The price of cure

A history of surgery in the New England Journal of Medicine paints a vivid picture of why healthcare is such a large part of the modern budget, while at the same time being such a new part that its cost continues to outrage our feelings and expectations.  Only a little over a century and a half ago, surgery was confined almost exclusively to the kind of interventions that could be completed so superficially and rapidly that they were somewhat likely to do more good than harm.  Live-saving amputations were the earliest examples.  Lacking anesthesia, surgeons put all their emphasis on brute speed.  With the discovery of ether, they slowly realized they could afford to take their time and refine their techniques.  With the further discovery of hand-washing and sterilization of equipment, surgeons found themselves able and justified in expanding their repertoires to more challenging areas, such as the torso, and to less emergent medical conditions.  Today, medical science acknowledges more than 2,500 standard surgical procedures, often performed with minimal invasiveness, and with a success rate undreamed of in the mid-19th century.

We no longer expect to die of such common troubles as appendicitis.  We don't yet, however, quite expect to pay for their cure.  Unlike food, shelter, and clothing, the provision of which has been an expected economic burden on individuals and families since the dawn of history, medicine still somehow strikes us as a miracle cure that some kindly wizard should bring to the door in a diamond phial.

6 comments:

Assistant Village Idiot said...

Actually, in D&D you had to pay those wizards pretty handsomely for those cures. That replicates the spirit than the reality of the Middle Ages, but it's not far off.

You could make a very solid case that until about 1950 - pretty dame recent - doctors killed as many as they saved.

Grim said...

Wasn't that "clerics" who provided the miracle cures? That would explain the expectation of charity, at least.

DebR said...

Who is this "We?" I certainly have no trouble with the concept of paying for services rendered. I do, however, take issue with structuring of the price. Why should the price for a 15-minute office visit vary from one patient to another? Why is it acceptable that the provider receive $50 for patients insured under plan A; $75 for plan B; $7 from the Government plan; and uninsured patients are billed $145? There has to be a more equitable way to do business....oh wait....some doctors tried and were convicted of "price fixing" or some such....

douglas said...

We'd all be better off if we went back to paying for our healthcare ourselves. If the doctor is giving you a 'cash discount' it means that processing all the other methods- insurance, government plans- costs them the difference (or they're gouging the insurance companies)- that's just wasted money.

Texan99 said...

DebR -- I agree. The price structure is ridiculous and obviously could be improved if we got rid of some of the crazy distortions. Nevertheless, I hear a stead drumbeat, even from many conservatives, expressing a concern that the cost of healthcare is beyond the means of average Americans. To me, that is a complaint that makes no sense. It reflects an instinct that healthcare should not eat up a greater percentage of our national wealth than it did in our grandparents' generation, but it's comparing apples to oranges. Our grandparents simply died of things that we now have the resources to cure.

Nevertheless, those resources don't come out of thin air. We have to choose to devote them to healthcare rather than to something else less important. When the economy is growing very fast, that's a less painful choice, of course. But if the aggregate cost of healthcare is a certain percentage of GDP even after we do our best to implement efficiencies, then it is what it is, and no amount of wealth-redistribution will change it or hide it, despite the fantasies about "free/affordable healthcare available for all." The most we can do is take up a collection to alleviate the burden on the most unfortunate among us. We can't ever get away with considering most Americans to qualify for the category of the most unfortunate among us.

bthun said...

"We'd all be better off if we went back to paying for our healthcare ourselves."

Yup, way back when that seemed to work pretty well, IIRC. Add in a catastrophic health insurance policy with a Medical Savings Account, and you've got a fair amount of protection. Playing the odds being the nature of insurance anywho.

"If the doctor is giving you a 'cash discount' it means that processing all the other methods- insurance, government plans- costs them the difference (or they're gouging the insurance companies)- that's just wasted money."

I've yet to have a doctor refuse me if I ask for a cash tendered at time of service discount. Usually that discount is between 15% to 25%. Yes, I'm chea... er frugal, in that I always ask how much, for everything. I research and shop too, especially if I'm making my first appointment/visit with said provider. As I've mentioned, I'm genetically predisposed to be chea... er frugal.

Bottom line, IMHO Gub'ment involvement in almost every instance inflates the cost of thing while deflating the amount and quality of thing delivered.

Same as it ever was...