Former Vice President Cheney, suffering from congestive heart failure, would certainly die without either a heart transplant or an assistive implant. He received what is known as a left ventricle assist device, which is illustrated in the picture preceding this post. As is the case with the former Vice President, patients needing an appropriate, advanced, life-saving medical technology should receive it. But this post is not, per se, about the former Vice President. It is about the unsustainable cost of medical advances in a society in which a disease-inducing lifestyle is commonplace.
Let me first say, however, that I wish the former Vice President the best. Although I believe that as a politician he deserves no respect from me for his political views and actions, I believe that as a sick human being he deserves compassion.
Now to the unsustainable cost of medicine as it is now practiced. The type of fix to Mr. Cheney’s problem will, in the final analysis, cost several hundred thousand dollars. These and other advanced medical techniques – along with inordinately expensive pharmaceuticals – are undertaken in hundreds of thousands of cases each year. The soaring cost of these proliferating medical advances will undermine health care reform. Why?
In the current, profit-driven health care system, government policy is being steered away from human ecology toward products and procedures for fixing clearly preventable diseases. This is not to say that the former Vice President’s heart condition could have been ameliorated through early preventative measures. Some people will still contract a disease in spite of preventative measures that could and would greatly reduce incidence and prevalence of that disease.
Nevertheless, a growing body of research – mostly ignored in the health care debate – suggests that heart disease can be treated and even reversed through diet, exercise, and stress reduction (more about this below). I am not a physician but as a policy person, I am raising questions about the lack of emphasis on the impact of human ecology and lifestyle in health care reform legislation. The narrative fails to include much about underlying causes and alternative treatments for diseases.
Rather, the current health care cost narrative, replete with ageist metaphors and symbols (e.g. unplugging granny), is that the aging society (e.g. Baby Boomers) will “break the budget.” The narrative ignores individual health as a trajectory that begins in childhood. It has a beginning, middle, and end. Unfortunately, focus on costs in the denouement, otherwise known as the “last year of life” (LYOL), ignores life-long development and costs. Not much is expressed about increasingly poor diet, environmental toxins, smoking, lack of exercise, lack of access etc., etc., etc. Furthermore, there doesn’t appear to be anything in the discussion about power of industries to force policymakers to continue business as usual.
Over three decades ago, Arnold Relman, former editor of The New England Journal of Medicine identified the corporate health juggernaut as the “new ‘medical-industrial complex’” (NEJM, 1980;303: 963-70). He warned that, “… it creates the problems of overuse and fragmentation of services, overemphasis on technology and ‘cream-skimming,’ and it may also exercise undue influence on National Health Policy.” Nearly a quarter of a century later, John Greyman had the following to say in the Journal of the American Board of Family Medicine: “Increasingly, Wall Street and the interests of shareholders have replaced Main Street in shaping the organization of health care, the market, and even clinical decisions” (JABFM, 2003; 16(5): 444-454).
Most Americans who have lived for a few decades have probably come to accept amazing high dollar advanced technologies as an inevitable and normal course of things in the progress of medical science. But Ira Rutkow, surgeon and medical historian, in his recently published book Seeking the Cure: A History of Medicine in America placed the matter in a broader perspective:
“Prior to World War II there had been little of this escalation. Most of the early innovations – Morton’s discovering anesthesia, Lister’s sterilization procedure, Fitz’s defining appendicitis – had minimal material and research costs. But the situation changed in the 1950s due largely to increased investments in science and the rise of the medical-industrial complex. Medical treatments became more powerful and more expensive. New biotechnologies like open-heart surgery, organ transplantation, and coronary heart stenting carried enormous price tags; even everyday diagnostic tools like CAT and MRI scans can cost thousands of dollars (page 305).”
As Dr. Rutkow, went on to say, “Health care gets better and better, but is affordable by fewer and fewer (page 305).” Nevertheless, in the current discussion about health care, aging Baby Boomers are erroneously and fallaciously blamed for the coming fiscal crisis while the ole proverbial metaphorical gorilla in the room is ignored. The gorilla everyone is ignoring in this discussion is advancing medical technology. This is not the typical 800 pound gorilla; it is a 2000 pound gorilla in an ugly mood with a free market ideology.
In view of former Vice President Cheney’s recent heart surgery and implant, my earlier post regarding medical device charges was coincidental (“The Death of Senate Bill 2221 – A Bill to Clean Up Corruption and Market Manipulation in the Medical Device Industry,” posted July 13, 2010). Medicare and Medicaid – the taxpayers – fund a large share of costly medical procedures. In spite of that, the medical device industry is able to kill a bill that would provide the taxpayer fair negotiating rights. This is only one of a large number of examples of an industry’s power to influence government policy for its members’ benefit but to the detriment of the public interest.
As heart disease and other chronic illnesses such as cirrhosis of the liver increase, transplantation, implantation, bioengineering, bionics, and so forth will be available for improving and prolonging life. These procedures will not be concentrated in the elderly population. In fact, life-prolonging, heroic measures become much less common as patients pass 80 years of age. Furthermore, they will be so costly that the current out-of-control, pseudo-free-market health care system will collapse under its own weight.
Because medical technology industries hide their data, it is hard to know exactly how much of the out of control health costs are due to increasingly sophisticated and expensive pharmaceuticals, devices, equipment, and procedures. It is typically estimated be the cause of two-thirds of health care cost increases (P. Ginsberg, NEJM ,2004; 351 (16): 1591-1593).
My hypothesis is that aging per se accounts for very little of spiraling upward, out of control health care costs.. No doubt we are likely to consume more medical services as we age. However, a large share of the very expensive medical care is consumed by patients below the age of 65. But let’s concede that medical services are more likely to be consumed by patients over the age of 65 than patients under the age of 65. Having recognized that we tend to suffer more maladies as we age, we still have to ask about justifiable costs and alternatives.
As mentioned above, a growing body of research suggests that the American diet, driven by agri-business, and corporate giants in food processing and fast food, plays a major role in chronic illnesses. This research further inidicates that these diseases can be slowed and even reversed by dietary changes, exercise, and stress reduction (see e.g. T. Campbell 2006, The China Study; C. Esselstyn 2007, Prevent & Reverse Heart Disease; Ornish, et al. 1998, “Intensive Lifestyle Changes for Reversal of Coronary Heart Disease,” JAMA, 280(23), 2001-2007).
Although diet, combined with environmental toxins, is driving a large portion of chronic illnesses that, in their end stage, will, due to expensive technologies, be costly beyond the ability of society to pay for them. This is not an aging problem. It is a lifestyle problem that begins long before old age.
In the final analysis, the power of industries providing fixes for diseases caused by the food distributed by other powerful industries will suppress discussion of lifestyle change as necessary for true health care reform (along with a single payer system covering all Americans). Because of this state of affairs, I am not optimistic about the success of the Affordable Care Act. The operative word is “affordable.”
*Please note that I do not adhere to a strict format for citing references. This is, after all, a blog.