PERSPECTIVE ON HEALTH CARE : Medical Miracles Have Faustian Trade-Off : Every ‘success’ that postpones death deepens the fiscal black hole that will face the next generation.

Marshall McLuhan once observed that “nothing fails like success.” It is worth keeping in mind as we reform our health-care system. The more successful we are in treating acute disease, the more we must spend treating chronic disease.

Most of our “miracles” of medicine set us up for more expensive health care down the line. Most studies show that the lifetime health-care costs of smokers are substantially under those of nonsmokers. In any given year, we spend more on health care for smokers because it is a health-impairing habit. Yet, from a systems standpoint, smokers die efficiently. Smokers generally die of their first or second disease, while the rest of us are saved from four or five serious illnesses before we die a negotiated death in a hospital or nursing home. The same results follow many of our “cures.” We have reduced mortality, but have increased morbidity. Our medical miracles too often become our fiscal failures.

This does not mean we should stop fighting cigarettes. We need a smoke-free America because it will make us more healthy and productive--but it will not, in the long run, save us health-care costs. Those 400,000 people still die having consumed far more health care.

This public-policy dilemma affects our policy. Neonatology miraculously saves 500-gram babies, but it also gives us a significant number of disabled. Because we all must die of something, almost every “success” ends up costing us more health-care dollars and usually more Social Security dollars.

The Population Reference Bureau published a study, “Death and Taxes,” which found that curing cancer and curing heart disease would increase federal spending. They were not arguing that we shouldn’t try, but they wanted us to realize the consequences. They found that “the postponement of death increases federal costs, requiring more taxes.” Like Faust, we were not fully aware of the trade-offs.

Reform we must, but with open eyes. Of course, we should continue to “cure” disease, but we cannot “cure” death. Chronic disease at the end of life is far more expensive than acute disease in mid-life. Health care is a fiscal black hole that can absorb all our children’s resources. We need a deeper dialogue on how we set limits. We have invented more health care than we can afford to deliver to everyone. Unless we set some limits on “high-cost/low-benefit” procedures, we will bankrupt our children.