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Clarification to This Article
The article incorrectly said that a generic formulation of the heart attack drug Plavix is available. In August 2006, Apotex, a Canadian pharmaceutical company, briefly sold a generic version of the drug, also known as clopidogrel. Plavix's maker, a joint venture of Sanofi Aventis and Bristol-Myers Squibb, got a court injunction prohibiting further importation. In some parts of the United States, however, generic clopidogrel continued to be available for as long as a year. The supply is now exhausted. Generic versions of the drug, unapproved by the Food and Drug Administration, can be bought over the Internet. Those drugs can be seized or refused entry by the government.

As Health-Care Quality Rises, So Does Price

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By David Brown
Washington Post Staff Writer
Sunday, July 26, 2009

Two decades ago, a famous clinical experiment showed that if a patient in the throes of a heart attack chewed and swallowed an aspirin tablet, the risk of dying fell from 13.2 percent to 10.2 percent.

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If progress since then had come so cheap and easy -- a 23 percent improvement for an investment of three cents -- health care in the United States wouldn't be in the state it is.

But that's not how things happened.

Instead, the fight against heart disease has been slow and incremental. It's also been extremely expensive and wildly successful.

In the 1960s, the chance of dying in the days immediately after a heart attack was 30 to 40 percent. In 1975, it was 27 percent. In 1984, it was 19 percent. In 1994, it was about 10 percent. Today, it's about 6 percent.

Over the same period, the charges for treating a heart attack marched steadily upward, from about $5,700 in 1977 to $54,400 in 2007 (without adjusting for inflation).

The treatment of coronary heart disease -- of which heart attack, or acute myocardial infarction, is the most significant component -- this year will cost about $93 billion. It's a huge contributor to the $2.3 trillion annual bill for medical care in the United States. Cardiovascular disease is responsible for 35 percent of deaths in America and has been the leading cause of death every year since 1900, except 1918, the year of the Spanish flu epidemic.

The evolution of heart attack treatment over the past three decades is a story of doing more things to more people at greater expense with better results. It is a portrait in miniature of medicine in the United States.

Although inappropriate care, high administrative costs, inflated prices and fraud all add to the country's gigantic medical bill, the biggest driver of the upward curve of health spending has been the discovery of new and better things to do when someone gets sick.

"Money matters in health care as it does in few other industries," wrote Harvard University health economist David Cutler in 2004. "Where we have spent a lot, we have received a lot in return."

Beyond heart attack treatment, similar stories can be told about cancer, premature birth, arthritis, HIV infection, mental illness and innumerable other common conditions. The trend in all of them toward more intensive, expensive and better treatment is not likely to change with health-care reform, however constituted.

Providing health insurance to the 47 million Americans who don't have it -- the key feature of the bills before Congress -- is likely to expand heart attack treatment and increase spending on it, not pare it back and reduce the cost.


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