February 2017
On Health Care Spending

The oldest patient I ever had lived to be over 100 years old. She was small and frail a bit stooped, but was she remarkably healthy with no real medical problems, and her mind was delightfully sharp. In the last year of her life she developed esophageal cancer. She found a surgeon who was willing to operate on her, and came to me five times over the next two months with different family members seeking my support for this very difficult surgery. Her family was adamantly against the surgery. I explained to her that she was very likely to die on the operating table, and if she survived the surgery then her recovery would be a struggle. Medicare and her supplemental insurance would cover the cost. so this was not a concern to the patient or her family. After the fifth visit I realized that she could not live with the thought that this cancer was growing inside of her. She proceeded with the surgery and died on the table.

A bad outcome? The patient died painlessly under anesthesia in her sleep, and she no longer had to live with the thought of this alien thing growing inside of her. The surgeon was paid his full fee despite the result. probably around $5000; and the hospital was paid about three times that So there were no losers in this story; it was all free; everyone was happy. The truth, of course, is that nothing is free and every decision has its costs. The taxpayer paid for this misbegotten medical intervention for the benefit of the surgeon and the hospital.

When I began medical school our nation was spending about 12% of GDP on health care, but now medicine accounts for about one out of five of every dollars spent in America. Is 20% the upper limit on healthcare? Hardly! There is no limit on health care spending except for policy, or national bankruptcy. Our leaders do not have the moral courage to set limits on health care spending so insolvency seems to be the mostly likely resolution. But in the meantime, even before the government admits that it can no longer print or borrow more money, there will be havoc. This year health insurance coverage for WFMA employees rose 31%. Such cost increases are crippling for small business. Ordinary people now have access to health insurance under the ironically named Affordable Care Act (Obamacare ), but it is an insurance they cannot afford and which will become ever more expensive year by year. Will the wealthy vested interests allow policy limits on health care spending? In the Great Depression Will Rodgers put it this way, 'We have the best Congress money can buy."