The fate of the long quest for hospital-cost control becomes ever more uncertain because of the ouster of its most vigorous champion, HEW Secretary Joseph A. Califano Jr. But even allowing for the value of getting this measure enacted into law, the reality of medical economics is that cultural and biological changes, in combination with technological inventiveness, far outweight the price-management potential of mere legislation.
As Victor Fuchs, a Stanford University health economist, points out in the current issue of Public Interest, a sizable piece of growth in national health expenditures can be attributed to the combined effects of the aging of the population and the breakdown of multi-generation family togetherness -- so that nursing-home expenditures have risen from 2 percent to 8 percent of national "health" costs since 1960. And the trend continues, in line with the mounting elderliness of the population and the cultural preferences and economic wherewithal for privacy on the part of those who earlier might have resided with their kin.
Fuchs also suggests that medical attention has become, to some significant extent, a stand-in for the psychological support formely provided by community orginizations or by clergymen, that traditional office-based medicine is paying a role previously filled by a varinty of institutions and relationships now is decline.
It can be argued in response that "health care" shouldn't be chargeable for these shifts in housing, counseling, and handholding, and that some adjustment is in order in the gross national ledger-book. But, regardless of where the costs are assigned, a crucial element in health-care economics is the survival of more people into are ranges that make them customers for more medical attention. Thus, while the good news on one medical front is that impairment and death rates from cardiovascular ailments have fallen sharply, a consequent effect is that people survive to age levels where, statistically, they are more vulnerable to other diseases. And these diseases are often chronic and expensive.
The quest for cost controls collides not only with this surge in the ranks of medical consumers but also with signs of a new round of dazzling developments in medical technology, which, lowing a relative quesence for several years, now seems to be getting a second wind. With electronic microprocessors setting the pace for catalogues full of new monitoring, diagnostic and treatment equipment, and surgeons and scientists finding important new clues to successful organ transplants, the stage is being set for a lot of wonderous -- and very expensive -- medical feats. Whether their contributions to good health will match up with their costs is a separate matter. But if the medical profession and, in turn, the public are persuaded that a medical techonology has arrived -- as, for example, kidney dialysis and transplantation -- it is difficult to conceive of economic and political arrangements that limit access by personal ability to pay. In terms of such class-related conforts as private rooms and no waiting for treatment, money still buys privilege. But at the heavily isured, high-technology end of medical care, the pattern in this country is remarkably egalitarian. Where there's an opportunity to incur mammoth bills, equality prevails. thanks to the patchwork of insurance schemes that, in one way or another, feed money into the health-care system.
That the system is out of control, and perhaps politically uncontrollable, has long been evident. But what must now be faced is the likelihood that the medical economics system is now on the brink of a new burst of growth, the recent decline in hospital costs -- a slight and -- notwithstanding.
Recent experience shows that when pushed to the wall by the treat of federal cost controls, hospital administrators can find relatively painless ways to cut down on extravagance and mindless waste. Most of the fat, however, has now been squeezed out of the system. Meanwhile, just on the horizon is a boom in new tracks that simply defy political containment -- even if, as has often been the case in the past, they're not all that benefical. The point is that medical miracles occur often enought to inspire hope even in hopeless cases.And it's difficult to come to grips with that by act of Congress.
In recent weeks, it's been reported that surgeons and researchers on immunology feel highly encouraged by new developments in organ transplants; as a result, heart transplants, once considered a medical high-wire act of little practical value, are now moving closer -- though they still have a long way to go -- to acceptance as a standard medica procedure.
Whatever the implications, political wisdom may call for recognizing that, apart from economizing at the edges, it may simply be impossible to put any effective clamp on medical costs.
The hopes of old age and the promises of new technology are difficult to beat.