How to Fix Costs of Health Care? Let’s Do the Math

Gregory Jackson, M.D. — Thu, 10 Sep 2009 17:00:27 +0000

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We’ve been hearing a lot lately about how we can’t have true health care reform without substantive cost-cutting. Dr. Abraham Verghese of Stanford University recently wrote in the Wall Street Journal, “The bottom line is that our health care is costly because it is costly, not because we deliver more care, better care or special care. Alas, a solution that does not address the cost of care, and negotiate new prices for the services offered will not work. … if [President Barack Obama] is to be the first President to successfully accomplish reform there does not seem to be much choice: cut costs.”

I couldn’t agree more. But the whole health care debate going on right now seems to be looking for ways to reduce cost by reducing services when we should be looking to reduce the cost of services.

The good news is that costs can be reduced without stifling research in pharmaceuticals and medical device development or without forcing insurance companies out of business. The easiest way to contain costs to is to make sure people are healthy and to intercept diseases early enough to treat them successfully. In fact, it would be helpful to look at the real costs of preventive care versus a serious illness.

In my family practice, I focus on prevention by conducting comprehensive physical examinations and various screening tests to determine how healthy my patients really are. Some patients come in every year, others every 18 months or two years. Let’s say that a patient comes in at age 30 and then has comprehensive physicals every 18 months until age 60. That would be 20 physicals at approximately $2,000 each, or $40,000 total. And let’s toss in around $5,000 for preventive or interceptive treatment for anything that comes up, since most serious diseases –– like cancer –– if detected early, can be easily prevented or managed. That’s a grand total of $45,000.

Now, let’s look at the costs of full-blown diseases. Has anyone checked the price of chemotherapy lately? Chemo for breast cancer can run $80,000, and that would be after surgery, hospitalization, imaging, radiation, and other specialists, which could all total $150,000 or more.

Death from colon cancer is the third most common cancer death in both men and women. It can be prevented or detected early by performing colonoscopies. Treatment of this disease if not caught early results in major surgery, lifestyle changes –– such as colostomy (a bag that collects body waste from a diversion of the colon to the abdominal wall) –– and expensive chemotherapy for many patients. Again, the cost for treatment can run higher than $150,000. Yet precancerous polyps can be easily removed during screening colonoscopies conducted every 5 to 10 years for around $1,200, before they have a chance to grow into colon cancer.

The number one overall killer is heart disease. Sadly, heart attacks can be inexpensive because often the first symptom of heart disease is death. For those who are fortunate enough to make it to bypass surgery, the costs alone can be as high as $25,000 to $30,000 for an uncomplicated case. Angioplasty costs are around $15,000 to $18,000 per case. That doesn’t include all of the follow-up medications, appointments, and other procedures, months of recovery and rehab, or serious lifestyle changes. Prevention of this disease obviously begins with diet, exercise, cessation of smoking, and stress management, most of which are relatively inexpensive.

Screening is also necessary to identify other major cardiovascular risk factors such as high blood pressure, high cholesterol, and diabetes. Other tests, such as cardiac stress testing and echocardiography, which is a soundwave study of the heart, can also assist heart doctors in predicting a patient’s chances of dying of this disease.

You’ll hear many allegations that screenings are not necessary and drive costs up. Granted, performing an echocardiogram every couple of years can cost around $300 to $650, but that is lot cheaper than triple bypass surgery. The American Heart Association estimates that in 2009 alone, cardiovascular disease will cost $475.3 billion, an astounding figure that includes direct costs (such as doctor’s fees and hospitalization) and indirect costs, which includes lost productivity from the illness or death. If you want to do some math for comparison, multiply our $45,000 preventive physical cost by all 305 million Americans and we’d end up with $13.725 billion over 30 years, a mind-bogglingly huge savings.

I can guarantee this: We and our loved ones will experience outcomes that we will regret if we do not do everything in our power to prevent or intercept disease. How are we going to feel when we learn that someone in our family has a terminal illness like lung cancer, which could have been detected much earlier through a simple annual chest x-ray? No cost can match that, the price of loss.

We have a once-in-a-lifetime opportunity to create and bequeath to our children the best and most affordable health care system in the world. I believe it must be a system designed to maintain health. After all, we can save both money and lives through preventive care.

For more on Gregory M. Jackson, M.D., visit his blog, “Reality Check: How to Live Better Longer.”

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How to Fix Costs of Health Care? Let’s Do the Math

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