Medical Advances Raise Costs

S.Q. Lapius sat hunched over his desk wearing the green eye-shade, working numbers on a piece of foolscap with a pencil.

“Another paper?” I asked wonderingly, since Lapius was not in the habit of writing for the mathematics journal.

“No, Harry, just doodling to find out where I stand with the Internal Revenue Service.”

“Calculating your deductions, then?”

“I have no deductions, Harry.  My entertainment is for my own pleasure.  I walk to the hospital.  I do not own a car.”

“Certainly you must be looking for some tax shelters then?”

“As a matter of fact, Harry, I am not.  This year I intend to pay every cent the government believes that I owe to them, because they are going to need every penny they can squeeze out of the populace.”

“I do this as a voluntary gesture, and will accompany my payment with a letter explaining that I would rather pay a full tax than see the government contriving by fair means or foul to reduce the cost of health care to Americans.”

“How noble, Simon.  Your new attitude towards the tax couldn’t possibly be influenced by the fact that last year you were subject to an investigation, and indeed there was a small brouhaha between you and the IRS.  Or were you on the enemies list?”

“Joking aside, Harry,” Lapius said, looking up. He pushed the eye-shade up on his forehead. “The government is in a terrific bind medically speaking.  They are undertaking a commitment to deliver what they call ‘health care’ to people, but consider the matter as if the profession and science of medicine have been standing still, and not advancing. As if medicine was a profession that had finally made all the discoveries that could be made, and now could be delivered to the public like a birthday cake on the Bicentennial.”

“What are you getting at?”         

“Simple,” he said, “this government makes its calculations of medical costs on the basis of last year’s figures and project the future on the basis of population growth.  Actually the costs will jump precipitously because of all the new inventions and modalities that are being placed in the hands of the doctors.”

He continued, “Just consider the list of sophisticated treatments and diagnostic tools that are coming on stream.  We all know about organ transplant and renal dialysis.  Perhaps these have already been taken in account.”

“But in addition, consider the remarkable advances in x-ray technique.  Just the EMI scan alone will cost millions of dollars to the insurers.  This technique enables the brain to be x-rayed millimeter by millimeter, the different densities from different planes superimposed in a computer, so that the most minute differences in x-ray densities can be determined.”

“Sure, but to a great extent that will replace the cost of arteriography.”

“Not true.  Arteriography is an invasive somewhat dangerous technique.  It will still be used but the EMI scan, risk free, will be used as a screening tool and each procedure costs the patient and his insurers over $200.  Then consider echo, or sonar.  Within five years every doctor will have this in his office if he intends to practice the best quality medicine.  The technique will be used, and properly so, to investigate the heart of anyone with a serious murmur, so that accurate data can be gathered instead of the excellent educated guesses now done with stethoscope and conventional x-ray. With echo heart valve lesions can be determined accurately.  Enlarged hearts can be distinguished from pericardial effusions.  Abdominal masses can be defined.  Pregnancies can be determined as being normal or not.  The techniques are not cheap.  The public will have the choice of paying for the best medicine available, or going back to the older and less precise techniques. Add to these, all the plastic prostheses that will enable the arthritics to walk again or use their arms.  There are plastic knees, elbows, mandibles swiveling on smooth plastic ball and socket joints.  The surgical techniques for inserting these devices are time-consuming and expensive.  More operating room space will be required.  Instruments, nurses, you name it.”

“The government is trying to save a few pennies here and there by dealing in generic drugs, while the real cost of medical care will be soaring, not due to inflation, but because the science has advanced so miraculously.”

“All the people with aneurysms or plugged arteries are now salvageable.  Coronary by-pass surgery and plastic heart valve replacement are becoming commonplace.  The government will need every penny it can get.  That’s why I intend to pay my full taxes.”

“What will you do with the money that is left over?” I asked.  “Donate it to the government?”

“Not directly, Harry.  I intend to use the surplus to buy tax-free municipal bonds.  After all the cities need money too.”