THE FIGHT AGAINST HEART DISEASE—“EXTREMELY EXPENSIVE AND WILDLY SUCCESSFUL.” I argued here that it is wrong to talk about the increase in health care costs without taking into consideration the improvements that those higher costs are achieving. The quote in the caption is from a wonderful article in the Washington Post by David Brown that analyzes some of the improvements. Here are the numbers:
“In the 1960s, the chance of dying in the days immediately after a heart attack was 30 to 40 percent. In 1975, it was 27 percent. In 1984, it was 19 percent. In 1994, it was about 10 percent. Today, it’s about 6 percent.
Over the same period, the charges for treating a heart attack marched steadily upward, from about $5,700 in 1977 to $54,400 in 2007 (without adjusting for inflation).”
The death rate from heart disease is less than a third of what it was in 1970. About half of the decline in that death rate since 1980 is due to improvements in medical care and about half to a lower risk profile—“less smoking, lower cholesterol, better blood pressure.” I note that lower cholesterol and better blood pressure may partly be due to better drugs.
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Your argument says nothing about whether we are getting the best buy for our health money in this or other areas. To do so, you’d have to compare the success rates and costs in other advanced industrial states with different health care systems.
For example, you might be excited to buy a computer that is fantastically better than what you bought in 1983 for a much lower price in 2009. But if something even better were available for half the price (as is often the case) from another merchant, you wouldn’t be very pleased with your purchase just because it was cheaper and better than your old model!.
I’m not trying to take on the job of determining whether we are getting the best buy for our health money. In fact, I think there are a whole lot of improvements we can make, and I have identified some things we can do–washing our hands more and doing a lot more comparative research on the results of treatments. I’m just saying that adding up costs without considering the results is not helpful, and yet the argument shows up all the time.
When you link success in improving survival rates and cost, you can not escape some inference about value. Should we ask why medical gains, unlike technological transformations in other sectors like IT, have almost never provided greater value with declining costs?
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