Health Care Realities; Sensible Ideas for Cost Control

Article excerpt


Ah, the rites of spring! Baseball, cherry blossoms and the annual report of the Medicare trustees, who duly report that Medicare is going broke. Yet each year we have the routine response of politicians and pundits who wring their hands about the unsustainable rate of growth in health care expenditures.

Here's a typical comment: "Despite a massive increase in health expenditures together with a marked expansion in health workers over the past decade, the nation's health has improved less than expected. The benefits have not appeared to justify the costs. ... We have emphasized high-cost, hospital-based technologies e a situation e made all the more serious by the lack of emphasis on

prevention of disease" Those observations were not made yesterday. They were made by Dr. John Knowles in a book titled "Doing Better and Feeling Worse: Health in the United States," published in 1975.

It is useful to look back to see far how we have come even as some things stay the same. In 1974, cardiovascular disease was the cause of 39 percent of all deaths. Today it is about 25 percent. Cerebrovascular diseases were responsible for 11 percent of deaths back then. In 2004 they caused 6.3 percent of deaths. Kidney diseases were linked to 10.4 percent of deaths and now they are associated with 1.8 percent.

Of course, the longer people live the more likely they are to die from cancer or Alzheimer's. The percentages of deaths attributed to influenza and pneumonia have remained almost constant, as have the percentages of people dying from respiratory diseases.

In general, however, more people regard themselves in good to excellent health now than about a decade ago. Fewer people have disabilities that limit their activity or require institutionalization. More people are getting screened and treated for chronic illnesses like depression, diabetes, high cholesterol and cancer. (Hypertension seems to be an outlier.)

The percentage of people unscreened and untreated for the disease has remained constant over the past five years.) We can thank spending on medical technologies that delay or prevent the emergence of disease for many of these gains. For anyone who thinks we can spend less on health care across the board and still have these benefits, consider that in 1974 many of the drugs and surgical techniques to keep heart patients alive were not available.

As Harvard University health economist David Cutler has noted: "The average person aged 45 will live three years longer than he used to solely because medical care for cardiovascular disease has improved. …