Survival At Any Cost – Why Health Costs Rarely Go Down

There is a land of the living and a land of the dead, and the bridge is love - the only survival – the only meaning.

Thorton Wilder (1897-1975), The Bridge of San Luis Ray (1927)

December 30, 2011- I knew a surgeon, John Najarian of the University of Minnesota, who did organ transplants. “Dick, “ he said to me, “I never knew a patient who didn’t want to live another day.”

To patients, in other words, medical care is all about survival

I thought of John as I read an article in today’s New England Journal of Medicine entitled “The Savings Illusion - Why Quality Improvement Fails to Deliver Bottom-Line Results.” Its four authors, from the Dartmouth Institute for Health Policy and Clinical Practice, maintain quality care rarely saves money because of structure of medicine is designed to save lives.

That’s what we doctors are here for – we love to save lives, and that’s what patients want – they would love to live another day.

I did not completely follow the logic of the Dartmouth people until Stuart Gitlow,M.D., writing in an AMA website “Take Back the Professional Advisory Group,” explained it to me. The Advisory Group, a provision of Obamacare, is designed to have the last word on lowering doctor pay, and Congress cannot override its decision.

Doctor Gitlow’s decision is simple – and profound.

Everybody wants to survive another day – at any costs. Sink or swim, live or die, and survive or perish- when it comes to living or dying- money is no object.

Here is Doctor Gitlow’s explanation.

“What these authors ignore is that the expected healthcare cost is infinite. That is, humans have one priority that outweighs all others - survival. Survival is more important than housing or eating. And survival in later years can be achieved only at increased cost.

Housing does not have an infinite cost - there is a basic need for shelter which can be met inexpensively. Food does not have an infinite cost - there is a maximum food intake for any one individual. Survival, on the other hand, not only can cost as much as one is willing to spend, but we want to spend as much as possible so as to live as long as possible in as healthy a manner as possible.”

“If I have $1000 to spend, and I can choose to spend $500 on my house and $500 on my food, but I'm dead, that was poor planning. I'd much rather spend $1000 on healthcare and live in a shelter eating table scraps. “

“The goal of any one person is, therefore, NOT to reduce healthcare costs but rather to increase them.”

“Each time I hear that healthcare costs are taking a larger percentage of each dollar spent, I am pleased, for it is certainly my perspective that the bulk of my future expenses should go toward my survival and my family's survival.”

“One day, perhaps this will change. Perhaps we will discover the gene/s responsible for aging of cells, and determine a method of turning aging off. I wonder how we might approach that fork in the road for then the equation would change - healthcare would be inexpensive but the supply of people would be infinite. Other factors would then become limiting.”

Tweet: The goal of doctors and patients is not to reduce health care costs, it is to survive.