Innovations, Pets, and Health Care Reform

Two pieces worth reading on health care innovation.  First, Glenn Reynolds on his family:

President Obama talks about the importance of prevention in a way that suggests that when people have heart attacks it's their own fault. But my wife, a longtime vegetarian and marathon runner, had a freak heart attack at the age of 37.

It wasn't from too many Big Macs. After some rough patches, she's now doing well, thanks to an obscure and expensive anti-arrhythmic drug called Tikosyn, and an implantable cardioverter/defibrillator. Not too long ago, she'd have been largely bedridden. These medical innovations made the difference between the life of a near-invalid and a life that's close to normal.

My mother had a hip replacement. Her hip didn't break - she basically wore it out with exercise. When the pain got too bad, she got it replaced, and now she's moving around like before, only painlessly. Not too long ago, she would have been chairbound.

My father had prostate cancer; his doctor suggested waiting but on biopsy it turned out to be pretty aggressive. It was treated with radioactive "seed" implants. He's now been cancer-free for several years, without the side effects of earlier treatments -- or, worse, of cancer.

My daughter had endoscopic sinus surgery this spring. She had been sickly and listless, complaining of constant migraine headaches, missing a lot of school, and generally looking more like a zombie than a teenager. Several doctors dismissed her problems, or prescribed antibiotics that didn't help much, until we found one who took the extra step.

A head CT scan done on a fancy new in-office machine showed a nasty festering infection, the surgeon cleaned it out, and now she's like a normal kid again. Before laparoscopy, her condition would probably have remained untreated, and she would have been another "sickly" kid. Better to be well.

The normal critique of socialized medicine is to point out that people have to wait a long time for these kinds of treatments in places like Britain. And that's certainly a valid critique. I'm sure my mom and daughter would still be waiting for their treatments, while my father and wife would probably be dead.

The key point, though, is that these treatments didn't just come out out of the blue. They were developed by drug companies and device makers who thought they had a good market for things that would make people feel better.

This is something I've been saying for a while.  But it touches on something else I've been thinking about--the way in which our attempts to measure health care innovation are going to bias our health care output towards things that can be measured.

The death of Dr. Helen would have shown up in any system's statistics.  It's a hard fact which is easy to measure, hard to game.  But if she had merely been bedridden, the loss that represents would be hard to measure, and easy for the system to "improve" by deciding that being bedridden wasn't so bad, after all.  An old woman waiting for a hip replacement (or not getting it at all?)  A daughter whose health was sort of permanently dragged down by a lingering infection?  The system rarely looks for ways to fix things that the system doesn't measure.

Meanwhile, The Enterprise blog has one of the more fascinating health care charts I've seen in a while:

Veterinary spending is rising just about in line with human medical spending.  Kudoes to AEI for publishing a graph that seriously undercuts one of the major conservative arguments about health care:  that the main problem is consumers who don't bear their own costs.  Veterinary spending is subject to few of the perversities that either left or right suppose to be the main problems afflicting health care spending.  Consumers pay full frieght most of the time.  They are price sensitive, and will let the patient die if keeping him alive costs too much.  There is no adverse selection.  There is no free riding on mandatory care.  Government regulation is minimal.  Malpractice suits are minimal, and have low payouts.  So why is vet spending rising along with human spending?

Two reasons, presumably:  technological change and rising income.  As we get wealthier, we spend more of our income on former luxuries, like keeping our pets healthy--nineteenth century veterinary care for sick cats consisted of a sack and some stones to weight it down with.  And improvements in health care technology are giving us more things to spend that money on.  With the help of my family, I bought my dog five extra years of life with an MRI that diagnosed his slipped disk; without it, we'd have had to put him to sleep when he was three.  Worth it?  I think so.  But in 1950, I couldn't have afforded it, even if it had been available.