JAMA Dec 12. 2007
Health care today costs are 5% of our gross domestic product. It will rise to 20% by 2050. How can we contain this growing monster? How effective are each of our medical treatments? Which treatment is best?
Your treatment depends on the judgment of your doctor and the medical symptoms. Only one half of medical care is really based on supportive evidence. This explains why one half of the drugs disappear each year from the doctor’s arsenal.
Hospitals and doctors employed by hospitals encourage fee for service. This results in expensive procedures and treatments being performed as long as you or your insurance will pay for it. What incentive do you the patient have in seeking lower cost treatments if you only pay a tiny portion of the costs.?
Private companies don’t know what treatments work best for each patient and which treatments are ineffective. Medicare can’t determine which services should be covered.
HOW CAN WE BALANCE THE BENEFITS VS. THE RISKS?
Both the doctor and you the patient have to begin choosing fewer less expensive services. Insurance companies must change the way they pay and the way they cover drug devices and procedures that are cost effective.
Change the incentives. If the patient pays a part of the additional cost of a more expensive treatment, he can determine the need and benefit of the treatment.
Yet if there were an incentive to provide too little care, additional services would be eliminated with the burden on the patients with major health problems who might need these services. Their higher deductibles and high costs will limit the spending of those who don’t need medical services.
Reducing the medical costs in many chronic diseases may help the quality of care but it does very little to reduce costs of everyone’s medical care. There is now an attempt to target the management and care for those who need the most care. We can predict general risk but it is very hard to predict an individual risk. Insurance companies pool their customers who pay premiums and everyone wins.
HUMAN GENOMES AND YOUR MEDICAL RISKS
Synthetic genomes recently were constructed to include all the genes found in a naturally occurring bacterium. After mapping out the human genome eight years ago, Dr Venter is set to make artificial life forms with a minimum set of genes necessary for life. The science is rapidly pushing forward. Once the individual genes are mapped that are related to each disease entity, we will determine everyone who is at risk for any disease. Since we now can locate and isolate individual genomes, we can also find those who are at greatest risk.
Unfortunately some of us will become less attractive to insure. Now insurers can “genetic-cherry pick” and select coverage they will offer based on their specific risk. Screening programs are very expensive for both the government and the individual. Few with benefit and many are harmed.
Prevention medicine is really not working. Everyone thinks his or her doctor has all the answers, and will bail them out of any disease they might develop. Insurance enrollees switch insurances every 5 years so what could motivate them to pay for prevention 10-20 years down the road? Universal health care proponents say the shared risk might promise incentives to private insurance companies.
Tailored screening programs are being developed by public endeavors. If they can target the high risk populations they can efficiently screen them. To target your individual risk you must brunt the cost, the intense surveillance and also subsequent treatment. If you are found to carry a predisposing mutation, you will bear the increased insurance expense. Others will seek less expensive care, take their savings, and run.
Little does everyone know that we all have mutations and we all carry genomic risks for some disease. All of us are flawed with our genomes and we all need each other. Groups of patients will be identified who might benefit from a Big Pharma drug. Everyone with a disorder will randomly get some medication.
Insurance companies will want to pool their premiums to share the risk. No one company could cover the brand prophylaxis needed to improve medical care. Some will not even cover a drug that would help. Insurance profits would tumble if each of us got the right drug and the right dose.
Currently health care is rationed by one’s birth and income. Genetically based medicine will increase health costs by finding random risks for large number of people who will need high tech surveillance
We are all in the same boat and we share the medical boat ride together. Each of us is genetically flawed. Government health care is not a panacea for all the complex problems in our health care delivery system..
Yet what is our choice? What do you think?
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