Healthcare Costs & Medical Technology
Almost everyone knows that this country has a scandalously large number of people who lack health insurance, now up to 46 million and growing. That number is vivid and evocative. But it has overshadowed another, more serious issue—that of the steady escalation of health care costs. Largely due to the use of medical technology, those costs are now increasing at an annual rate of 7% a year. The Medicare program as a consequence is projected to go bankrupt in nine years, and overall health care cost to go from its present $2.1 trillion annually to $4 trillion in 10 years.
The high cost of new diagnostic and treatment technologies means that they have to be used selectively, and at that point decisions must be made about who should get to use them. In recent years there have been increasing charges of improper use of these new technologies, coupled with increasing discussion of their costs and benefits. Unfortunately, the use of such technology tends to spread indiscriminately and so add indiscriminately to health care costs. Given this situation, there is a need to examine the relevance of new diagnostic and treatment methods, the causes of technological abuse, the ethical aspects of the use of medical technology, and even the relationship between technology and society. Indeed, if there is to be generally effective acquisition and use of health care resources, such examination is essential.
Unfortunately, there is a great deal of bad news. The same technology that offers hope for ever-increasing life expectancy is also leading to increased demands on the health care system from a growing population of senior citizens. Ethicists and health professionals alike are now raising questions about when and from whom treatments should be withheld, as competition for the scarce medical resources of the health care system grows beyond the system’s capacity to provide care for everyone. The system, too, is burdened by costs that have spiraled wildly out of control.
The system, too, is burdened by costs that have spiraled wildly out of control. In 20 years, the total cost of medical care for the nation has increased from less than $50 billion a year to over $500 billion. The average cost of a one-day stay in a hospital has now risen to over $500, the total cost of a coronary bypass operation and follow-up treatment has reached $37,300, and the average cost of delivering a baby now exceeds $2500. As costs have increased, fewer people have been able to afford the medical care they need. Over 37 million Americans — including over 12 million children carry no health insurance at all. Unable to afford private health care, they must rely on a public health system that cannot deal with such a burden. Others simply do without.
We need a good dialogue on health care reform, but one that moves beyond organizational and management schemes. For me, those are rhetorical questions. But for everyone, questions of this kind are the place to begin any serious discussion about the control of costs and technology—and that discussion merits attention every bit as much as that of the uninsured. It will be harder but even more necessary. There is a huge economic gap to be closed and no less of a cultural gap as well. We have become accustomed to live (and die) with an expensive and disorganized system, one that serves many ends other than health—a system designed for ever-increasing affluence. It builds upon a model of health and of medical progress that is open-ended and infinite in its aspirations. Suffering, aging, and death are enemies to be conquered, at whatever the cost to other social needs.