Monday, September 28, 2009
Bending The Curve The Right Way--Through Better Medicine, With Help From eBay
This article was first published at Fox News' Fox Forum.
In the first part of this two-part piece, I noted that the hot issue-within-an-issue for Washington healthcare wonks is “bending the curve” on healthcare costs--that is, reducing future increases.
Even Barack Obama is talking the “bend” talk. In an interview with The Washington Post in July, the President used the “b-word” no less than 11 times. In this particular passage, he said that he wants to bend the cost curve, not only for government expenditures, but also for private-sector expenditures. “The problem we have in this whole debate is that bending the cost curve, curbing health care inflation, is harder to measure in part because it doesn't just involve government outlays; it also involves what's happening in the private sector.”
But of course, talk of “bending curves” is simply a fancy way of saying “cuts.” As Howard Gleckman observed earlier this year in Business Week, “When it comes to Medicare, ‘bending the curve’ means rationing care.” Got that? And since Obama mentioned private-sector expenditures as well as government expenditures, we can assume that he wants to extend rationing to everyone.
But as I also noted, head-on attempts at “bending the curve” are doomed to failure, at least in a small “d” democratic society. Why? Because poll after poll shows that the American people think they should be getting more treatment, not less. And they vote accordingly, which is why Obamacare is in so much trouble.
So what’s the answer? Are we doomed to ever-escalating healthcare costs because people want more treatment? No. We are so “doomed” only if we see health care and medicine as static and unchanging. But if, instead, we see health care and medicine as dynamic, if we see that the variables of health and medicine can be changed--as when, for example, a new or improved treatment comes along, or even a cure--then it’s possible to see hope for outcomes that are not only cheaper, but better.
And that hope is well-grounded in medical history.
We might consider, to start, the humble headache--although, of course, for those suffering from a migraine, there’s nothing humble about it. In the dark past, and yet not so long ago, some extraordinarily awful “cures” have been attempted; for example, there was trepanation--drilling a hole in one’s head to let the bad stuff out. Needless to say, trepanation was among the many “cures” that didn’t cure very well.
But then in the late 19th century came aspirin. Aspirin was the wonder drug of its day, and to many pain sufferers, it still is. And yet while aspirin was plenty expensive to research and develop in its the 1800s, today it is off-patent and mass-produced, so it’s cheap and abundant.
So what’s the lesson here? The lesson is not to “bend the curve” on ineffective methods for curing headaches--finding cheaper ways to drill holes in heads--but instead, to find effective methods for curing headaches. Effective is better than ineffective. Effective means bending the curve the right way. And over time, the curves of those cures will be “bent upward,” even as new varieties are introduced to the market, so that every niche need is properly serviced.
The same model applies, as well, to historically more lethal diseases. Thanks to the dynamism of science, we didn’t just bend the curve on smallpox, we flattened the curve on smallpox. A malady that was killing millions of people a year into the 1960s, smallpox was officially declared eradicated by the World Health Organization back in 1979. As in, no more. Instead of humans being kaput because of smallpox, the smallpox virus is kaput because of humans. Yet if we hadn’t eradicated smallpox, today we’d still be talking about “bending the curve” on smallpox, which would mean, for example, figuring out ways to squeeze savings from smallpox hospitals. (And of course, we would also be struggling to calculate the economic harm done by the loss of those who were killed and disabled by the disease, although health care bean-counters rarely worry about questions of lost economic output; they focus only on direct healthcare outlays.)
Now let’s take a more current example, a disease wrecking lives today: amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease. Every year, 5,000 new cases of ALS are diagnosed; when the diagnosis is made, treatment can easily cost $200,000 a year. Most patients live two to five years after diagnosis, which means that a single case of ALS could easily cost hundreds of thousands of dollars, and on into the millions. So how to bend that curve? Only the hardhearted would say of ALS victims, “Well, they’re going to die soon anyway, so let’s cut back and let them go quickly.” The rest of us would say, “We need to do what we can for these unfortunate people.” And then we would add, “But of course, it would really be great if we could figure out a cure!” Indeed, the best and also cheapest way to deal with ALS is to eliminate ALS, so that it goes the way of smallpox.
That makes sense, doesn’t it? As Robert Frost observed, “The best way out is always through.”
Just on Monday, ALS sufferers, and their families, received some good news. The Food and Drug Administration approved for clinical trial a new treatment produced by Neuralstem Inc., based in Rockville, MD. There’s no way to know how these trials will turn out, but now there’s hope--hope founded in the vast success that Serious Medicine has enjoyed over the centuries.
If we did it with headaches, and we did it with smallpox, then we can eventually do it with ALS--if we keep at it.
The same Robert Frostian best-way-out-is-through logic also applies to medical devices and techniques. Let’s take another example of a medical device that’s so embedded in our thinking that we have forgotten how hard it was to develop: eyeglasses. The idea of using corrective lenses goes back more than a thousand years, to the 9th century; the first wearable eyeglass is thought to date from the 13th century. Yet even rich people were poor back in those days, and so the work of inventors and craftsmen over all those centuries represented, in relative terms, an enormous investment. But thanks to their accumulated good work, eyeglasses today are cheap, and so are contact lenses.
And now we have other eyesight-improving procedures, such as LASIK. As the spelled-out name--laser-assisted in situ keratomileusis--suggests, LASIK is not easy. Or at least it wasn’t easy to invent and to refine. But now that the procedure has been invented and refined, it has become easy--at least easy to pay for. Indeed, it’s now possible to shop for LASIK on eBay. Now that’s bending the curve!
I could cite other examples, too, such as minimally invasive, or laparoscopic, surgery, which is in the process of cost-crashing more and more kinds of surgical procedures.
So this is how we “bend the curve” in a politically and ethically acceptable fashion: We research and develop new approaches, which are faster, cheaper, and best of all, better. The only kind of healthcare cost control that will work over the long run is healthcare improvement. That is to say, Serious Medicine.
Medical history tells us that this is so, and common sense underscores that point as well. So why are the healthcare policy elites talking about “rationing” when they could be talking about improved health and lower costs?
Are you curious about that? Good! Then why not ask your elected official exactly that question at the next town meeting?
UPDATE: News out of Thailand tells of a huge possible breakthrough--a vaccine against AIDS. The vaccine effort, financed by the US government, appears to thwart transmission of the disease in Thai trials. If this finding bears out, it will be huge, knocking out a disease that has killed tens of millions. And that will be another example of cost-curve-breaking, as opposed to just a cost-curve-bending. We need more of those.
Posted by James P. Pinkerton at 7:25 PM