Dr. Clif CleavelandIn the 53 years since my graduation from medical school, advances in diagnosis and treatment of illness and injury have occurred at a breathtaking pace.
Imaging techniques can reach into any part of the body to locate tumors or small, blocked arteries. Because of advances in cell biology and pharmacology, malignancies that were once rapidly fatal can now be cured or managed as chronic conditions. AIDS, which exploded onto the world stage in the 1980s as a deadly epidemic, can be carefully managed as a chronic disorder. Vaccines have blunted the spread of hepatitis A and B. New medications offer cures to victims of hepatitis C. Prompt diagnosis can reverse heart attacks and strokes early in their courses, preventing death and disability. The list of medical triumphs expands continually.
We should be celebrating these successes in biomedical science. Instead, the price tags associated with health care place unsustainable pressure upon personal, corporate and governmental budgets.
“American Sickness: How Healthcare Became Big Business and How You Can Take It Back” by physician-editor Elisabeth Rosenthal provides an invaluable analysis of the unaffordable mess in which we find ourselves.
Dr. Rosenthal approaches health care as a physician would approach a sick patient. A diagnosis is elicited, followed by a history of the present illness and a review of systems.
The diagnosis is straightforward: Costs are out of control.
A stark example early in the narrative involves a man with an uncommon, severe arthritis. For years, he enjoyed a symptom-free life, thanks to periodic intravenous infusions of Remicade, which blocks inappropriate actions of the immune system. Each infusion, which was administered in the hospital where his physician’s practice was located, cost $19,000, which his insurance paid.
After several years, his rheumatologist relocated her practice to another hospital in the same city. Subsequent infusions in the new hospital rose to more than $130,000 each. His insurance covered most of the new cost. Same drug, same means of delivery, same physician. Efforts to explain the steep price increase led the author down a series of rabbit holes.
The review of systems outlines the contributions of health insurance, hospitals, drug and device manufacturers, providers of care, labs and a growing body of middlemen who drive the costs of care. Increasing consolidation of hospitals leads to market dominance and control of pricing of services.
Pharmaceutical companies game patent laws to extend their pricing power over unique products. Minor changes in the formulation of older drugs permit steep increases in once affordable medications for asthma, diabetes, cardiovascular disease and other common illnesses. Makers of generic drugs may be paid to delay marketing products that would compete with more expensive brand-name agents.
There are no simple solutions to our current dilemma. Many politicians argue that removal of government regulation would open health care to competition. Consumers could then shop for the best buy for their medical needs. They would need a background in medicine, accounting, law and business to make sense of masses of data to determine which of multiple therapies was safest and most cost-effective. Other advocates for reform promote the benefit of more governmental intervention, such as extending Medicare to everyone.
Powerful lobbies for every component of our health-care system further complicate efforts for reform. Each lobby insists that no harm come to its sponsoring organization.
Dr. Rosenthal provides 10 economic rules of the “dysfunctional medical market.” These include Rule 2, “A lifetime of treatment is preferable to a cure, and Rule 4, “As technologies age, prices can rise rather than fall.”
In five appendices, the author provides resources for the individual consumer. A price calculator for procedures, prescription drugs and hospital services can inform choices. A glossary of medical terminology provides insight into itemized bills for services. Is a test or procedure really necessary? Templates for letters of protest in response to sky-high bills are presented.
This is a necessary book for all of us who wish to advocate for an affordable health-care system or who face the uncertainties of illness among loved ones. Congress should call a time-out before pushing any health-care agenda to afford members a chance to absorb this important narrative. Diagnosing the ills of the system is necessary before prescribing a remedy.
Contact Clif Cleaveland at ccleaveland@timesfreepress.com.