better ways of doing things to all individual practitioners, so we can adopt them quickly. On the other side of the coin, we need a system that can take responsibility when something goes wrong from these new ways of doing things, so that individual practitioners are not left hanging when the system makes a mistake.

    Just as this system could speed along improvements in care and quality, it could impose levels of rationing heretofore not seen in this country. This way, save money, time, resources and suffering. We all win.

  4. AN 80-year-old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened. Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

    Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

  5. A grandfather who beat cancer was wrongly told the disease had returned and left to die at a hospice which pioneered a controversial ‘death pathway’. Doctors said there was nothing more they could do for 76-year-old Jack Jones, and his family claim he was denied food, water and medication except painkillers. He died within two weeks. But tests after his death found that his cancer had not come back, and he was in fact suffering from pneumonia brought on by a chest infection. To his family’s horror, they were told he could have recovered if he’d been given the correct treatment.

  6. “on the babies… babies don’t survive when less than 22 weeks… anywhere… You will spend tens of thousands on a neonatal ICU and still end up with a dead baby.”

    Wow Mark, you really just don’t have a clue do you. Where do you get your information that you can be this badly informed, whats worse is you actually claim to be looking for info and are still this far off.

    Odds of a Premature Baby’s Survival by Length of Pregnancy
    Length of Pregnancy Likelihood of Survival
    23 weeks 17%
    24 weeks 39%

    ” they are not killing grandma or babies and not withholding necessary care. ”

    Yes Mark they are. I’ll give you names of specific individuals;

    Rosemary Munkenbeck says her father Eric Troake, who entered hospital after suffering a stroke, had fluid and drugs withdrawn and she claims doctors wanted to put him on morphine until he passed away under a scheme for dying patients called the Liverpool Care Pathway (LCP).

    Mrs Munkenbeck, 56, from Bracknell, said her father, who previously said he wanted to live until he was 100, has now said he wants to die after being deprived of fluids for five days.

    Liberal Democrat MP for Bristol West, Stephen Williams has condemned the announcement by the National Institute for Health and Clinical Excellence (NICE) that it will not approve access to Alzheimer’s drugs for those suffering from mild or early stages of the disease.

  7. We have been over this before. This is all alarmist distortion. When you dig down into the actual facts of these stories, they are not killing grandma or babies and not withholding necessary care. They do refuse to pay for unnecessary care.
    For example, on the babies… babies don’t survive when less than 22 weeks… anywhere… You will spend tens of thousands on a neonatal ICU and still end up with a dead baby. And babies born before 24 weeks rarely survive anywhere.
    Expensive drugs that give a few months of survival for terminally ill patients are a waste of money (at any price). I just had a few friends who went through very expensive terminal cancer treatment. They may have lived a few months longer but their lives were not worth living… they literally wished they were dead. Please don’t do this to me.

  8. “So.. What NHS rationing?”

    Expensive Cancer Drugs

    http://www.telegraph.co.uk/health/healthnews/8459107/Kidney-cancer-drug-too-costly-despite-manufacturers-discount.html

    Britain’s drug rationing body agreed that advanced kidney cancer patients would experience an “overall survival gain” of “more than three months” if they took everolimus.

    The pharmaceutical firm that makes the drug, Novartis, had also suggested a lower price than the previously proposed £2,822 a pack, equivalent to £34,235 a year.

    But in final guidance published on Tuesday the drug rationing body, the National Institute for Health and Clinical Excellence (Nice), insisted that it could not recommend the medicine as it “does not provide enough benefit to patients to justify its high cost, despite the discount offered by the manufacturer”.

    Premature babies

    http://www.dailymail.co.uk/news/article-1211950/Premature-baby-left-die-doctors-mother-gives-birth-just-days-22-week-care-limit.html

    Doctors left a premature baby to die because he was born two days too early, his devastated mother claimed yesterday.
    Sarah Capewell begged them to save her tiny son, who was born just 21 weeks and five days into her pregnancy – almost four months early.
    They ignored her pleas and allegedly told her they were following national guidelines that babies born before 22 weeks should not be given medical treatment.

    Senior Care

    http://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html

    “Sentenced to death on the NHS
    Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors have warned.

    Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor Photo: GETTY IMAGES By Kate Devlin, Medical Correspondent 10:00PM BST 02 Sep 2009
    448 Comments
    In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

    Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

    But this approach can also mask the signs that their condition is improving, the experts warn.

    As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others.

    I’m very interested how your investigation didn’t come across any of these. Just these three items alone would save the US 10s of billions a year. They would never be accepted here though, acts like the above get insurance companies sued and huge jury awards against them.

    Look forward to your responce.

  9. “but not in solo/small practices”

    Well, that writes off all of Western Europe, Japan, and Australia.

  10. “Primary care is a big part of the answer, but not in solo/small practices.”

    Are there any measured examples where costs and quality (both) have been positively affected by larger systems?

  11. Dr. Vickstrom – please get off the victim train – I am not a doc hater. And I’m sorry if you construed any of my comments to mean that I want you to lower your prices. Your prices are not the problem. The first part of your comment is the problem – our “atomized” fragmented system. That is in fact the focus of my beef with physicians and hospitals – who have resisted most efforts to build systems and structures that promote coordination of care and that can leverage scale and capital to deliver better care. Primary care is a big part of the answer, but not in solo/small practices.

  12. I don’t think this problem is limited to the working poor, unless the term poor is widely applied now to include most of the middle class. I do support a universal payment system, but I prefer the delivery system to remain atomized, since any aggregation into large molecules seems to be associated with increased costs, increased greed, over utilization and increased negotiation power, which lead to increased prices.
    If we were able to reduce what we pay to large health systems, drug and device manufacturers and other profiteering factors, perhaps there will be enough money to subsidize the poor.

  13. Nate, I don’t understand your point.
    The NHS covers all of these preventive services and has unlimited lifetime maximum. I hear a lot of whinging about NHS rationing and wait times but every time I investigate, there is nothing substantial.
    So.. What NHS rationing?

  14. Folks, this is not an either/or proposition. We have to spend less and we have to do better with what we’ve got. But there is no nation-wide system to this. It’s all atomized. This is the problem. What is this “American heath-care system” of which you speak?

    As for the rationing of developing countries not returning here, I take issue with that. Many of my patients don’t get anything at all, because they can’t afford to even come in to see me. And before the doc-haters on this board dare me to lower my prices, I can’t. I’m a county employee. The government sets my fees. And there are little in the way of subsidies for the working poor, you REALLY have the short end of the stick in our society.

  15. When politicians say long list of preventive services must be covered at 100%, plans must have unlimited lifetime max’s and come up with the dumpest appeal law imaginable why wouldn’t we expect cost to increase faster then inflation?

    If I could ration care like the NHS does I could match their cost, its illegal here though.

  16. Have you read Starr’s book? He goes into detail how the medical profession avoided industrialization.

    Steve

  17. There is cost and there is volume. Both are too high here. You should judiciously cut volume (ration), but you should also selectively reduce costs. The third world mentality of who gets care, although sensible, is not very likely to make a comeback in developed countries. And neither is the cost of providing care in Ghana something that will be accepted here. We went to town with expectations of how much care we should have and how much we should be paid for providing care. Both need to climb off the high tree.
    And to pcp’s point, this would be much easier accomplished if we weren’t hellbent on industrializing primary care, and all health care in general. On the other hand, perhaps industrialized health care will do for costs and availability what industrializing the making of shoes did for footwear.

  18. They also have a strong, healthy network of primary care docs, largely in small, independent practices We’re working as fast as we can to destroy primary care in this country.

  19. ‘ the fundamental fact that no one in the current “system” is the least bit interested in doing things differently or in any way recieving less of the $2.3T than they do today’

    But when the docs here bring up rational rationing – which is doing things differently, results in better care with fewer complications, and reduces the $2.3T – you attack them. I don’t get it.

  20. I agree that we need to focus on costs. So far, the debate has been limited to Medicare. Even there, the efforts were not enough and the current Congress is trying to overturn them. Plus, I remain skeptical that we can really affect costs w/o also addressing the private sector. As OOP costs rise and the percentage of plans with deductibles and co-pays rise, medical costs continue to advance faster than general inflation.

    Other OECD countries show us that it is possible to have quality care with lower costs. Of note, those countries also have universal care.

    Steve

  21. Perhaps Dr. Vickstrom, (and I will assume that you are in fact a physician, just as you assume I am a lay person with no knowledge of healthcare) you are in fact very engaged in working to make care better. Perhaps I lumped you in with the other physicians I have been associated with over the course of many years of working in healthcare. Perhaps my fuse is too short on this subject. But when it comes right down to it I am a patient. And I have a right to be mad too. And yes “Fail” is the grade I would give physicians (as a group) as well as hospital administrators over the last many years in terms of actually working to make health care better. Which is not to say that there are not many many excellent physicians (and administrators) who are working very hard every day. Just not enough and not by way of leadership of fundamental systemic changes.

    Michael highlighted the cost of care – you and particularly doctor mad highlighted the role of rationing, eliminating services, and reducing patient expectations as an initial response. That’s all I responded to. I’m sure you are an excellent and hard working physician for your patients when they come to see you with reasonable expectations.

  22. @TWA

    I think you are purposefully trying to misunderstand me. The fact is, we already ration. It doesn’t work. If we are going to change it, we need to change expectations first.

    As for the dilettantes who claim we physicians do not care about better care, that is simply hogwash. We are always working towards doing it better. We do so with our eyes on never doing it worse. So change takes place slowly. I’m sorry that medical care doesn’t work like a a one hour episode of ER.

    This shows the fundamental fact that people trying to change the current system have little comprehension of it. The fact that people who complain about “lack of accountability” have no accountability themselves. Particularly when they post from a pseudonym. Fail.

  23. Michael – I think what this shows is the fundamental fact that no one in the current “system” is the least bit interested in doing things differently or in any way recieving less of the $2.3T than they do today – particularly physicians and hospitals. Anytime a conversation includes the phrase “if patients would only…” its a recipe for status quo and a lack of accountability. At this point in time, we either give the ACA a chance, or we give up and let the health care system drag us down into 2nd world status.

  24. So rather than focus on providing better care (which would as a matter of fact COST LESS) you would rather just ration? And this from physicians?

  25. Rationing. Let’s be honest, we already ration. We ration by personal wealth and age, mostly. It is not working. We need to find a new, more effective way of rationing. I think the first step would be to concede that we are not immortal, and that spending resources proving negatives is a waste.

    The most effective and efficient health care rationing I have ever been a part of was in rural Ghana, with snake antivenin. There was never enough to go around. So, the young women with children got it first, followed by the young men with children. Then the middle-aged adults in their 30’s and maybe 40’s; then the teens. Last were the small children (you can always make more) and the old (their time is up anyway).

    Bizarre as this may seem to greedy, entitled Americans, it worked. This was what people expected. There was very little drama, as everyone knew the rules and this was what they expected. I point this out because I think the first problem we have with health care costs is one of inflated expectations. No rationing scheme will work if people do not expect it and buy into it.

  26. Cap the amount available per year.

    Make some priorities over what will no longer be covered like new dialysis over 75 and new feeding tubes for nursing home patients for starters. Throw in now disability for cocaine addicts and no dialysis for them either. Stop funding all drug treatment since it does not work.

    Once you get started it gets easy to cut things.

    Stop paying for statin drugs if you are over 70. People can buy them on their own; since the demand will be lower the price should go down.

    And stop paying for scooters.

    Anyone else want to add to the list?

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