I watched President Bill Clinton speak to the press while standing outside of his house last night, just one day after doctors inserted stents in the arteries around his heart. I spoke to my mother last evening, who is entering her second week of therapy after having her second hip replacement surgery in the last six months. I thought about my eighty-nine year old grandmother, who underwent a surgical procedure two weeks ago and was moving around her kitchen the next day as if nothing had happened. These advances in modern medicine, as amazing as they are, have had a tremendous impact on our healthcare delivery system’s costs.
According to Richard Rettig, now an adjunct senior social scientist at the RAND Corporation, new medical technology affects the costs of health care through the following "mechanisms of action":
- Development of new treatments for previously untreatable terminal conditions, including long-term maintenance therapy for treatment of such diseases as diabetes, end-stage renal disease, and AIDS;
- Major advances in clinical ability to treat previously untreatable acute conditions, such as coronary artery bypass graft;
- Development of new procedures for discovering and treating secondary diseases within a disease, such as erythropoietin to treat anemia in dialysis patients;
- Expansion of the indications for a treatment over time, increasing the patient population to which the treatment is applied;
- On-going, incremental improvements in existing capabilities, which may improve quality;
- Clinical progress, through major advances or by the cumulative effect of incremental improvements, that extends the scope of medicine to conditions once regarded as beyond its boundaries, such as mental illness and substance abuse.
Richard Rettig “Medical Innovation Duels Cost Containment,” Health Affairs
When I was a child, all medical procedures involving the heart required the patient’s chest to be cut open. It was common to see people in their sixties and seventies who needed canes or walkers to get around, and many more who seniors who always seemed to be rubbing their knees. And surgery was rarely performed on ninety year old patients.
The recent research in this area seems to be written mostly from the perspective of the technocrat. The analysis I’ve read tends to quantify the added lifespan medical technology makes possible in terms of life expectancy costs versus an actual dollar value per additional year of life in order to justify whether or not our broader healthcare policies make sense.
I also remember from my childhood the visits we would make to aged family members and friends who had been bed-ridden or house bound for years with conditions similar to those President Clinton and my mother suffered from. Our technological advances appear to dramatically raise the quality of life, a factor that seems to be missing from many of the equations and theories floating around regarding the future of our healthcare system.
However heartening it is to see the former President begin to look like his old self again, however moving it is for me to hear my mother sound like her old self again, the reality is, America’s challenge going forward is to figure out how to sustain these kind of everyday medical miracles without neglecting our other civic responsibilities.