This past week, my eighty-five-year-old aunt had a heart catheterization and she received a pacemaker. Since she has no children, I was down in Florida for the surgery. Although her surgery was prompted by heart irregularities, the surgery was elective. The surgeon was a decent and competent man; yet I cannot help but reflect on the economics of her surgery.
My aunt is about 100 pounds overweight; she eats terribly and has done very little exercise, even walking, for at least 30 years. After her hospital stay, she was transferred to a rehabilitation center. Not pleasant for her or the taxpayer.
According to Shannon Brownlee’s excellent book Overtreated, there are more than 2 million heart catheterization procedures performed in the United States each year. Of those 2 million, 1.2 million are elective—meaning, like my aunt, the patient has symptoms but is not in immediate danger of dying. Of the 1.2 million elective procedures, 160,000 are inappropriate, “according to cardiologists’ own rules.” Most importantly, Brownlee writes, “The latest research…suggests that the vast majority of elective cardiac procedures are no more effective at preventing heart attacks and death than medical management, which involves giving patients drugs and counseling.”
I don’t know if Brownlee includes dietary and exercise advice as “counseling.” By my own observations of the number of overweight health care professionals and the horrific food served in hospitals to sick patients, I’d conclude that the medical industry is singularly unqualified to provide such counseling.
Dean Ornish is perhaps the most well-known physician promoting dietary and lifestyle changes as alternatives to drug and surgery for heart patients. He observes that, “More than $30 billion were spent last year on angioplasties, yet randomized trials clearly show that they don’t prolong life or even prevent heart attacks for most people. In contrast, studies show that most heart disease is completely preventable today, simply by changing lifestyle.”
To be sure, the dietary portion of the Ornish program is rigorous—whole grains, beans, fresh fruits, and vegetables are stressed—while animal food, fats (less than 10%) and processed foods are minimized. Ornish is not the only one who has come to these dietary recommendations. No, I am not naïve enough to believe in magic bullets; but the evidence is overwhelming that health care expenditures would fall dramatically if Americans moved toward this type of diet. This raises many questions:
- Should individuals who don’t take responsibility for their health be allowed to transfer their healthcare expenses to the rest of society? In other words, should they be bailed out?
- As long as the medical industry is set up to focus on treating acute sickness through expensive drugs and surgeries, how will medical costs ever be significantly reduced?
- Why do so many Americans grow up without even a rudimentary knowledge of what contributes to a healthy diet and a healthy lifestyle?
And there is a larger question: When will our current health care system collapse? The current system is simply too expensive and wasteful. We cannot afford it!
We have seemingly learned nothing from the collapse of our housing and banking industries. When the housing bubble was well underway, experts assured us that housing prices could go up at a rate of 30% per year for many more years. Anyone who had even some knowledge of the history of bubbles understood that these forecasts were made by people who were ignorant, or by government officials, or industry shills.
Should we now trust so-called healthcare experts who tell us that more government involvement will fix what ails our health care system? More government involvement? What has government involvement given us already? How about financial incentives to pay for expensive drugs and procedures rather than incentives that encourage prevention? How about an educational system that teaches little of what promotes health? How about privileges to the drug companies and the AMA?
Mish Shedlock has called taxpayer supported banks “zombie banks”—they are the living dead of the financial industry and they would collapse without bailouts. But what of zombie patients—those who take little responsibility for their health and consume much of our healthcare resources? I have no easy answer. Americans are bighearted; we give generously to charities that help those who played no part in their misfortune. But we cannot continue to fund zombie patients.
Am I being cruel and heartless? The day will come when the healthcare bubble will burst; we will no longer be able to afford the current health care system. Those who take little responsibility for their own health will be suddenly wrenched off their support system; that will be real cruelty. It is far better to begin the process of change now while there is still time for individuals to get the care they need as they wean off the old system and adjust to new realities.