Thursday, August 27, 2009

Heroic medicine vs. public health, part II

In the previous post, I described some hypothetical trade-offs that might need to be made in a health system with strictly limited resources, such as the British or Canadian systems, for example. Critics of those systems point out that the beauty of the U.S. system is that we can choose to pour in more resources whenever we want - and indeed, over the past 25 years, we have done just that. Spending on health care now accounts for about 17% of the gross domestic product (GDP), and with new treatments and technologies being added every year, that percentage has only been climbing. Not only do we spend more of our wealth on health care than any other advanced country in the world, since our GDP is far larger than any other country's, we outspend them by almost twice as much ($6600 per U.S. citizen vs. $3800 per French citizen in 2006, for example). Who's paying for that difference? You are, in the form of lower raises in salary and increased cost-sharing.

I've already mentioned many good things that we don't get for these immense amounts of money: free immunizations and other preventive care, primary care physicians for all, etc. But what else would we do with the billions of dollars we currently spend on "heroic medicine," such as inserting cardiac stents into 90 year-olds, keeping comatose patients on dialysis, using feeding tubes and artificial respirators indefinitely in patients with no hope of recovery?

Well, we could build more sidewalks. Or playgrounds. Public parks. Biking paths. These are the sorts of improvements that are designed to improve the public health - to encourage people of all ages to live healthy, physically active lives. In communities with the highest rates of obesity and diabetes, you generally won't find these sorts of improvements. So when certain members of Congress ridicule public health spending as irrelevant to health care reform, I'd like to invite them to take a look at the less touristy parts of my home town of Washington, DC. Let's take a look at the meager options some people have to make healthy life choices. Let them see exactly what they're trading off for the heroic technological interventions that do little to improve the health of my community and yours.

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