The further to the left or the right you move, the more your lens on life distorts.

Tuesday, August 11, 2009

Rationing the Future

Dean Kamen is one of this country’s most prolific inventors, holding over 440 patents primarily in the medical field. He was interviewed in Popular Mechanics, and his views on the health care debate are interesting and honest. I’ll present a snippet here but you should read the entire interview.
Popular Mechanics: The federal government is considering major healthcare legislation that may have implications for medical R&D as well as the treatment of patients. What do you think of the current proposals for reform, inside and out of Congress?

Dean Kamen: I'm very worried that the entire debate over healthcare is a misguided attempt to deal with a subject nobody really wants to deal with openly.

PM: In what way?

Kamen: Well, I mean the whole supposition that "We have a crisis in health care." Our health care system has seen some of the greatest achievements of the human intellect since we started recording history: We're developing incredible devices and implantables to improve the quantity and quality of people's lives. We're developing pharmaceuticals that alleviate the need for surgery and eliminate the volatile effects of diseases. We're making the surgeries that are necessary ever less invasive. You can get a stent through your femoral artery all the way up into your heart and fix a blockage without surgery. I'd say, if we have a crisis, it's the embarrassment of riches. Nobody wants to deal with the fact that we're no longer in a world where you can simply give everybody all the health care that is available.

Each side of this debate has created the boogieman and monsters, like "We don't want let this program to come into existence because that will mean rationing." Well, I hate to tell you the news but as soon as medicine started being able to do incredible things that are very expensive, we started rationing. The reason 100 years ago everyone could afford their healthcare is because healthcare was a doctor giving you some elixir and telling you you'll be fine. And if it was a cold you would be fine. And if it turns out it was consumption; it was tuberculosis; it was lung cancer—you could still sit there. He'd give you some sympathy, and you'd die. Either way, it's pretty cheap.

We now live in a world where technology has triumphed, in many ways, over death. The problem with that is that it's enormously expensive. And big pharmaceutical giants and big medical products companies have stopped working on stuff that could be extraordinary because they know they won't be reimbursed, according to the common standards. We're not only rationing today; we're rationing our future.

A money quote from later in the interview summarized the most honest view of high tech health care: “Nothing that has value, real value, has no cost. Not freedom, not food, not shelter, not healthcare.”

But the costs are high aren’t they? We did spend $260 billion on pharmaceuticals last year, and that is a lot on money. Kamen responds:
That means all those vaccinations to prevent diseases, all those pills to treat diseases, all those pills to cure them so we don't have to treat them anymore.

Is it worth it? Are we paying too much?

To put things in perspective. We spent $121 billion on soft drinks and $90 billion on alcoholic beverages. We spent $409 billion on professional sports. Kamen comments:
Now if somebody in this country wants to explain to me that we ought to be spending about twice as much supporting sports as on all of our pharmaceuticals, then stop spending. You don't like that drug? You don't want to cure this disease? Don't buy it. But don't make villains out of people so that we can turn what is a real social responsibility issue into a political debate.

And that’s what is dishonest about the comments made by some players in this debate. They want to demonize entire industries, suggesting the profit is a bad thing. Even though the drive to create profit has resulted in medical advances that are the envy of the world.

Take the time to visit an old cemetery and take note of the ages of people who were buried prior to 1950. Those folks spent relatively little on medical care, but their lives were often cut short by diseases that can be readily handled today—not with surgery but with a pill.