This
two year old article in the NewYorker is an amazing rundown on one view of the cost of health care.
It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.
McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.
The same author gave the most recent commencement speech at Harvard Medical School and
that's online too (pdf).
The current health care debate seems to be settled around who is going to pay for it. It's an important conversation, given that
people die when they can't pay for health care. But the two articles above talk about the disconnect between cost and quality of care.
Another link from the same author is an article in the New England Journal of Medicine about ways to
reduce the cost of cancer treatment. One of the suggestions that caught my eye:
Symptom-Directed Care When Chemotherapeutic Success Is Unlikely
We propose a routine switch to nonchemotherapy palliative care for patients with progression of disease after receiving three consecutive regimens. We are asking physicians and patients to follow guidelines such as those for breast cancer or lung cancer and to consider a recent ASCO position paper that reinforces the practice of discontinuing chemotherapy when the chance of success is minimal. This should not be seen as a “three strikes and you're out” program but rather as a switch to a different team. Treatment beyond the accepted boundary should be given only as part of a clinical trial or within a prospective registry, with Medicare's coverage with evidence development as a model.
I don't remember exactly, but my sister went through way more than 3 rounds of chemo and by the time she started hospice care she had tried 5 or 6 different drug combos. She survived a little over two and a half years after diagnosis. I know she wanted every day of that time. I doubt she would have lasted as long had we gone to palliative care after 3 rounds, or even after the third drug combo.
I'm grabbing a paragraph out of context and I didn't follow the footnotes, so I may not be understanding what's being proposed. But Lynne had quality of life thanks to the care she received past her first three rounds of treatment.
