How doctors’ moral obligation plays into proposals to reform healthcare in the United States.
When President Lyndon Johnson signed Medicare into law in 1965, the average life expectancy of Americans was 70. Many of the 19 million people who signed up for Medicare during that first year didn’t make it to their 70th birthday, and the Medicare budget was about $10 billion.
Over time, Congress increased the patient populations eligible for coverage – those under 65 with long-term disabilities, individuals with end-stage renal disease, hospice patients, and Americans younger than 65 with amyotrophic lateral sclerosis (known as Lou Gehrig Disease). And researchers began making advancements in healthcare, especially in cardiology,to reduce mortality in older age.
Fast forward to the present day. Medicare coverage now extends to some 50 million people, and today, the life expectancy in the U.S is 79. The $10 billion to run Medicare 50 years ago seems like chump change because the tab last year was almost 60 times larger - $591 billion in 2015. Much of this is due to Americans living into their 70s and 80s because studies have estimated the elderly consume 30% to 40% of healthcare resources.
The outspoken concern has been the cost effectiveness of healthcare, especially those proposals and ideas aimed at cutting costs. Last week, I had an opportunity to discuss this with a medical specialist. In basic and cynical terms, he said the “most cost effective event possible is sudden cardiac death,” especially at age 64, if it prevents Medicare expenditures completely. He believes there are very few medical preventions that can potentially be “cost saving.” There are very few chronic life-long diseases that do NOT affect mortality, and you can’t count cancer, diabetes, hypertension, hyperlipidemia, asthma or COPD among them.
Healthcare screenings for prostate cancer and mammograms do not save money, but we generally ignore the cost. They may, and often do, save lives. The specialist argues that taking the “financial benefits vs. cost to society” argument to its extreme could bring us to an inevitable and rather disgusting conclusion: wealthier members of society who pay a higher share of taxes should benefit more than those without the financial wherewithal to afford healthcare procedures. He says this is not the society we want to live in (and I agree). Thus, he says, the “financial benefit vs. cost” measure of a necessity of service (telemedicine or any other) is invalid, and decision-makers should reject it.
Faster access to services using technology will improve the delivery of healthcare. He gets it. But, he says it is extremely unlikely that it will save federal dollars. So, he believes the telemedicine industry should focus on improvement of the “efficiency of healthcare delivery and some specific outcomes,” like reducing the length of stay in the hospital and shortening the time gap between the onset of symptoms and diagnosis. He points out that we do not save money when we need to build better bridges, or to have better police enforcement, or to develop better weapons for the military.
Speaker Paul Ryan told Scott Pelley on CBS’ “60 Minutes” that unless Congress fixes it Medicare will go broke in ten years. And President-elect Donald Trump has made repeal and replacement of Obamacare a priority while maintaining the quality of care. The specialist warns that efforts that focus only on cost savings in either program may overshadow the moral obligation doctors have for their patients and the very purpose of providing medical care.