Sunday, September 27, 2009

Does Obamacare Make Room For Medical Miracles? Or Are Miracles Just Higher Costs? And How Will The CBO Score The Gift of Sight?

How will President Obama and his healthcare team react to a medical miracle? And how will the Congressional Budget Office score it? If a blind person gets a sight-saving procedure, is that a worthy, even heroic expenditure? Or is it just a bigger medical cost?

These questions go right to the heart of the current debate over healthcare policy, because they remind us that "healthcare policy" is not an end in itself. Healthcare policy is a means to an end. The end is better health for Americans. Better health that Americans can feel, touch, and, in this case, see.

The New York Times' Pam Belluck sheds valuable light (pun intended) on the increasing power of medical technology to restore sight. For example:

Sharron Kay Thornton, 60, from Smithdale, Miss., blinded by a skin condition, regained sight in one eye after doctors at the University of Miami Miller School of Medicine extracted a tooth (her eyetooth, actually), shaved it down and used it as a base for a plastic lens replacing her cornea.

It was the first time the procedure, modified osteo-odonto-keratoprosthesis, was performed in this country. The surgeon, Dr. Victor L. Perez, said it could help people with severely scarred corneas from chemical or combat injuries.

Now we might ask: How would the Congressional Budget Office "score" these research and medical expenditures that the Times reported on? What's the "fiscal impact" of the blind being able to see?

Should we "bend the curve" by telling Dr. Perez to slow down his efforts? I imagine that Dr. Perez would love to make his procedure cheaper and better and more available to all who need it, but the only way to do achieve such economies of scale is by expanding the procedure and repeating on many more patients, so that the cost of the underlying R&D for "modified osteo-odonto keratoprosthesis"--soon, we can imagine, in the spirit of LASIK, to be acronym-ed into, say, MOOK--is amortized over the widest possible number of beneficiaries, here in the US and around the world. And if this procedure could be spread around the world, it could be an attractive and profitable export, of a kind, for the US.

But we have to get there. And right now, the national policy trend is headed in the other direction.

It's a grim quip that doctors bury their mistakes. Well, it can also be said that bean-counters seek to bury their costs. Even if what looks like a cost to the government is a great gift to another human being.

But sometimes, bean-counters don't bury their costs, they merely blind them.

So back to my original questions: How will Obama and his healthcare team react to a medical miracle? And how will the CBO score it? Only one way to find out.

But my guess is that they will ignore everything in this Times article. Why? Because powerful leaders and experts in Washington DC do "healthcare policy." They don't fool, in any way, with "cures." Especially if those cures might cost more money.

1 comment:

  1. Jim: If America gets to the point that we proceed into Universal Health care, I would totally give up on innovative research and development and wonder if the new medical system could even handle primary and specialized care meaning regular stuff. In my old neighborhood in Upper Manhattan in the 1950's, a nervous breakdown often resulted in a disappearance. Do you realize that thirty years ago the mentally ill were treated by being electrocuted out of their thoughts? Today in modern 21 Century psychiatry, although genetically furthered and incurable, can be "cured" in a semantic sense with two week stays and in a de facto evaluation, patients essentially are not ill anymore even going on to success. President Obama has given us a heads up that he is going to tinker with the mental health system, a nuanced and niche area of medicine that in some way affects 50 million Americans and those around them. You all heard his ebullient rationale of switching the blue pill with the red pill. Those of you have suffering patients in your family know very well that rationing in the mental health field or causing people to switch physicians or reducing hospital time is bad for families and society. The Clunker Program did not work and I firmly believe that although this country requires health care reform, it is better to stay with the dog you know and fix it then go to that unknown dog that you do not know.