In the 1960s, the chance of dying in the days immediately after a heart attack was 30 to 40 percent. In 1975, it was 27 percent. In 1984, it was 19 percent. In 1994, it was about 10 percent. Today, it's about 6 percent.This relates back to Megan McArdle's point. How much of that medical innovation that is saving lives today came about because of the profit incentive to medical companies? And what future discoveries won't be made if medical and drug companies are limited in the amounts they can charge to cover new developments?
Over the same period, the charges for treating a heart attack marched steadily upward, from about $5,700 in 1977 to $54,400 in 2007 (without adjusting for inflation).
The treatment of coronary heart disease -- of which heart attack, or acute myocardial infarction, is the most significant component -- this year will cost about $93 billion. It's a huge contributor to the $2.3 trillion annual bill for medical care in the United States. Cardiovascular disease is responsible for 35 percent of deaths in America and has been the leading cause of death every year since 1900, except 1918, the year of the Spanish flu epidemic.
The evolution of heart attack treatment over the past three decades is a story of doing more things to more people at greater expense with better results. It is a portrait in miniature of medicine in the United States.
Although inappropriate care, high administrative costs, inflated prices and fraud all add to the country's gigantic medical bill, the biggest driver of the upward curve of health spending has been the discovery of new and better things to do when someone gets sick.
"Money matters in health care as it does in few other industries," wrote Harvard University health economist David Cutler in 2004. "Where we have spent a lot, we have received a lot in return."
Beyond heart attack treatment, similar stories can be told about cancer, premature birth, arthritis, HIV infection, mental illness and innumerable other common conditions. The trend in all of them toward more intensive, expensive and better treatment is not likely to change with health-care reform, however constituted.
Providing health insurance to the 47 million Americans who don't have it -- the key feature of the bills before Congress -- is likely to expand heart attack treatment and increase spending on it, not pare it back and reduce the cost.
The revolution in heart attack care has occurred over the working careers of cardiologists who aren't even very old.
"When I was in medical school, about all we had to offer was oxygen, morphine and prayers," said Eric Topol, director of the Scripps Translational Science Institute in La Jolla, Calif.
Topol, who turned 55 last month, graduated from medical school in 1979. For 15 years he was head of cardiology at the Cleveland Clinic, where he helped run some of the clinical trials that have changed treatment so dramatically.
Today, someone having a heart attack who gets to a hospital in time is likely to get cardiac catheterization, angioplasty, the placement of a medicated stent, therapy with four anticoagulant drugs and, on discharge, a handful of lifetime prescriptions.
"There's been a complete transformation in how it's handled just since I've been in medicine," Topol said.
That transformation has saved the lives of millions of Americans.
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Friday, July 31, 2009
Why medical costs have steadily increased.
The Washington Post had an illuminating story this past weekend about how costs of treating heart attacks has steadily increased in the past three decades. However, the survivability rate has also steadily increased. As doctors learned more and new treatments were tested, they were able to save more lives. However, all that innovation costs more money.
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By my calculations $97 billion out of $2.3 trillion comes to about 4%. I would hardly call that a "huge" contribution as the WaPo does.
Rick
"Providing health insurance to the 47 million Americans who don't have it -- the key feature of the bills before Congress -- is likely to expand heart attack treatment and increase spending on it, not pare it back and reduce the cost."
So, what are you saying? That you're OK with health care only being available to Americans who can pay the most?
That is also an argument for shutting all our public schools. If parents can afford to educate their kids privately, great. If parents don't have the means, then why should the rest of us pay for it?
(The reason why the rest of us should pay for it, is the whole nation benefits when all children are educated. Even if some of the richest in society have to pay a bit more. And the whole nation benefits, when all Americans have health care, even if the richest have to pay a bit more.)
The point is that we can't afford to cover everyone receiving expensive treatments without bankrupting our economy. The only way to treat more people at lower cost is to limit what people are charged. If those payments are not enough for those providing the treatment to stay in business, the treatment will not be available. If companies cannot make a profit on medical innovations, there will be no more medical innovations. Thus, instead of 47 million getting reduced care, 350 million will. Of course then we will have achieved equality of outcome.
Biddle,
Perhaps you would like your medical treatment to be administered by the same people that run the public schools in the District of Columbia.
Would you?
Priscilla, thanks for your calm and well-reasoned response.
You are making the argument that "insuring everyone means paying for the most expensive care for everyone".
But that is not a given, is it? Insuring everyone won't magically cause more heart attacks to happen, will it? The same rate of heart attacks that happen now, will happen in future. You can't just assume that all 47 M uninsured Americans will get heart attacks. You'd need to show numbers, not just assert "it is so".
And a big part of the Democrats health reform is to work on preventive care: get people taking small steps that lessen their risk. Give them information and programs to help us change diets and exercise more.
The current health system is broken beyond belief. Insurances companies are in business to maximize their profits, and the best way to do that is to deny benefits to as many people as possible. Heaven forbid someone in your family gets pregnant and then loses their job. New insurance will say that pregnancy is a "pre existing condition" and refuse all coverage.
Reform is desperately needed. Every other Western country manages health care with government participation, and without bankruptcy, and I have faith that Americans will too.
Answer this, BB. Do you honestly believe that a "rich person" should not be allowed - by law - to acquire any more or better medical treatment than an indigent person who can afford to pay for none? Do you believe that everyone in the US should receive the exact same level of treatment, despite their ability to pay?
And BB, please retire your straw man that conservatives think poor people should receive no care at all. Utter BS.
Perhaps I may ask in turn, equitus. How much health care, in your view, should the government give to those who are without means?
The Bush answer was none. If a condition developed into an emergency, you could go and see if an ER would take you in, and patch you up.
I think Americans deserve better. How much better, do you think, equitus?
ERs are required to treat patients, even undocumented. Americans don't deserve anything more or less than described in the compact they made with each other at the beginning of the Republic. I have no more right to get the same healthcare the very wealthy have then I have a right to an Aston Martin DB9.
Speaking of straw man arguments, using Census Bureau figures, Biddle's 47 million uninsured breaks down like this:
▪ 9.5 million people are illegal aliens ( That would bring the total down closer to "37 million" using a figure that probably underestimates illegal alien numbers )
▪ 8.3 million uninsured people earn between $50,000 and $74,999 per year and choose not to purchase insurance ( Look! Now we're down around "29 million" )
▪ 8.7 million uninsured people earn over $75,000 a year and choose not to purchase insurance ( That sounds like we're approaching "20 million" )
▪ 6 million are estimated to be eligible for Medicaid but have not signed up (Sign up for the next bullet comment....)
▪ That leaves 14 million "at risk" Americans lacking health insurance
http://lifeandpoliticsintherealworld.blogspot.com/2009/07/47-million-uninsured.html
Finding a way to provide care for less than 5% of the population that consists of people that are between jobs or truly incapable of paying for or acquiring insurance does not require a complete upending of the best health care system in the world. Not unless your motive is to socialize medicine for the sake of a political agenda.
A sincere, cost effective approach to providing care for the truly needy Americans that don't currently benefit from the World's best health care system would be targeted to their needs, not the whims of politicians seeking greater influence in the day to day lives of every American while they exempt themselves from the same system they would impose on us. A comprehensive effort to reduce health care cost would also address the expenses we all absorb through ever increasing litigation yet nothing in the Democrat plans to date even mentions tort reform. There simply must be tort reform if we are to reduce insurance costs and failing to address this reveals that certain legislators are more interested in the health and welfare of a particularly lucrative form of litigation than the betterment of our health care system.
Biddle claims that "Reform is desperately needed". But he either fails to understand the scope of the problems and true numbers of those impacted or does not care because a greater political goal is preeminent. He's also blowing smoke when he claims that "Democrats[sic or sick] health reform is to work on preventive care: get people taking small steps that lessen their risk. Give them information and programs to help us change diets and exercise more". Is he kidding? Do we have to have spend trillions of dollars to tell Americans to stop shoving doughnuts into their faces and to get some exercise? People have been officially warned of the hazards of alcohol and tobacco for decades but partake nevertheless. Instead Biddle puts his "faith" in Americans to do better even when we've watched our population's waistlines expand exponentially.
Finally Biddle says, "Every other Western country manages health care with government participation, and without bankruptcy, and I have faith that Americans will too".
That is patently false. Go get free health care in Panama. I lived there and I know that whatever claims the Panamanian government might make about any health care it does offer is overstated, to put it mildly. In wealthier western states there are more resources to be squandered by government health care systems but the end result is rationing, long waits, limited access, and a steady stream of their citizens and subjects coming to the United States for health care services unavailable or denied in their home countries.
Tort reform and true free market health care is the best chance for improving health services for as many Americans as possible, not Biddle's "faith" that Congress, for a mere trillion dollars or more, can inform Americans to eat more wisely and exercise more.
Biddle,
Raise your hand if you'd rather have your medical care in Canada!
http://www.eyeblast.tv/public/video.aspx?v=GduznzqGaG
(Psst...Pssst! Biddle that's a link up there. We use them here and so should you. Click on it.)
Get well soon!
Plus having a healthcare system in the industrialized world is next to impossible considering that they are funded just like the post office. If they are spending faster than their income then Congress will hold some hearings, moan and whine about serving the communisty and then simply fund it again.
I should point out that under Salvador Allende the health care clinics in Chile that he had built did indeed go bankrupt which cost him the support of many of the poor after already having lost the middle-class.
Insuring everyone to the same standard of care, for the same amount of money, automatically means that people now getting the best care will see a reduction in the quality of their care, otherwise known as rationing.
What really bothers the Obamas of the world is that the highly productive people get more better "stuff" - including health care. They view this as somehow immoral.
Perhaps you could answer my question, BB? You are the one defending the current Dem proposals.
I'm tempted to assume that you do in fact think that everyone should receive the same level of care, even if that means significantly poorer care for many/most. But you've griped before about my ascribing beliefs to you, so - as you requested - I decided to ask you. See where it got me?
I've seen plenty of alternative ideas for reform on this board and elsewhere, and I find a lot that I can like a heluva lot better than the system you favor. So, assuming tfhr and PP are answering for me, will you now answer my question?
I didn't think so.
I did answer your question, Equ. Betsy chose not to publish my answer.
For the record, we are in agreement on this point - there should not be legal restrictions on the amount of additional health care an American can purchase.
It's at the other end where we disagree. As every other Western country has done already, America will eventually provide national healthcare. Be proud of it.
For the pedantic, "Western" here means first world developed Western countries, not banana republics where a lazy man scrubs latrines for government pay.
Bill, I'm not going to publish your comments where you make gay innuendos in your chosen nicknames for other commenters. I wouldn't accept that sort of immature insult from my students and I do believe that you are no longer in middle school, right?
Biddle,
So you are now the the sole arbiter of what constitutes a western nation. In doing so you also feel free to slander countries as "banana republics" because they don't meet your fanciful "standards" of health care. Brilliant.
If you mean wealthy countries then say wealthy countries but be careful because many of your idyllic "first world developed Western countries" traditionally suffer from taxation rates and unemployment rates that are worse than America's right now and will never be accepted here. You avoided naming a specific country because each time you do someone will take you apart on it as has been done before when you've declared France and Scotland as medical Utopias.
I'm not sure what your fantasy for scrubbing toilets is about but we've heard it all before. Seems to me you've been bumped off of here for that sort of thing in the past as well. It's also apparent that if you had a decent argument you would respond with it but instead you resort to slurs that ultimately end up getting banned here.
I challenged you on your 47 million figure and you FAILED to back up your exaggerated claim. Instead you ran from the challenge went back to your favored toilet defense.
I provided you with a link to Paul Krugman finding out for himself that his rosey personal opinion of Canada's health care system is not universally held by Canadians. You left that alone but in this "teachable moment", it would be worth your time to find out why Canadians come to the United States for treatment.
Stop making excuses - blaming Betsy - for your failure to effectively support your liberal positions. Come here with a well reasoned and supported argument and leave the gay and toilet insults for your personal friends.
Biddle, you give liberals a bad name. (worse than liberal)
More bad news about perfect health care in real Western nations like Canada and the UK:
http://www.youtube.com/watch?v=gdx_2cuPgQQ
Biddle, did you know that a dog can get an MRI in Canada faster than a human? Copy and paste the link and let John Stossel explain since you won't listen to anyone here.
HSAs and Free market solutions to health care costs from John Stossel:
http://www.youtube.com/watch?v=xLT00Ew78_M&NR=1
Biddle, this speaks to your desire to get more Americans to take better care of themselves and WITHOUT government intervention!
How about this BB? What if a plan were put forward that guaranteed some basic level of insurance for that 5% or so that wants it but can't get it? Furthermore, the CBO and other independent agencies should agree that it the policy will have little or no effect on the private insurance and health care market. Would you support such a plan?
I'm assuming you won't, that you think the only "fair" way to do this is to pass a 1000+ page bill totally restructuring a big chunk of our economy and costing trillions in tax increases. But I thought I'd ask.
Or instead of tampering with something that most people think others are having a problem with simply set up something, as equitus points out, specifically targetting those that are truly not covered. And whatever the reason, loss of job, lack of coverage at place of employment, etc and then means test it.
"What if a plan were put forward that guaranteed some basic level of insurance for that 5% or so that wants it but can't get it?"
Hi Equ.,
I differ with you on the number 5%. How about we just take the number out, and agree something like "the government will organize a health insurance plan for which all Americans are eligible".
We also need to regulate insurance companies to stop the ex post facto cherry picking that they do now - there can be no more denial of coverage based on "pre existing conditions" or "not declaring acne treatment 20 years ago".
(If you don't do this, the health insurance industry will simply use the govt plan as a dumping ground for the risks they don't want to cover).
"Furthermore, the CBO and other independent agencies should agree that it (the policy) will have little or no effect on the private insurance and health care market."
For me, the goal isn't "preserve the profitability of the current health insurance industry". The goal is "bring health care to ALL Americans, at affordable and sustainable levels."
Insurers have profited greatly at the expense of Americans. They are an important stakeholder, but not the most important one. Insurance companies are running something that is not sustainable, and so they will have to change.
"Would you support such a plan?"
I welcome the dialog, and from your thoughtful viewpoints, I feel more encouraged that there is a compromise in there, that we can both live with. This is the first time I have felt this in 30 years of health care debate.
Bill B. wants to "bring health care to ALL Americans, at affordable and sustainable levels". I prefer a plan that would bring competent and effective health care to all Americans and am quite certain that the Federal government cannot do that "at affordable and sustainable levels" with any plan Obama and Pelosi are likely to come up with. Massachusetts and various foreign countries have tried and failed miserably. Free bad medical care is not what we need, and it's not even free unless you think higher taxes don't count. I suppose if you're in the tax bracket that doesn't pay any federal taxes, the new plan would be 'free' -- for you, at least -- but that would make you a bit of a parasite, wouldn't it?
What foreign countries are you thinking of when you say "they have failed miserably" to bring health care to their citizens?
Let's not argue about semantics, so just restrict yourself to industrialized western nations.
Is Canada on your list?
BTW, the Federal government *already* brings acceptable healthcare to millions of Americans. It's called Medicare.
I'd be quite happy if all Obama did was open medicare eligibility to all Americans, charged people enough to cover the costs, and negotiated with medical suppliers for sustainable rates. Just doing all that would be enough for me. Let the market decide!
How can there be a debate if one side only wants to talk about their version of the problem and excluding contradictory information and solutions. Especially when it could be argued that there really is no problem for the majority of Americans. Bill says basically that the fair and polite debate he has in mind is to simply accept his definition of the problem and then merely tinker with a solution based on what many people are coming to realize is a false description of problem.
It's simlar in arguing that if one kid in a class is identified with a reading problem then all the kids in the same class must also go through remedial reading. And they will be billed for that tutoring whether needed or not.
Just what exactly is your objection to opening Medicare to all Americans who wish to join, and pay the full economic premiums, Pat?
Ah, were it that simple as it appears that ready or not we are all going to be enrolled in some form of Medicare and the magic money fairy will pay the difference between was is collected and what is spent. Since, as I and others have pointed out, something like 80% of the American public that is insured are happy and don't wish to change. And as I and others again have pointed out wishing to join and being required to join are two different things.
This is somewhat like Pew's manufactured demand for campaign reform during a period when there was no demand outside of a few chest thumpers and shallow thinkers.
What have you got against Americans and mind your own business Bill? If by now you haven't noticed what I have said and the links I've provided then there really is no point in explaining it again to someone that is simply not paying attention.
Biddle,
You said, "...open medicare eligibility to all Americans, charged people enough to cover the costs, and negotiated with medical suppliers for sustainable rates."
All Americans - that would fatally overload a system already nearing insolvency.
Cover costs - who's costs? The doctors? The hospitals? Medicare already pays lower than it should for many services and it creates financial difficulties for the service providers who in turn pass that expense on to the rest of us.
Sustainable rates - for whom? Rates for the payer or payee?
Do you not understand the premise behind the FICA-Medicare deduction that comes out of your paycheck each month?! The idea is that you pay into that system for DECADES before you start drawing from it.
If you wanted to put someone on Medicare today with immediate eligibility for benefits, wouldn't they have to make up the difference in payments not previously made in order to avoid bankrupting the program? What you'll end up doing is wrecking what is left of Medicare and thereby short change those people currently drawing benefits even though they've actually contributed fully to the system since it's inception or since they began working.
"Let the market decide!" Congratulations on the breakthrough, Biddle. I hope you don't get drummed out of your liberal navel gazing clubs for that one but your advocacy of the current plans on offer from the Dems is decidedly anti-free market.
By all means, say what you mean but mean what you say.
Again, I recommend that you check out the URLs I provided to you for the Stossel reports on Health Savings Accounts and medical care in the UK and Canada. You could learn a lot.
Here is a URL for an excellent lay down of conflicting government policies, Social Security, Medicare, Medicaid, and choice:
http://www.floppingaces.net/2009/08/03/seniors-boomers-healthcare-choice-enroll-in-medicare-or-lose-your-social-security-retirement-checks/
Read it and if you had any doubts left about welcoming still more government involvement in your health care, they will evaporate faster than your FICA tax contributions.
Pat,
Please google for "americans poll health care problem" to find out how out of step with the majority of Americans you are.
I take it that you have no issue with "opening Medicare to all Americans who wish to join, and pay the full economic premiums" since you have not articulated one when asked.
Frt - can you keep quieter? Your noise is perceptible to the adults talking.
I do believe Bill B. just made a fart joke when he called tfhr 'Frt'. That's rather bold behavior coming only a day or two after our host deleted one of his comments for making "gay innuendos in [his] chosen nicknames for other commenters". This must be the hardest site in the world to get banned from.
Actually you might want to have checked your claim first as the current Gallup Poll shows that most Americans, again 80%, are currently happy with their healthcare, very few have any confidence that either Pres Obama or Congress know what they are doing and at something like 20 or 30 to 1 they place the economy and jobs first and healthcare a weak 2nd or 3rd depending on how the questions are asked.
The link below is to an article published by one of the editors of the Gallup Poll who concluded by saying;
"Americans also appear dubious about the benefits of what they perceive to be less-than-fully-informed representatives in Washington rushing into a new healthcare reform law when the need for such legislation is not the highest on the public's agenda."
Most of the rest of the questions show some support for the idea of healthcare reform but the citizens also appear to not see what the rush is about and they also don't trust those pushing for such reforms. And the seem adamant about being forced to chose another plan.
http://tinyurl.com/lv89c4
Bill you must be a masochist to make such weird statements without checking their bona fides first. Or do you really enjoy being made to look ridiculous simply because you can't be bothered to do any of your own research.
Michael - I assure you I was not making jokes of any kind, nor was I making a gay innuendo in my first post.
I do accept that some people could misinterpret those words that way. But that is not my style.
Most of the rest of the questions show some support for the idea of healthcare reform
Yes, thank you. You are acknowledging my point. The speed with which we get there is not really the important thing to anyone.
To paraphrase a famous American war criminal, "It is unknowable how long that [endeavor] will last. It could last six days, six weeks. I doubt six months."
The citizens are in favor of some kind of healthcare reform but not this kind much as they are all for peace, love and happiness. I must have missed the trial which particular war criminal are you referring. Cheap shot and as usual dead wrong!
No one named 'Michael' has posted anything on this thread, so why does Bill B. address someone that way? He knows, and I know, that it's because he's a contemptible cowardly creep.
Please ban him, Betsy. You know he will never stop being the creep that he is, hiding behind his own impenetrable pseudonym while 'outing' others and constantly mocking the rules you try to enforce here. You've banned him many times before, and, like an alcoholic or wifebeater, he never changes. This site would be so much better without him.
Andsince that quote was made in 2003 I can only assume that the American people trusted that caveat and voted for the Republican ticket in 2004.
Or perhaps you are referring to that favorite of the Kennedy and Johnson Administrations who predicted that the US could withdraw from Vietnam "by the end of 1965." Or that other famous Democrat who stood in a shool door and read out the statement, "and I say segregation now, segregation tomorrow, segregation forever."
Biddle,
We've covered a lot of ground here. What was your point?
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