Agraphia Medical Tragicomedy


Back on my soap box!

Computer: fixed!

Alright folks, you're in for a long read, so sit back, grab some popcorn, and slog through this diatribe on healthcare policy!

I went to an AMA-sponsored conference today. Don't tell anybody, but I just went for the food. I'm starting to think that a lot of these "conferences" for the rest of my "professional life" will be similar. Go for the food, and the tax-deductible plane ticket to New York... maybe attend a lecture or two. It's kind of like college and free pizza, only upscale.

Anyhow, it turns out the conference was pretty awesome. It was an overview from the AMA (read: Republican. AMSA is the Democratic, opposing organization) about healthcare reform. Healthcare reform, by the way, is everyone's hotbutton issue lately. That, "be nice to your nurses" and "treat your patients like humans". Interesting what a change that is from what was taught 30 years ago.

One of the most interesting ideas brought up at the conference was that of prioritization. Depending on the stats you read, ~1% of people use 25% of the money, and the next 5% use 55%. Of course, this is entirely the point of insurance: you aren't expecting to get cancer... but when you do, your individual costs are defrayed in the "risk pool" of your other insurance-mates. Oregon attempted to reign in skyrocketing costs in the late '80s by implementing the Oregon Health Plan, which is now defunct (through political backstabbing). The OHP attempted to take the most common 800 procedures and rank them in terms of efficacy, by weighing cost vs. outcome. Anything below "the line" was simply not covered. Appendectomy was their poster child: it is a routine, relatively cheap procedure performed that is lifesaving (usually on a young, previously healthy person). They decided that this procedure had immense worth to society. Other things, such as artificial heart implantation, cost millions to implement and saved someone a couple months of life, at most.

Of course, this wades into a massive moral quagmire. Do we not cover life-saving procedures simply because they cost too much?

The argument, of course, is this. If your 20-year old car broke down and the mechanic, in his esteemed opinion, said that the axels were shot, the battery was going, the gearing was stripped, the engine was corroded, and it would cost him $20,000 to fix it up in parts and labor, would you do it? Of course not. It may be crass to compare people to cars, but the analogy works.

Now take that same $20,000 and buy tires for everyone who has a flat. That's an awful lot of cars that you just put back on the road, for the same price as fixing one that was poorly kept (or, lets face it... too old). That was fundamentally the basis for the talk we got. Assuming that the insurance company only has $20,000 to spend, it would be criminal to blow it all on a single person.

So, in the end, that's where we are. 46 million people in America are sitting on the side of the road with flat tires, while people who can afford insurance get bumped into the arena of care where 22-week old premature babies cost millions to save, and 90-year old women get neurosurgery. The talk was particularly good because the keynote speaker was willing to take a relatively unpopular stance: that you can't justify spending millions and millions of dollars on new, massively expensive procedures that don't do much good.

As a last aside, people that go down to Ecuador to provide charity care don't bring full surgical and radiological suites with them. They bring antibiotics, because for a very small amount of money you can do a huge amount of good. The same concept needs to be applied to our healthcare system- start from the ground and build up.


Also, know who I haven't seen many people point the finger at? Big pharma. Think back to the last time you watched TV. How many ads did you see for Lunesta (with that glowing butterfly)? How about Ambien? Pop quiz, hotshot: how much money did Sepracor, the parent company, spend advertising Lunesta this year? $60 million. Total revenues for the new wave of sleep drugs (Lunesta, Ambien CR, Indiplon, Ramelteon) are projected to hit $4.4 billion by 2009.

So here's my question. $4.4 billion dollars. Where does it come from? A quick Google search reveals that Lunesta costs $3.50 for one tablet... which means that an insomniac will rack up $1277.50 a year for their Lunesta prescription. So if they are paying a fraction of that cost via copays... where does the rest of the cost of the prescription come from? Bingo. $4.4 billion have just been added to the overall cost of our health care, which we'll collectively see as higher premiums.

Another interesting point that was brought up is that drug companies lump marketing R&D into their overall R&D budgets. Pfizer, for example, spends $3 billion a year on advertising. R&D costs were $7.7 billion. Without taking into account the marketing R&D, Pfizer spent almost half as much on advertising as they did on research. Again: where does that money come from? The $3 billion spent on advertising has to be coming back to the company in the form of revenues. Otherwise they wouldn't be spending it. Which means (drumroll, please) that that extra $3 billion is indirectly being paid for by the end-healthcare user. Like it or not, you're paying to see that damn butterfly interrupt your Seinfeld reruns. Forbes magazine cites a total Big Pharma advertising budget of $25 billion per year.

Now, to be fair, $25 billion is a drop in the bucket of the $1.9 trillion (16% of US GDP) that we spent in healthcare in 2004. But every advertising dollar must be bringing in revenues, otherwise they wouldn't be spending it. Just imagine how many people are going to suddenly develop sleeping problems because of the fact that there are drugs to treat them. My point is, advertising drives spending.

Quick aside, by the way. I would never try to defend any of these statistics, because they change depending on what source you get them from. Its a little frustrating, actually.

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  1. Excellent form, Zac, excellent form.

  2. There are some things that bother me about your editorial, here, Zac:

    -I certainly want to be taken care of when I get older. That’s why it’s called health insurance. I’m pumping money into the system now when I’m young and healthy so that I can be taken care of if I get sick when I’m older.

    -Insurance companies are playing god. Why does the insurance industry get to decide who lives and dies based on a cost/benefit analysis? The artificial heart you speak of is not used to extend life for a few months, but to bridge the time gap until heart transplantation.

    -Try telling any patient that they don’t have enough money to live. This is certainly an argument against health savings accounts, and both your argument and mine are conducive to the fact that we need global health care.

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