You start coming out from under the deep anesthesia. First your eyes start to open. They work. Then you haphazardly try to move an arm, your head, and your lips to speak. And none of that works at all.
You’re strapped in and breathing through a machine and taped up 32 ways against Tuesday. So you go back to your eyes, which work. Mounted over the foot of the bed is a clock. Those big, easy-to-read hospital clocks. You’re a little dopey, but you slowly realize it says three minutes to six. The last time you were conscious, you think, was about 8:45 in the morning.
Now you’re not dopey; you’re stunned and scared and reflexively lurch to get up. But all the medical machinery holding you down keeps you down.
And for some reason there is no pain at all, even though you are already suspecting you’ve been filleted like a flounder.
On the very day that Steve Jobs died a new report suggests that the U.S. health care system is spending too much money on people near the end of their lives. The timing of the two events could not have been more ironic.
Had Jobs been under the care of the British National Health Service (NHS) or the Canadian Medicare system, he almost certainly would have died two years earlier. That would have been a major loss for the world, by anyone’s reckoning.
Here’s the back story. In 2004 Steve Jobs was diagnosed with pancreatic cancer. He reportedly underwent successful surgery. Then, in 2009 he received a liver transplant. He died on Wednesday.
I haven’t seen Jobs’ medical records and I have made no real attempt to get the details about his medical condition. But for the point I want to make here, none of that really matters. Jobs’ case is interesting because of the issues it raises.
In most places in the world today a diagnosis of pancreatic cancer would be considered a death sentence. Aggressive treatment of the condition would be considered a poor use of medical resources — one involving considerable expense in return for only a few extra months of life. Perhaps Jobs’ cancer was of a rare variety that could be removed by surgery.
Dr. Scott Gottlieb, a resident fellow at the conservative American Enterprise Institute, published an op-ed in the Wall Street Journal last week that returned to the much-exploited story of Nataline Sarkisyan, the 17-year-old Californian who died before receiving a liver transplant. Gottlieb used the story to make the argument that “the U.S. has the best health care in the world.”
Gottlieb is squaring off against John Edwards, who has been suggesting that if Nataline had lived in a European country she might have lived. Edwards blames CIGNA, her for-profit insurer, for refusing to cover the procedure. Dr. Gottlieb, who is a former FDA official, responds with a double-barreled argument: “Americans are more likely than Europeans to get an organ transplant, and more likely to survive it too.” He sounds confident, and at first glance, his argument seems persuasive.
But a closer look reveals that Gottlieb makes his case by carefully culling the numbers that fit his argument, while omitting those that don’t. Unfortunately, too many people involved in the healthcare debate play fast and loose with the facts. Everyone interested in reform should be on the look-out for those who don’t cite solid evidence for their assertions. If they don’t give you their source, it may be because they don’t want you to look it up—and because they realize that they are cherry-picking the numbers.
Before engaging Gottlieb’s argument, I should acknowledge that, as I have said in an earlier post, I think Edwards has picked a bad case to make his argument for healthcare reform. I am not at all certain that the transplant would have helped this particular patient. And while Edwards puts all of the blame on CIGNA, Nataline’s insurer, I am bothered by the fact that the hospital asked for a $75,000 down payment on the surgery and then refused to go forward without it. As one physician/blogger from the very same hospital where Nataline was treated asked: “Why didn’t the hospital simply perform the surgery and defer payment from the family or CIGNA [Nataline’s insurer] until later? If it was such a great idea, why didn’t they exhibit the outrage and strength of conviction to go ahead regardless of CIGNA’s assessment?”Continue reading…