Our High-Tech Health Care Is Both the Glory and the Curse
Consider cataracts as a case study of why we can’t control health-care costs. A cataract is an eye disease that can lead to blindness. Until the late 1970s, surgery was painful and only partly restored eyesight. Now new plastic lenses can be inserted into the eye surgically. They dramatically improve vision. Cataract surgery has soared. In 1987 an estimated 1.4 million operations cost more than $4 billion.
High-tech medicine is the glory and curse of our health-care system. Americans like to believe that the best available health care can be affordable if only waste can be squeezed from the system. But new medical technologies, many highly beneficial, are driving up costs. Of course, there’s waste: surplus hospital beds, unneeded surgery and excessive testing. But even if it all were eliminated, the savings might only temporarily offset the higher costs of new technologies.
Some experts, like Dr. William Schwartz of Tufts School of Medicine, argue that cost-containment programs can’t stabilize medical spending. Time is proving them correct. Health costs are rising rapidly despite efforts to curb them. The government recently reported that the increase in 1987 was 9.8%--about double the inflation rate. High-tech medicine and affordable health care may not be compatible.
Americans generally like their health-care system. In polls, about 80% of us say that we’re satisfied, reports Jon Gabel of the Health Insurance Assn. of America. But, as cost pressures spread, today’s satisfaction may evaporate. Private health-insurance premiums are rising rapidly. Escalating Medicare and Medicaid costs are a major cause of the huge federal budget deficits.
High-tech medicine isn’t the only cost pressure. Population growth, particularly among the elderly, adds to expense. Drug-abuse and alcoholism-treatment costs are rising rapidly. One major insurer, Aetna, reports that its hospital admissions for substance abuse and psychiatric care have risen 50% since 1984. But new surgical techniques, diagnostic tests and pharmaceuticals are the main reason health costs continually outpace inflation.
The revolution in cataract surgery shows why. Medical breakthroughs raise costs because thousands, or millions, of new patients potentially benefit. New treatment has improved the lives of millions of older Americans. Everyone wants the best treatment. Doctors can prescribe it, because insurers or government pay most bills. In 1987 patients directly paid only 10% of all hospital costs and 26% of doctors’ fees.
Cataract surgery now probably costs less per patient. Patients go home after the operation, whereas they used to stay in a hospital for up to a week. To see, the patients once needed glasses with thick lenses. Surgery was a last resort for those nearly blind. Now patients with milder symptoms find it attractive. The patient load has quadrupled since 1978.
Some of this growth is wasteful--the result of doctors’ abusing a system in which reimbursement is so easy. Dr. Hunter Stokes of the American Academy of Ophthalmology thinks that 25% of the operations may be unnecessary or premature. Even without these, surgery levels would have tripled. Because Medicare pays for most, it’s as if Congress had enacted a multibillion-dollar health-care program.
With details changed, the story could be retold for countless other medical advances. Efficiencies, if any, are offset by the huge growth in patient volumes. More doctors learn the new techniques. More patients hear of them. Success rates improve. Between 1975 and 1985 the number of annual coronary-artery bypass operations jumped from 61,000 to 250,000. It’s this sort of arithmetic that overwhelms cost-control efforts.
In 1983 Medicare adopted a new method for paying hospitals that tended to limit unnecessary stays. Private insurers increasingly require advance approval for surgery. Companies are pressing employees to join health-maintenance organizations, which closely monitor costs. Between 1983 and 1985 health spending didn’t rise as a share of gross national product. But since 1985 it has jumped from 10.4% of GNP to 11.1%. In 1965 it was 5.9%.
Experts like Schwartz of Tufts think that the United States will ultimately have to ration health care--that is, deny some types of care--to prevent costs from becoming oppressive. Cost-containment programs already involve a subtle form of rationing, and these programs will grow more aggressive. Patients will have less freedom to choose their doctors. Doctors will have less freedom to practice as they please. Some companies are making employees pay a bigger part of their rising health costs.
All this will breed discontent. One man’s reasonable waste reduction is another’s unreasonable restriction. People will believe that they’re paying more and getting less. The irony is that the health-care system is a victim of its own sophistication. Advances in technology, which ought to be a cause for unreserved cheering, also have adverse side effects. Americans like to think that all good things are compatible. Sadly, the high-tech medical system does not work that way.
