The evidence is in. But no one cares.
Doctors should do what works, right? Data-driven science has guided improvements in most other human endeavors. But health care, curiously, just doesn't work that way.
When it comes to taking care of themselves or their loved ones, Americans want every possible treatment effort expended, no matter how expensive it is or how marginal the improvement in health. The depth of this delusion is detailed in an article in this month's Health Affairs.
Of course, we all want the best for our families. Yet we don't make such all-or-nothing demands in any other aspect of our lives. Is the safest car on the market the number-one seller? Not necessarily. Would we willingly write a blank check for builders to construct the absolutely safest house possible using all the latest high-tech approaches yet invented? Hardly.
In both cases we balance cost and benefit to arrive at reasonable compromises. Building codes and automotive regulations have greatly improved safety over time, but cost is an ongoing consideration in their development.
What's even more unreasonable about America's "everything, all the time" philosophy is that this approach isn't even safer. There is ample evidence that over treatment and excessive testing is in fact quite bad for us. Overly invasive treatments risk avoidable complications and too much testing can expose us to more radiation than is healthy.
Yet most Americans still don't understand this. During the managed care wars in the '90s, the boogieman was corporate hegemony. Tone-deaf HMOs made it easy to believe that profit motives were interfering with good care and the doctor-patient relationship. Doctors, anxious to protect both autonomy and income, actively stoked the flames.
Going forward, big government or socialism is more likely to be cast as the villain. I expect to hear of lot of rhetoric along these lines from GOP candidates hoping to ride negative voter sentiment in the mid-term elections.
By replaying the tired "insurers as villains" meme to get health care reform over the top, President Obama isn't helping. Nor are the Tea Partiers who see a government rationer behind every tree. Without a more rational approach to health care, not only will we break the national budget, but we'll remain vulnerable to any purveyor of dubious devices or treatments who knows how to make a good emotional case for its use.
Anyone out there remember laetrile? Thousands of patients swore that it cured cancer. Desperate for a cure, some rejected proven options. High profile celebrities like Steve McQueen added to the allure. But under rigorous scientific testing, the claims of proponents just didn't hold up. Cancer patients treated with laetrile had essentially the same results to be expected from no treatment at all -- except that toxicity of the treatment itself was a problem. It took 40 years to reach this conclusion.
Will it take a complete collapse of our system to learn this one, critical lesson?
Comments
Nicely said.
Our collective obsession with longevity lies at the root of all this insanity. Yet as a species we seem pathologically unwilling to accept the reality of our out-of-control impacts on the earth that hosts us.
motherjones.com
I agree that we have an obsession with longevity. The problem is that quality of life over quantity of life sounds very good until people are put in the position to actually make good on it. When you're in the moment, "saving" Grandma's life (by extraordinary interventions) feels natural, even if it means an unacceptable quality of living for her and million dollar bills.
Taking decisions out of the hands of the insured (or their family) will always feel forced, and the organization that removes that power from individuals will always be vilified. This is a no win situation. The fix has probably more to do with a cultural shift than a political or economic one.
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