WILMINGTON — The cost of health care has been rising at twice the rate of inflation for about 30 years. It continues to rise at almost 14 percent per year and may be getting worse.
The health-care industry is very creative and devises marvelous new treatments and procedures. But the health care industry is a business. It needs to make money.
The net result is that it develops myriad new treatments but not many cures or preventions. All the new high-tech drugs and procedures are long-term. Many of the vaccines we have today were developed 30 or 40 years ago.
If Pfizer developed a drug that cured arthritis, it would be used once - not daily for 30 years. So Pfizer has many arthritis drugs and has become one of the most profitable companies in the country. The cost of treating arthritis continues to rise as the industry develops better and more extensive treatments.
It is worth studying why health care has seen such radical increases.
There is no doubt that the technology has improved dramatically. We treat things we didn't even know about in 1950. Drugs are available for every ailment you can imagine. Just look at your television screen, and you'll find that about one quarter of the ads are for some pill or elixir or machine that will treat your medical symptoms.
“Sure, go ahead and eat burgers and fries every day and gain 60 pounds - we have a marvelous pill and a diet plan to fix it.” But none of those pills actually cures the problem! At best they manage it. Treating symptoms is a long-range project, and a bonanza for drug manufacturers.
We spend billions of dollars each year developing new drugs, new procedures, and new machines to treat the ills of society. But the focus remains on treatment - not the prevention or cure. That approach has created an overwhelming increase in medical costs.
Yet, our government spends literally billions of your tax dollars supporting development of these “miracle drugs.” Forty-four percent of medical research in the U.S. is supported by government subsidy. Taxpayers spent $28.4 billion on drug research in 2005.
We do have a few vaccines that actually prevent measles, polio, flu, and pneumonia. But if you worked at Pfizer, which would you prefer to make - measles vaccine or Viagra?
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Developing a universal health care system will be an impossible task if costs continue to grow at such high rates. How can we put the brakes on such inflating health care costs?
One look at the current system, and you'll see why it is out of control. The Department of Health and Human Services and its subsidiaries, the Food and Drug Administration and the National Institute of Health, subsidize the drug companies to the tune of $4.9 billion a year. This money goes to one of the most profitable industries on earth - an industry that made a 19.7 percent profit last year.
Grants to the drug industry should be much better controlled. For example: no research grant should be made to any drug company for development of treatments - only for prevention or cure.
The results of research are rarely accurately predicable. If a drug company develops a treatment with their research instead of a cure, that's OK, but 20 percent of its profits should be taxed until the grant is repaid twofold or threefold.
Drug companies are perfectly capable of supporting their own research on profitable treatments. Since they are remarkably profitable, that is where their research efforts go.
But American drug companies accept those federal grants, then charge the American citizen who supplied the funds more than any other country for the drugs that they develop. That is immoral and ought to be illegal.
It is outrageous that American-made drugs can be purchased for less in any other country. Your tax dollars should not be fed into that process. There should also be a ceiling on the profit margins of drugs developed by companies that accept federal money.
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The drug and instrument manufacturers will make huge profits on many new products that treat many self-imposed ailments.
Obesity is getting to be a serious national problem. Although it is largely a result of the prepared-food industry that makes delicious, but unhealthy, food ubiquitous, it is at least partly due to the many drugs and treatments that lower cholesterol, reduce blood pressure, or clear plaques from the blood vessels. Drug manufacturers literally invite you to eat bad things because they can cure you.
But obesity is largely self-imposed. Why should tax dollars pay to develop profitable treatments for avoidable ailments? Tax dollars should support prevention and education rather than control. They should teach people to eat a healthy diet rather than treat the problems after they occur.
Plenty of us will require management and control to keep the treatment industry thriving. But it would be better if fewer of us needed it.
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Another way to achieve affordable universal health care is to do it stepwise. We should first pass a law that supplies prevention or cure for every citizen - not for treatment, just for existing preventions or cures.
It is peculiar how practices change to follow sources of money. When prevention-and-cure dollars are assured, more effort will be applied. This will have a measurable effect on the health-care costs. As we gain control of these costs, the law might be expanded to cover certain treatments whose numbers will expand as the costs become manageable.
Drugs are not only the only source of waste in our medical system. We have a more complex issue of diagnostic tests.
Currently, the more tests you run on a patient, the more Medicaid, Medicare, and other medical insurance plans pay. That is aggravated by the litigious nature of our society, in which we sue others for anything that happens to us. This is largely because lawyers entice patients to seek large settlements so they can receive a 25-percent, 33-percent, or even 50-percent fee.
Doctors, whose malpractice insurance premiums have skyrocketed, will run as many tests as possible to avoid being sued for negligence, which will further increase their already-exorbitant premiums. Since insurance pays for the tests, they run as many as they can.
We need a law that restricts lawyers' fees to 15 percent on medical malpractice suits. That would slow down the lawsuit explosion, and allow doctors to run tests as they see fit. Let's have a medical system, not a legal one.
In that system, we should require hospitals and clinics to show good cause for running expensive diagnostic tests of doubtful pertinence to the case at hand.
Today, when a patient shows symptoms, doctors and hospitals run batteries of tests to analyze them in minute detail. But relatively few ailments require all that testing. Many years ago my doctor found my heart problem in his office with a stethoscope. He ordered a battery of tests.
The diagnosis didn't change at all, but it cost me $5,000.
I suggest that government oversight committees, cooperating with hospitals and physicians (not insurance companies), establish a series of test procedures for various symptoms. If the first level identifies the problem, no more tests are run. If not, the second level of test is ordered. And so on.
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Perhaps we should consider an excess-profits tax for industries that dominate any public services. We had such taxes in World War II, and they did prevent some excessive gouging of Uncle Sam by military subcontractors.
When a company gains dominance of a vital resource, it should then be held accountable for its equitable delivery. Such anti-monopoly (anti-trust) laws have existed for a long time. They were used to break up Standard Oil before 1920, and to break up AT&T in the 1980s. If profit is the sole reason for making a drug, perhaps we should consider another drug.
Most industrialized nations have national health care programs. Our American system, operated by insurance companies, provides less coverage to a smaller percentage of people and for a greater cost. It strongly supports those who have enough resources to afford health care.
We hear loud and dire warnings from the insurance companies against having nationally operated or universal medical coverage, but the system we have isn't working. So what's the problem? Medicare is not a perfect system, but it works. It costs about 15 percent of the insurance company plans!
The warnings about a single-payer system emphasize the problems that can arise. No system can avoid all problems. Canada, France, Cuba, Norway, and Sweden all have systems that provide better coverage for more people at a lower cost than our current system. Shouldn't we at least give that a look?
The opposition comes from those now in the dominant position. They stand to lose their current income unless they make their system more responsive to our national need. If they can, let them continue. If not, let's emulate the alternative that works best. We will get a picture of where the problems lie, if we can follow the dollars. But the perpetrators of our current system keep those numbers obscure.
The primary reason that medical expenses get out of hand is because there is inadequate oversight. No industry serving the public need should be self-regulating. That puts the industry into a conflict of interest.
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Abuse is not a one-way street. Not all the blame falls on the insurance companies. A fair amount of it falls on ambulance-chasing lawyers who tend to squeeze the system for all the money they can get - deserved or not. Advertisements by lawyers claiming that they will get you a large settlement if you ever used a Guidant pacemaker are outrageous.
And some of the blame falls on patients who don't seek regular medical attention but go to the emergency room when the problem gets out of hand. Making the ER your primary care center is enormously expensive and wasteful.
It will take a multifaceted approach to make universal health care effective and affordable. The problem is complex and will require many solutions.
But we should at least get started. Got a better idea?