Thursday, June 16, 2011

Declining Marginal Returns: U. S. Medical System

Continuing with our medical issues coverage, a nice (long) piece that discusses the current situation of U.S. medical practice.  I have only taken from the portion that shows some of the problems.  The author outlines some solutions.  I don't pretend to  know if his solutions are appropriate: to some degree they are more a scaling back of expectations than a solution.  But with the Baby Boom now retiring, it is going to be difficult to pay for their living expenses, little less increased medical costs.

How American medicine is destroying itself (ht Big Picture)
Daniel Callahan and Sherwin B. Nuland, The New Republic, 19 May 2011.

Average life expectancy...steadily increasing for many decades, now shows signs of leveling off. S. Jay Olshansky, a leading figure in longevity studies, has for some years expressed skepticism about the prospect of an indefinite increase in life expectancy. He calls his position a “realist” one, particularly in contending that it will be difficult to get the average beyond 85. He also writes that it is “biased” to assume that “only positive influences on health and longevity will persist and accelerate.” That view, he notes, encompasses a belief that science will surely keep moving on a forward track—a projection that is not necessarily true. Simply look at the “breakthroughs” that have been predicted for such scientific sure things as stem-cell technology and medical genetics—but have yet to be realized. These breakthroughs may eventually happen, but they are chancy bets. We have arrived at a moment, in short, where we are making little headway in defeating various kinds of diseases. Instead, our main achievements today consist of devising ways to marginally extend the lives of the very sick.
Then there are chronic diseases, now the scourge of industrialized nations. If the hope for eradication of infectious disease was misplaced, the hopes surrounding cures for chronic diseases are no less intoxicated. Think of the “war on cancer,” declared by Richard Nixon in 1971. Mortality rates for the great majority of cancers have fallen slowly over the decades, but we remain far from a cure. No one of any scientific stature even predicts a cure for heart disease or stroke. As for Alzheimer’s, not long before President Obama recently approved a fresh effort to find better treatments, a special panel of the NIH determined that essentially little progress has been made in recent years toward finding ways to delay the onset of major symptoms. And no one talks seriously of a near-term cure.
In the war against disease, we have unwittingly created a kind of medicine that is barely affordable now and forbiddingly unaffordable in the long run. The Affordable Care Act might ease the burden, but it will not eliminate it. Ours is now a medicine that may doom most of us to an old age that will end badly: with our declining bodies falling apart as they always have but devilishly—and expensively—stretching out the suffering and decay. Can we conceptualize something better? Can we imagine a medicine that is more affordable—that brings our health care system’s current cost escalation, now in the range of 6 percent to 7 percent per year, down to 3 percent, which would place it in line with the annual rise in GDP? Can we imagine a system that is less ambitious but also more humane—that better handles the inevitable downward spiral of old age and helps us through a somewhat more limited life span as workers, citizens, and parents?

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