Can't we just call a duck a duck?
Have you ever wished that politicians could just honestly present realities? Two recent examples come to mind in which politicians say that our society can achieve mutually exclusive goals.
The first is the attempt to become more environmentally responsible while trying to stimulate the economy. Basically, consumerism involves the consumption of natural resources. The extraction and sale of these natural resources creates jobs which is great for the economy, however it is really lousy for the environment. So while "cash for clunkers" is great for the economy, it really is bad for the environment. The reality behind this debate is that people in the USA consume too much. As a country, we need to lower our standard of living to something that is sustainable.
The next example is the health care debate. Obama is promising to socialize health care while not decreasing people's current access to care and also not increasing the deficit or taxes as a result of doing it. That is sheer lunacy. The president also struggles with the facts of the debate. In a recent speech, he stated that we need to spend more money preventing and managing diabetes rather than paying a surgeon $50,000 to do a leg amputation for it. I agree about the prevention part, but disagree about the surgeon part. Surgeon's do not get paid even $1000 for an amputation. Furthermore, the fee they do receive for the amputation includes all of the care they provide to that patient for the 6 week postop period, they also have to pay office costs and malpractice costs out of that fee.
President Obama also said that we can save costs by using cheaper equally effective treatments. He gave this example. "If there is a blue pill that works just as good as the red pill, but costs half as much, we should use the blue pill." I agree. However, the problem is that often times the red pill works 20% better than the blue pill, but costs 3 times as much. Patients who are not paying for the pill themselves think they deserve the red pill.
Our healthcare system spends horrible sums of money on treatments that only very marginally improve outcomes. We also spend tonnes of money on people who are going to die in a matter of weeks no matter what you do. For example, Avastin is a drug used for chemotherapy in colon and rectal cancer. It was found to increase survival from 8 months on average to 10 months on average. Basically if you took the drug, you were on average going to live 2 months longer than someone who did not take the drug. That's great right? The problem is, that a course of chemotherapy with this drug costs $30,000. Another example is the terminally ill patient whose family has not accepted the fact that they are going to die imminently. The patient gets lots of blood transfusions, radiographic studies, blood cultures, antibiotics, and other meds all to very marginally delay what all of the healthcare providers know is an imminent death. However, Americans believe that they have a right to receive any medical test or intervention that might possibly be of any benefit no matter how miniscule regardless of their ability to pay. We already have socialized medicine. This is all just an argument about who is going to pay for it.
What currently happens in the healthcare system is that when you show up in an emergency room, that hospital is obligated to take care of you regardless of your ability to pay for it. It is like showing up in your local grocery store, declaring that you have no food whatsoever at home, and expecting them to load up your grocery cart with free groceries since no one can live without food.
What needs to happen in our healthcare system is an honest discussion. We all die. We need to be more comfortable with our individual mortality. We also need to decide at what level a treatment becomes prohibitively expensive. In other words, at what level does a treatment become so expensive that it is too expensive to be the standard of care?
I think the Democrats have been brave to tackle this minefield of an issue. The status quo cannot continue. However, I would really like to hear the president say that part of the answer to the healthcare issue is an acceptance that death eventually finds us all and that we cannot afford every invention that medical technology brings us. The benefits of a treatment need to be weighed against its cost.
The first is the attempt to become more environmentally responsible while trying to stimulate the economy. Basically, consumerism involves the consumption of natural resources. The extraction and sale of these natural resources creates jobs which is great for the economy, however it is really lousy for the environment. So while "cash for clunkers" is great for the economy, it really is bad for the environment. The reality behind this debate is that people in the USA consume too much. As a country, we need to lower our standard of living to something that is sustainable.
The next example is the health care debate. Obama is promising to socialize health care while not decreasing people's current access to care and also not increasing the deficit or taxes as a result of doing it. That is sheer lunacy. The president also struggles with the facts of the debate. In a recent speech, he stated that we need to spend more money preventing and managing diabetes rather than paying a surgeon $50,000 to do a leg amputation for it. I agree about the prevention part, but disagree about the surgeon part. Surgeon's do not get paid even $1000 for an amputation. Furthermore, the fee they do receive for the amputation includes all of the care they provide to that patient for the 6 week postop period, they also have to pay office costs and malpractice costs out of that fee.
President Obama also said that we can save costs by using cheaper equally effective treatments. He gave this example. "If there is a blue pill that works just as good as the red pill, but costs half as much, we should use the blue pill." I agree. However, the problem is that often times the red pill works 20% better than the blue pill, but costs 3 times as much. Patients who are not paying for the pill themselves think they deserve the red pill.
Our healthcare system spends horrible sums of money on treatments that only very marginally improve outcomes. We also spend tonnes of money on people who are going to die in a matter of weeks no matter what you do. For example, Avastin is a drug used for chemotherapy in colon and rectal cancer. It was found to increase survival from 8 months on average to 10 months on average. Basically if you took the drug, you were on average going to live 2 months longer than someone who did not take the drug. That's great right? The problem is, that a course of chemotherapy with this drug costs $30,000. Another example is the terminally ill patient whose family has not accepted the fact that they are going to die imminently. The patient gets lots of blood transfusions, radiographic studies, blood cultures, antibiotics, and other meds all to very marginally delay what all of the healthcare providers know is an imminent death. However, Americans believe that they have a right to receive any medical test or intervention that might possibly be of any benefit no matter how miniscule regardless of their ability to pay. We already have socialized medicine. This is all just an argument about who is going to pay for it.
What currently happens in the healthcare system is that when you show up in an emergency room, that hospital is obligated to take care of you regardless of your ability to pay for it. It is like showing up in your local grocery store, declaring that you have no food whatsoever at home, and expecting them to load up your grocery cart with free groceries since no one can live without food.
What needs to happen in our healthcare system is an honest discussion. We all die. We need to be more comfortable with our individual mortality. We also need to decide at what level a treatment becomes prohibitively expensive. In other words, at what level does a treatment become so expensive that it is too expensive to be the standard of care?
I think the Democrats have been brave to tackle this minefield of an issue. The status quo cannot continue. However, I would really like to hear the president say that part of the answer to the healthcare issue is an acceptance that death eventually finds us all and that we cannot afford every invention that medical technology brings us. The benefits of a treatment need to be weighed against its cost.
posted by The Mad Hatter at 5:35 PM
4 Comments:
Good to hear from you again. That was an interesting inside perspective on the hubub, one you don't get all that often.
Thanks
Excellent!....Well put!...Dr. Burkholder. I couldn't agree more on your perspective. As a health care provider myself, I'm sick of all the "waste" that I see in our ER's and Hospitals today. There are way too many tests/procedures being ordered by physicians/health care providers just to avoid litigation. It stinks...BIG TIME!
It seems like the one big piece of the health care field that is not even mentioned in the current attempts at reform is the malpractice issue. If there were changes to the legal system that eliminated or severely restricted the malpractice lawsuits, it seems like a lot of money could be saved.
I appreciate you putting in words what I have been feeling all along. I really wonder if we would be in this position if Lawyers were barred from the medical field.
When we needed to get our sons eye operated on, we tried to go to Canada where we could afford it, but were told that they would not see us because we could sue them for malpractice. We ended up going to Thailand for the surgery and were thankful that there was a good quality place that we could go but that was also affordable.
Keep up the good work Dr. Hans! Someday I want to have a good sit down and talk with you again. It's been way too long!
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