After reading Lewis Thomas’s wonderful essay from 1974 called “The Technology of Medicine,” I have come to the disturbing realization that perhaps health care costs are rising out of control because the medical industry simply does not want them under control. As long as insurance picks up the bill, health care providers have little interest in capping costs. More telling, as Thomas points out, basic research into the causes of disease often leads to relatively cheap treatments and cures. Too many cheap alternatives would destroy the health care business, so there’s little incentive even to do that.
Thomas presents the now-alarming example of how antibiotics that targeted tuberculosis shut TB hospitals down. In 1974, this was still considered a good thing, but can you imagine that happening now? The health care lobby would scream. My home town, a city of about 300,000 people, has several hospitals that provide award-winning cardiac care. But it is also home to a private, for profit cardiac specialty hospital. With the price of the average bypass at about $80,000, you can imagine how much the for-profit hospitals would stand to lose from a cheap and effective treatment for coronary artery disease.
Basic research has big initial costs too, of course, and part of the reason nobody but cheritable organizations like the American Diabetes Association and the American Cancer Society want to fund it is that there is little immediate payoff. The market model makes R&D, especially “R,” a bad bet since markets figure success a quarter at a time and not over the course of years or decades. But if Thomas’s thesis has any merit, and treatments that go to the cause of disease tend to be fairly chep in the long run, then there’s even less reason for the health care industry to pursue basic research into the origins of illness since it counters their goals of making a profit.
We can see this directly in this fall’s flu vaccines crisis. Flu vaccines are relatively expensive to make, but are, more importantly, a one-shot-a-year proposition. Unlike Viagra, the use of which depends on the mood of the male user – and, let’s face it, males will use it every chance they can get – or Celebrex, which is used to treat chronic pain, or the many cholesterol-lowering drugs out there, which may be used over the course of 15 or 20 years, a measly little vaccine does not garner many dollars. So those who still make them only make just enough for the expected demand, and if any becomes contaminated, as happened to Chiron, the needs of thousands of potential flu sufferers will not be met.
The case gets somewhat more complicated when politics enter the picture. Will politicians that receive substantial donations from the health care industry or get attention from their lobbyists be willing to move toward more basic research when it may substantially lower the profits of that industry? And with Senate leader Bill Frist’s deep ties to the health care business, how can we expect any movement toward cheaper, more caused-based treatments? When profits are so tied to expensive measures that fail to treat the origins of disease, the cost of medical care has nowhere to go but up.
Sorry, the comment form is closed at this time.