Wednesday, June 01, 2005

Cost and Prevention

It is not uncommon to hear public figures talks about prevention as a means of reducing health care costs. Some readers will have seen Larry Mathis’ Letter to the Editor on that subject as recently published in Modern Healthcare. The unedited version is below. Larry is the retired CEO of Methodist Health Care System in Houston and a former Chairman of the American Hospital Association.

I have just returned to my home following the American Hospital Association’s annual Washington meeting, where I listened in amazement to our lawmakers and regulators speak about health care costs. One talked about how preventive care and innovative treatments would lower costs; another opined that the new Medicare prescription drug program would lead to lower medical care costs because the drugs would prevent more serious, more costly illnesses.

Are our national leaders hopelessly naïve or, incredibly, do they believe what they are saying?

Health care costs in this country will continue to rise and preventive care and better treatments will be major causes of that rise.

I am a prime example. When I was 44 years old, I suffered a heart attack. I was given tpA, a then experimental clot dissolver, and angioplasty. The treatment worked and, after a two-night hospital stay, I returned to work two days later. This successful treatment was much more effective and less costly than earlier alternatives: serious heart damage, long hospital stays, and a slow recovery and return to work. New technology saved me. It saved me to live on through four subsequent catheterizations, three angioplasties, two stents, and numerous other less serious medical and surgical treatments for a variety of ailments. I’m 61 now, in pretty good health, and I’m looking forward to other successful medical treatments to keep me alive and to lower my golf handicap.

Had I died at age 44 from my first heart attack, I would have spared the health care system the enormous expense of all my subsequent treatments.

The medical establishment cured the infectious diseases that took the young lives of so many: yellow fever, typhoid, typhus, small pox, diphtheria, whooping cough, and etcetera. Those who would have died from those diseases were spared to live on into middle age to develop heart disease. Our physicians and hospitals have made remarkable, but costly, strides in combating that killer, sparing many to live on to develop cancer. Now many cancers can be effectively, but expensively, treated or cured, thus sparing many to live on to develop Alzheimer’s disease at great continuing expense to our health care system.

From a macro-economic perspective, it is cheaper for the system when the patient dies of typhoid at age 19 than to live to be expensively (and successfully) treated for heart disease, cancer, stroke, and Alzheimer’s. Our very success is the enemy of cost reduction.

All of the buzzwords – prevention, early detection, screening, chronic case management – are nothing more than prescriptions for increasing the overall cost of health care in this country. If they save lives, it will cost more.

Based upon what I heard in Washington this week, our lawmakers and regulators seem to believe there is some magic bullet for controlling long-term health care costs. There isn’t. Unless, of course, our government has found a way to insure that we live pristine lives, devoid of smoking, violence, drinking, and risky sexual behaviors, and can provide a magic elixir that will prevent chronic diseases like heart disease, cancer, Alzheimer’s, and stroke and allow us to die peacefully and cheaply at home in our own beds at age 100.

As long as our population grows, as long as our population ages, as long as our hospitals and doctors find new ways to prevent and treat disease and injury, as long as we prize medical innovation and treatment, and as long as someone other than the patient pays for the bulk of it, health care costs will continue their inexorable rise.

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