Thursday, July 30, 2009

With health care more isn't necessarily better.

Europe spends thousands less for breast cancer treatment, the patient has a much easier time, and the outcome is astonishingly similar.

Marcy Wheeler (of the inestimable blog Emptywheel) had breast cancer a few years ago.

[She received] 6 rounds of chemo plus Neulasta, surgery, radiation, then five years of Tamoxifen--the standard of care in Europe would have been just the Tamoxifen. Or, by my rough calculations, well over $72,000 more in costs [for the US Treatment]. And, at least according to the limited studies they've done on women with breast cancer at my age, the outcomes are exactly the same.

Read about it here.

Why more cost, more pain (radiation, surgery, chemo--hardly a walk in even the darkest, most dangerous park), with no measuable increase in outcome in the US? Because doctors make more money if they push any given patient's insurance coverage to the limit. Capitalism at work.

The New Yorker, here, explains the perils of medical capitalism in an article that details how two areas in the US have close to identical medical outcomes, but one area's prices (evil region A, also called McAllen, TX) are twice (TWICE) that of the other good region B ( that slacker region served by the Mayo Clinic.) Why? Because in good region B, doctors are on salary, while in evil region A, doctors get paid by procedure. The doctors behave rationally and make more money for themselves, hurting their patients (because of the extra expense, pain, and risk of overdiagnosis) and the rest of us (as health care premiums go up all around). As a personal favor, read the article. Thanks.

I said "perils." Overtreatment is not good for anyone, except those picking up the paychecks. Why should someone, say Marcy Wheeler, be made substantially sicker (unnecessary radiation and chemo [I remember my aunt undergoing it. Horrible]), just so some guy who went to med school should have a better summer house?

On the subject of perils, I heard some congressmen getting all spittle-flecked discussing the horrors of the British system (not on the table here in the US, and so beside the point) because they didn't provide free mammograms until 50 for women.

I realise this is counterintuitive, but often too many madical tests lead to worse, rather than better outcomes. Why? Because overtesting leads to overdiagnosis, which in turn leads to unnecessary procedures, surgical and otherwise, all of which have a health cost. For way more than you want to know about breast cancer overdiagnosis, I suggest one of my favorite blogs, written by an oncologist, respectful insolence, here.

So, the senator was full of it. Cancer outcomes are a tiny bit worse if woman waits until 50 for her first mammogram, but if she has one one earlier, the health costs, such as unnecessary surgery associated with false positives more than balance out the danger. Not to mention the totally unnecessary expense.

Take home point? With health care more is not always better. More may very well be worse. And more expensive.

1 comment:

Allie said...

We should just move to Europe.