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Medical
Diagnostic Equipment Now A Necessity
By Alfred Longo
Andy Kessler wields the old-fashioned,
rubber-tipped hammer that doctors use to bang patients' knees with
an air of indignation.
A former money manager and technology
analyst, Kessler seems almost offended that the analog tool for
testing reflexes still has a place in modern health care, as do
other medical instruments he says fail to drill down to more useful
specifics. He wants detailed, personalized information about his
internal state of affairs and believes technology soon will make
that possible by embedding doctors' knowledge into silicon and software.
With health-care costs continuing
to out pace inflation and consuming ever more of the nation's economic
output, the question on many analysts' minds is how much more the
U.S. can afford to spend on its medical care and what value is received
in return.
For Kessler, author of the new book
"The End of Medicine: How Silicon Valley (And Naked Mice) Will
Reboot Your Doctor," the answer appears to lie in integrating
increasingly inexpensive digital diagnostic technology that promises
to spare patients costlier interventions down the line -- after
they've had a catastrophic event like a heart attack, for example.
A sense of urgency pervades the debate.
Not everyone believes cost growth is out of control but few dispute
its ill effects. As health-care costs spiral up, so too does the
number of uninsured people as more are priced out of the market.
Health-care expenditures consume 16% of the United States' gross
domestic product, up from 13.7% of GDP a decade ago.
"When it hits 20% or 25% of
GDP, we can't afford all this great health care anymore," Kessler
argued. "We need a new paradigm and I think the paradigm is
going to be rather than wait for you to get sick and spend all this
money on chronic care, this technology will come along just in time
to flip health care from chronic care to early detection."
"The way not to spend $1.8
trillion on health care is don't get sick in the first place, and
the way to do that is to have ever-cheaper silicon look inside of
you and say 'Ah, there's a problem.' And if you catch it early enough
the cost of care is cheap." See video interview with Kessler.
Looking for scale
Kessler focuses on three killers:
heart disease, cancer and stroke. One of the biggest obstacles to
changing medical culture is convincing private insurers and Medicare
to reimburse for particular procedures based on medical effectiveness
and cost effectiveness, he said.
He's bullish on the prospect of having
powerful scanning technology detect problems before they become
life-threatening, which employers and insurers may find attractive
once prices come down.
"It has to get cheaper to screen
a mass number of people than to wait until you drop from a heart
attack and get patched up," Kessler said. "When you have
a heart attack, it costs about $30,000 to have an angioplasty, stents
put in and the like. If 1% of adults have a heart attack...and you
were to screen 100 of them at $1,000, that's $100,000 vs. 30-grand
to wait for one poor person to have a heart attack."
"You can see scans need to be
$300 or less before insurance companies would pay for this mass
screening," he said, noting if the technology depreciates 30%
a year, "that's in the next three to five years that we'll
have this mass screening."
While the notion of technology producing
a rapid switch into expanded preventive care for the masses is appealing,
Gary Claxton, vice president of the Kaiser Family Foundation, said
such a shift is likely at least a decade away.
"We're still at the point where
technologies are more often letting us treat things than letting
us prevent things," Claxton said. "Maybe we can figure
out how to change that, but it's not clear we have."
Sweeping tech changes are likely
a little further off than Kessler suggests, agreed David Cutler,
an economics professor at Harvard University and author of "Your
Money or Your Life."
"In the near term, what we're
likely to have [are] very expensive things treating people when
they're very ill, like in the cancer setting," Cutler said.
Discovering how to advance minimally invasive disease prevention
and developing more vaccines may save some money but there are limits,
he said.
"People ultimately get sick
of something and dying is very expensive. So some things that you
think would save money don't save a ton of money because they just
postpone [spending] until later years."
Another problem is that as health
care becomes more sophisticated, more people lose access to it,
Claxton said.
"As we get wealthier as a country,
we want to invest an increased share of our wealth into health care,"
he said. "The problem is... how we finance it is making it
harder for lower-income people to hang on."
Take biologically derived and genetically
based drugs, for example. A small but significant percentage of
covered workers find such specialized prescription drugs in an expensive
fourth tier of coverage beyond the typical ones of generic, preferred
brand and non-preferred brand, Claxton said. Average co-payments
for fourth-tier drugs are $63 while coinsurance is a whopping 42%,
according to the Kaiser Family Foundation.
Teetering on a 'big divide'
Health care isn't a normal business
given all the payers and varying incentives, said Paul Ginsburg,
president of the Center for Studying Health System Change in Washington.
"I believe the incentive in
our health system to invest in new technologies that promise additional
profitable services is much more powerful than the incentive to
invest in technology that will simply save money," Ginsburg
said.
The idea of expanding preventive
care also is hindered by systemic weaknesses, Cutler said. "The
part where the medical system is really at its worst is in dealing
with people in nonemergency situations. We're just horrible at it."
About 20% to 30% of health costs
could be cut by figuring out which procedures aren't valuable, he
said. And for many reasons people often don't do what they know
they should do to improve their health.
"We've known how to treat high
blood pressure since 1969," Cutler said. "Currently, one-quarter
of people with high blood pressure are controlled."
Kessler sees the shift toward mass
screenings starting with wealthy people demanding them for diseases
that scare them, a phenomenon Ginsburg said will lead to a "big
divide" pitting the desires of the affluent against the struggles
of lower-income workers trying to stay insured.
Said Ginsburg: "I see that as
a major societal conflict between the people that have a lot of
money and want to do a lot more to improve their health and the
people who can barely afford what they have today, and whether in
a sense we're going to force them to stay in the same pool and have
a single standard of medical care or whether we'll have more tiers
and more inequality of access to medical care in our country."
"The mood today is in the direction
of the latter."
“Star
Trek” Health Care of Yesterday Is Just About Here Today
By Benjamin Jordan
You had to be impressed with the
health care on "Star Trek." Climb up on a futuristic exam
table or get a "tricorder" waved over your body and you
get a complete diagnosis in seconds. The underlying idea was that
technology could go a long way to improving our medicine and our
lives.
While we're nowhere near that ideal
today, we can at least see the horizon. We have whole-body scanners
and they continually get better and more precise. We have unraveled
the human genome and that knowledge will eventually lead to individualized
treatments at the cellular level.
The problem, as with just about everything
in health care, is cost. These advances don't come cheap and thus,
at least at first, they will only come for the wealthiest among
us. But if there is one thing we've learned about technology, it's
that in most cases it does have the power to drive prices down over
time. So making a bet on high-tech health care might be worth it
in the end.
In our lead story, health-care writer
Kristen Gerencher looks at the expanding role of technology in medicine
and whether high-tech approaches have the ability to stem cost increases.
Read her Vital Signs column, plus find out in Realty Q&A about
some of the clever ways mortgage fraudsters are seeking to prosper
these days and check out Robert Powell's column for the best tool
to use to calculate savings withdrawals in retirement, on Friday's
Personal Finance pages.
One other problem with relying too
much on technology in health care is that the biggest strides we
could make today are all low-tech: eating right, quitting smoking
and hoisting our keisters out from in front of all that tech gear
and exercising.
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