Thursday, July 15, 2010

“ I Feel Like A Million Dollars.” The Case of the 80 Year Old Driver. Obamacare in Perspective

Yesterday, because of a broken Tie-rod which rendered my car’s steering inoperable, I paid a driver to take me to a doctor’s appointment.

During the ride, the driver confided to me he was 80 years old. I asked about his health. He replied,” I used to be totally disabled. I couldn’t walk. But thanks to a spinal fusion, two hip replacements, two knee replacements, two cataracts, and a heart pacemaker, I feel like a million dollars. Now I can work, I can see, I can drive, and I can even run.”

Give the matter any thought at all, and you will realize.

• The driver’s experience is what differentiates the U.S. from other nations, who ration these procedures. In the process, they create waits of months to years.

• Why seniors are so leery about Obamacare, which calls for $575 billion cuts in Medicare over the next ten years, and why remarks of Doctor Donald Berwick, Obama’s designate as head of CMS is so provocative to critics, “The decision is not whether or not we will ration care -- the decision is whether we will ration with our eyes open.”

Only time, the ten years it will take to roll out Medicare reform, will tell if this skepticism is justified.

In the meantime, we can ask these questions: Why is U.S. health care so expensive? Is it worth it? One reason is that U.S. citizens, no matter what their age, have quick access to high tech procedures that restore them to normal or near normal function.

Our driver, disabled and unable to walk, was restored to employment, to feeling well, and to being able to run.

It is useful to consider the cost of these various procedures, among the commonly performed in the U.S.

• Hip and knee replacements, about 1 million of these will be done this year in the U.S., at the cost of about $50,000 each. This amounts to $50 billion to the U.S., and $200,000 for the driver, who had four replacements.

• Spinal fusion, about 150,000 patients will undergo this most common spinal operatio.n. At $70,000 per fusion, this will cost the U.S roughly $3.5 billion.

• Cataracts, 3 million per year, at a cost of about $4000 each.
This totals about $12 billion, and $8000 for our driver.

• Heart pacemaker and heart support implants, 100,000 per year, at a cost of about $100,000 each (pacemaker costs + operative + inpatient costs). $10 billion to U.S. and about $400,000 for the driver.

These costs are approximations. They are averages. They will vary with the complexity and nature of the various procedures. Nevertheless, they represent huge expenditures, $75 billion to the U.S. and $400, 000 for the driver. If one factors in such additional expenses as drugs, lab tests, and imaging (CTs, MRIs), the costs are undoubtedly much greater, perhaps even double, maybe close to $1 million for our driver.

Are these expenditures worth it? They are to the driver, who feels like a million dollars. And they are to the 47 million Medicare recipients who expect these procedures to be done when they need them.

How can the government reduce these costs?

• One, by overt or covert rationing.

• Two , by reducing fees for physicians , hospitals, and rehabilitation facilities.

These will not be easy decisions for the Obama administration to make. The fact that indications for these procedures – pain, disability, immobility, and heart failure – are usually clear cut makes decision-making even more difficult.

The case of driver who, thanks to effective medical care that made him fully-functional, puts the matter in perspective.


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