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The health care dichotomy in the United States

Charles Dickens provides a great description of the state of health care in the U.S. today: “It was the best of times, it was the worst of times …”

It’s the best of times because we have developed incredible technology that saves lives, eases suffering and extends our useful life span. It’s the worst of times because we can’t afford the cost of providing it for everyone who could benefit — and our leaders refuse to acknowledge the real situation.

A reasonable metaphor would be a lifeboat in the middle of the ocean. Let’s say it has the capacity to accommodate 20 people but is already carrying 25 and waves are splashing into the boat. Our scene is even more ominous, since another 15 survivors are in the water begging for safety. Since the craft is already in danger, taking the compassionate option will ensure that all will drown more quickly. A real Hobson’s Choice.

The hyperbole may be exaggerated — but not by much. Our health care system is, in fact, “taking on water,” and the best solution our leaders can think of is to add 30 million to the system. The pending collapse will be devastating to the larger domestic economy as well — which is also “taking on water” at an ever-increasing rate.

Yet politicians seem incapable of addressing the real root of the problem in anything more than an occasional superficial reference. The fact is that we, as a society, have the technical ability to provide more health care than we can afford.

Are there any real solutions? Perhaps.

One possibility would be to expedite technological advances that actually lower cost. One prime example is the emergence of minimally invasive procedures in recent decades (i.e., endoscopy). This allows not just lower cost but improved diagnostic techniques and better treatment.

For example, angiograms and angioplasty provide heart patients with an incredibly preferable alternative to open chest surgery.

Another example is radiosurgery, which can handle some previously inoperable brain tumors on an outpatient basis — sometimes brain surgery in the morning and back to work that afternoon.

And even better, as soon as these breakthroughs appear, they are extended to more patients and new applications are developed (the best of times). Ironically, though, that “extension” process almost always ends with a significant net increase in the cost (the worst of times).

Another plank in a possible solution would be to address the growing problem of unnecessary care. Recent studies show, for example, that as many as 80 percent of the visits to a doctor’s office are simply not needed. However, doctors can’t deal with this, because they can’t tell which patient may actually have a serious problem in progress. Further, it’s not in their compassionate nature to turn patients away for any reason. And politicians can’t deal with it either — any restriction on access would be suicidal to their careers.

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