There is no question that health care costs in the United States have been increasing at an alarming rate. The nation's health care bill in 1984 was nearly $400 billion, of which more than $100 billion went for Medicare and Medicaid payments to the 30 million elderly, disabled and underprivileged.
Government officials are concerned about the amounts spent on health care, which now accounts for more than 10 percent of the gross national product.
But with steadily increasing amounts of health care required for an aging population -- 26 million today are over 65, and that number is expected to double in the next 20 years -- many observers believe it will be difficult if not impossible to put a lid on costs short of denying these oldsters access to new medical technology or asking them to hand over a major portion of their pensions to pay a greater share of their doctor and hospital bills.
Yet some politicians are openly raising the specter of health care rationing becoming a way of life -- and perhaps death -- in the most prosperous nation in the western world.
There are no easy answers to the problem, but there are answers.
One is not to limit the use of high technology in health care, but rather to encourage it. We need to bring the benefits of medical technology -- high quality care, greater productivity, lower patient cost, flexibility and faster turnaround -- to a health care system that has too long rewarded efficiency and inefficiency alike with total reimbursement of costs.
Technology has been getting a bum rap; it has regularly been given the role of the villain in the health care scenario. But of the 107 percent rise in Medicare costs between 1977 and 1982, the congressional Office of Technology Assessment (OTA) reported that the vast majority could be attributed to inflation and less than 30 percent to new technology.
Without that new technology, it is likely the rise in costs would have been even more dramatic.
Consider the following:
Cataract operations now can be performed in a doctor's office with sophisticated microsurgery equipment at about one third the cost of hospital surgery. Whereas a few years ago a patient was faced with a six-week recuperation and extreme discomfort, today he or she can have the operation in the morning and go home for lunch. It has been estimated that if all eye surgery were done on an outpatient basis, it would save $1 billion a year.
Clogged arteries, a leading cause of heart attack, formerly required costly and sometimes dangerous vascular surgery. Now a physician can treat many patients by guiding a balloon-tipped catheter into the arteries and inflating the balloon at the point of blockage.
With diagnostic ultrasound, it is now possible to pinpoint many fetal abnormalities and take steps to correct them before birth, thus saving parents years of anguish and medical bills.
We don't need to ration technology, but rather we should embrace OTA's suggestion that "one way to reduce Medicare costs is to encourage the appropriate use of new and existing medical technologies."
Another answer to the problem of soaring health care costs is to put stronger emphasis on health maintenance. A significant portion of these costs can be traced to the $150 billion Americans spend annually on tobacco, alcohol and junk food.
As a nation, we spend nearly $29 billion each year on tobacco. The American Cancer Society estimates cigarette smoking will be responsible for more than 75 percent of this year's projected 139,000 new cases of lung cancer and is at the root of 30 percent of all cancers as well as a major cause of heart disease. In total, smoking-related disorders are estimated to cost the nation about $27 billion in medical care.
We absolutely need more education in this area. And think of the millions of dollars that might be generated for Medicare each year if there were some way of having automobile manufacturers and hotel and restaurant managers -- in fact, managers of all public places -- charge smokers for cigarette lighters, ashtrays, matches and the extra expense required to accommodate their habit.
Americans also spend $50 billion a year on alcoholic beverages, which translates into some 26,000 highway deaths -- half of all traffic fatalities -- and another 750,000 serious injuries. When you add up the cost of emergency and long-term medical care, plastic surgery, property damage and other aspects of alcohol abuse, the total is $70 billion.
And then there is junk food. Fifty years ago, malnutrition was a major cause for concern; today, overnutrition compounds diabetes, heart disease, stroke and arteriosclerosis. The total amount we spend on empty calories is hard to pin down, but consider that a few years ago, The Economist reported we were then spending $6 billion a year just to advertise junk food and $26 billion to wrap it in eye-catching packages. Figures from the Human Nutrition Information Services suggest we are annually spending over $75 billion more for food than is required to provide a nutritionally sound diet.
If we as a nation can spend $150 billion a year to ruin our health -- and in the process add upwards of $100 billion a year to our health care costs -- surely an offsetting investment in high technology health care is not out of line.