Former president George W. Bush, widely regarded as a model of physical fitness, received a coronary artery stent on Tuesday. Few facts are known about the case, but what is known suggests the procedure was unnecessary....We'll make sure nobody gets more care than they "need," as determined at a distance by experts like the author.
Although this may seem like an issue important only to the former president, consider the following: Although the price of excessive screening of so-called VIPs is usually paid for privately, follow-up tests, only “necessary” because of the initial unnecessary screening test, are usually paid for by Medicare, further stressing our health-care system. The media coverage of interventions like Mr. Bush’s also leads patients to pressure their own doctors for unwarranted and excessive care.
We were recently talking about how biotechnology struck me as a possible driver of jobs and wealth on a large scale, provided we could overcome the problem of ensuring that the elderly (and near-elderly) continued to be able to consume new biotech products and services at a rate that would justify heavy and continual investment. Now socialized medicine is one way that we might be able to ensure that, although hopefully not the only nor the best way.
If we were going to accept some sort of government-led health care system, then, it should be more like Bush II's "Medicare Part D expansion," and less like Obama's system of rationing care -- targeted at the elderly and near-elderly, and designed to enable them to consume the products of biotechnological innovation. The young would pay higher costs for this in taxes, but they'd at least have jobs out of which to afford these higher costs -- unlike with the current system, which is destroying jobs rather than encouraging investment in new jobs. As a kind of side benefit, the young would also get to use the advances in medicine themselves when they are older.
What we'll get instead is death panels, higher costs, fewer jobs, and a system designed not to enable but to limit the consumption that would lead to greater innovation and investment.
In other words, as usual with this crowd, we'll get the worst of both worlds: everything we didn't want, in exchange for nothing we might have wanted.
10 comments:
...the young would also get to use the advances in medicine themselves when they are older.
That'll be true only under this crowd's system, with its badly slowed rate of innovation.
In a proper system, investors would be paying for advances that will be long obsolete by the time the investors are old enough to need them.
Eric Hines
Well, presumably -- since they'd actually have jobs -- they'd keep paying up until the point at which they became eligible.
And, likely, the advances for which they paid early on will be necessary precursors for the further advances available when these investors need them in their own dotage.
Eric Hines
The same people who are too kind-hearted to let you expose yourself to the risk of not being able to afford medical care will be too fiscally prudent to let you receive it at their expense. Risks and rewards! Gotta sever them if we're going to wrap this thing securely around the axle!
Axle? You get an axle? Those kind-hearted folks told me it was their axle, and they declined to let me play with it--I might hurt...someone.
Eric Hines
"unwarranted and excessive care." -- says who?
Some fake big shot has decided that a doctor's recommendation to put in a stent was not medically justified. And then, this same fake big shot uses that presumptuous conclusion to address the "larger issue" -- his desire to deprive other people of their doctor's best judgment.
May the authors of that article, Vinay Prasad and Adam Cifu, never achieve a position of ordinary authority over others. They are too arrogant and selfish to be allowed any power over the lives of others.
Valerie
Finally got around to reading the opinion piece. Frankly, I've never met a professor of medicine who was any good at practicing medicine--including my two older brothers. The cancer doctor shows a broad reach of ignorance of heart medicine.
I just had my IRAN last month, and my GP told me about three different types of "stress" tests for the heart: the stereotypical treadmill, the CAP, and a carotid ultrasound. As you might expect, they are each optimized to look for different types of heart problems. And treatment varies with the problem actually found, which may not have been detected by any of these tests, and which failure to detect a particular type in no way invalidates the tests--or the treatments that follow.
If Mr. Bush had visited a general internist practicing sound, evidence-based care, he would not have had cardiac testing.
I guess my GP is not practicing sound, evidence-based care. She gives me an EKG every other year. It's also interesting to note that the study to which these guys referred was of diabetics--which disease thoroughly contaminates "ordinary" heart disease--of which there are many forms other than "coronary heart," on which these guys focused.
Instead, the doctor would have had conducted age-appropriate cancer screening.
Because that's a suitable sub for checking to see whether an aging heart is staying healthy.
It no longer would include even prostate-specific antigen testing for cancer.
My GP would beg to differ.
Because Mr. Bush had no symptoms, it is impossible that he felt better after these procedures.
A BS objection. It's more likely he'll continue to feel that way with the stent than without it. And his wife sleeps better, too, I'll wager--a factor these guys and their ilk carefully ignore.
As it happens, I had, some years ago, an A-fib event that was a one-off; although I'm on significant aspirin for the rest of my life as a result. The cardiologist who met me in my room in the hospital, being a highly cautious lady (why are all my doctors women?) was willing to install a pacemaker. She consulted--probably an unnecessary expense to our two heroes--and her colleague (a male: I wonder whether there's a pattern...) thought the pacemaker was unnecessary. She also would have had a conniption fit, had I told her I rode a bicycle those distances in that heat. She didn't like it that I routinely walk 4 miles (count 'em) in "that heat."
In the event, I remain healthy and active enough to have blown up a shoulder in a self defense class a couple years later.
The aspirin treatment for my heart? It has nothing to do with mitigating the likelihood of another such episode, or any sort of heart attack. The occurrence of the event puts me in a higher risk category for stroke; the aspirin is to mitigate that.
I'll gladly decline to treat either of these medicine men, in the interests of long-term cost effectiveness.
Eric Hines
Americans have been voting for Democrat economic control ever since the days of Reconstruction. NOthing has changed on that score, even if a black man becomes the nominated figurehead of the Democrat party.
Hmmm, I wonder what the two authors would say about the private foundation that pays for full cardiac work ups for any student athlete at Flat State U who wants one? It is funded by the family of a student who had an undiagnosed cardiac defect and who had his first and last heart failure during a practice game.
LittleRed1
The same people who are too kind-hearted to let you expose yourself to the risk of not being able to afford medical care will be too fiscally prudent to let you receive it at their expense.
That's a good line, Tex. Insightful and pithy.
Post a Comment