I don’t know everything that changed from the glorious 50’s, but here’s one.
If you lived in my small home town in 1955 and your dad had a heart attack (myocardial infarction), he’d be transported by hearse driven by the undertaker (which doubled as an ambulance) to the hospital, placed in a regular hospital bed, given morphine as needed for pain, and the nurse would check on him every so often to make sure he wasn’t dead. A short paper-strip EKG trace would have been taken and shown to the doctor, who would have also checked his heart with a stethoscope.
In 1985, he’d be transported in an ambulance staffed by trained EMTs capable of extensive pre-hospital care, placed in a bed with telemetric heart monitoring, supervised by specially trained nurses in an intensive care unit, and be administered a clot-busting drug as part of a clinical trial of early hospital interventions. If his MI caused an arrhythmia, he’d be given shocks and/or drugs by the EMTs, nurses and doctors to restore a normal rhythm. Then, he’d be transported by ambulance to a major referral center and have his veins imaged. If they were significantly blocked, he’d have surgery during which a team composed of surgeons and other doctors and technicians would crack open his chest, connect him to a heart-lung machine, stop his heart, and bypass the blocked veins in his heart with a vein from his leg. After that, he’d have extensive cardiac rehab by trained personnel, with the aim of changing his lifestyle. He’d also take a regimen of expensive drugs aimed at preventing another heart attack.
In 1955, his bill would have been about $1-2000 in today’s dollars. Thirty years later, it would be about $100,000 in today’s dollars.
I’m sure there are a lot of other factors in why the middle class is having a hard time keeping up a 50’s lifestyle, but this is one of them. In the 50’s, the middle class could self-insure or have a cheap “major medical” policy, because there just wasn’t that much medical care to buy. The opposite is true today — there’s more to buy than the average middle-class family can afford, even with insurance.
gnomedad
Yup. No Death Panels back then, because for a lot of medical problems, everyone just died.
Svensker
On the other hand… I recently found the bill for my son’s birth in the late 80s — 5 day stay in the hospital. $5000. In 2010 dollars it would be $8500. Can you imagine a 5 day hospital stay costing $8500? My husband’s hospital bill for his out-patient surgery last year was $18000, which was for 4 hours. (Not including, doctors, lab costs, etc.)
Maybe the hospital is amortizing all that fancy stuff that they didn’t have/do in the 1950s?
dr. bloor
Yeah–this is the big pink elephant in the room that everyone hates to talk about when discussing health care costs. Basically, we’ve developed magnificent tools, techniques and medications to keep people alive much longer than we used to–and by doing so, we create more demand for more magnificent tools, techniques and medications.
Paul Gottlieb
From what I remember, if your Dad had a massive heart attack back in the 1950’s he would most likely be transported not to a hospital, but to the local mortuary. The rate at which people survived their first heart attack has changed enormously since the 50’s
David Koch
Luckily when Tim Russert literally dropped dead, he stayed dead, and my taxes didn’t have to pay to repair his pepperoni pizza addled heart.
soonergrunt
The main problem I have with mcmegan is that apparently the rest of us who weren’t born with a silver spoon in are supposed to simultaneously be happy about the great advances of today and OK with not being able to take advantage of those same advances we cannot afford.
Zifnab
And if your dad went into that kind of heavy surgery, and he couldn’t afford to pick up the tab, any children worth their salt would happily take a third job and a fourth mortgage to cover the difference.
So I guess the question becomes how one brings down that six figure number, before it chomps away at family income.
stuckinred
@Paul Gottlieb: No kidding and rehab consisted of, sit down and rest. Now your ass is up on the treadmill mosty rickey tic. When I broke my back in 1975 the orthopod I saw after the harrington rod implant wanted to know what the hell I wanted to go to the University of Illinois kinesiology clinic (an early sports medicine operation) for> My football player buddies insisted and it was the best thing that ever happened to me. Rehab was in the frickin dark ages even then.
Zifnab
Actually, that’s another thing you might want to address.
Back in the 50s, you didn’t have a lot of debt servicing. Mortgage, maybe. But credit cards didn’t really exist. Student loans didn’t really exist.
How much debt does a married couple have when they get their first kid? How much debt does the married couple have when they send the kid to college? How much money has been spent paying off fines and fees and interest?
I wouldn’t be shocked to see a respectable chunk of income going into paying off various forms of debt – credit card, car, mortgage, etc. If you suction off 10-15% of a person’s income on – effectively – nothing, that would definitely cut into the budget for luxuries like vacations and Christmas presents.
Jim
You pegged 1955 and 1985. By 2005 you’d be taken to the ER, where an on-call cardiologist would get a stent into whatever artery was clogged, faster than you could say “hospital bill.” Out of the hospital after a day or two of observation. Cheaper than opening you up — in those cases where it could be used, of course. So some things have actually gotten better *and* cheaper. Unfortunately, they’re the exception rather than the rule.
WyldPirate
@Svensker:
None of these “developments” explains the extreme differences between the cost of care here in the US versus the cost of care in countries like Canada, France, the UK, etc. because these countries have the same sort of “developments” available for their people.
These differences in health care costs per capita–which are generally 40-60% less than in the US ALONG WITH better outcomes/longer life expectancy–are due to two things. The first and the worst, is a great big huge middleman called private insurance that doesn’t do a goddamned thing to improve anyone’s healthcare while hoovering off enormous profits. The second thing is the greed of the doctor’s themselves. This greed is primarily administered through the American Medical Association which keeps the numbers of physicians lower than market demands by limiting the number of physicians entering the work force by controlling the number of medical students and new physicians being trained.
The hand of the free-market system for healthcare is fisting the citizens of the US and it does not work for the benefit of its citizens. On top of that, it is impoversing its citizens, causing them to ignore preventative care due to the cost which results in worsening of conditions prior too first treatment (or continued treatment). Additionally, or medical care system is bankrupting government and causing industries to be less competitive.
arguingwithsignposts
And most of those hospitals were non-profit, often run by religious organizations or the county. Don’t leave that out of the mix.
Dennis SGMM
@Zifnab:
A minor correction from an Old Guy: credit cards didn’t exist but most department store chains offered revolving credit plans. They amounted to pretty much the same thing as a credit card.
Trakker
This is a good point. I grew up in the 50s and my dad supported a family of five kids alone. My mother stayed home and “kept house.”
Keeping house for a family of seven back then was no easy chore. All the clothes back then had to be ironed, the washing machines and dryers were cranky and inefficient. There was no air conditioning so ironing and cooking in a hot house in the summer was draining. We didn’t have a dishwasher so we kids had to do the dishes every evening (again not fun in the summer in an already hot kitchen). Also, we only had one car (which my dad drove to work) and the b&w TV only worked half the time (tubes were forever burning out).
While wages have stagnated for decades for those of us in the working class, life in other ways has improved significantly (and it’s improved just as much for the very wealthy, so this is not an argument that stagnant wages is the price we must pay for improvements in the quality of life). I’m just adding perspective.
WyldPirate
@Dennis SGMM:
You also had the oil companies come out with credit cards that were pretty widespread before major credit cards like american Express, Mastercard and Visa.
RSA
I’d also mention perception and expectations. Up until the 1950s, or maybe a bit before, when people came down with serious health problems that most that they could expect would be palliative care. Nowadays, people expect doctors to be able to fix pretty much everything. I if I’m remembering correctly, something on the order of half of our health care dollars are spent on people who die within six months of their treatment. Of course, we can’t predict the future, so this sort of thing is inevitable, but my point is that most of us have really, really high expectations about what medicine can do for us, as if with help we can live forever.
MikeJ
@Jim: Still not cheap though. I don’t remember what the total bill was when my dad had a heart attack a few years ago, but I do remember the ambulance alone was $15,000.
zzyzx
Yeah I was thinking about this yesterday, how even if it meant that I could have a little less stress over my job, I would not be willing to go back to a world with no Internet where cars are death traps that spend more time being tinkered with than on the road, where a vacation was a trip to the same local lake you go to every single year. We spend more but I do think we get more.
cintibud
Please note – I did not write that email with the intent of “Glorifying” the 50’s. That was a time of Jim Crow, “womens work”, “smear the queer”, “communists in the government”, shitty music, etc. It was only to point out how a low wage earning family could still keep a roof over their heads, get a decent, even excellent education and enjoy family time together. Things are undeniably better today – if you can pay for it. That’s the rub. If my unemployed friend with no health insurance has a heart attack, he will very likely survive – to see his house foreclosed on. I don’t know about him but my Father would have “climbed out on to an ice flow” before he would have let that happen to his family. He passed away from heart disease in 1990 – years before he would have today – but secure in the future of his family.
patrick II
The fancy medical technology does not have to be as expensive to use as they are here in the U.S. An MRI in the U.S. costs, on average, about $1700 dollars. In Japan that same MRI costs $160, and in France and Germany the cost is also between $160 and $170. A doctor who operated on my leg gets paid about $12,000 per operation — he does nearly 200 a year for a take of about 2.4 million. He also gets about $800,000 to be chief of surgery at his hospital, and also was paid another $2 million from the company whose device he put in my leg. That is a total of over $5 million and that is considerably more than a doctor from the 50’s even in adjusted dollars.
Medical care here is expensive not just because it is more sophisticated, but because we pretend it is a commodity in a free market,and it is not. When a television costs too much you can say no. When you have to mortgage your house for chemotherapy or die it is difficult to say no. The people who wrote the books on conservative economics — Smith and Hayek, acknowledge that and have other solutions. Those solutions are ignored and discounted by modern conservatives. The simplified laissez faire our politicians have been bribed into writing into law is just blackmail and not really free market economics.
This is written by a guy with a limp given to him by a doctor who takes payments from a medical device company and used an inappropriate operation to implant his company’s device because the first $3 million evidently was not enough.
gronald
+1 Christian Mastermix®
Our nation’s overall debt issues are abut healthcare, healthcare, healthcare, defense, and healthcare.
WyldPirate
@MikeJ:
When I had my MI in late 2009, the ambulance bill was $4500. I walked up to the ambulance (was at a large public event), told them I thought I was having an MI. They got me inside, hooked up EKG, confirmed MI, started an IV and oxygen, gave me aspirin and drove me 3.5 miles to the hospital. Pretty steep for less than 30 mins of service.
Mr Furious
Sorry. I think this “healthcare costs is a big reason families struggle now compared to the 50s” stuff is a horseshit straw man.
There’s no question that medical care costs are exponentially more than in the past, and those costs are passed down to insurance premiums—but those costs are not commonly borne by average familes in actual cash outlay, they’re paid by insurance.
Before everyone screams that those costs are passed down to consumers, I realize that. But those costs are spread across the insurance pool, just like the risks.
My first daughter has racked up probably a quarter million dollars in hospital bills in eight years. Maybe twice that, I have no idea. My second daughter has had exactly one medical intervention—a single stitch in her lip.
If we were two different familes with one of those kids each, there would be no difference in the amount of money I made, or paid out of my pocket for medical care. None.
Either way the total tab for each families medical care (however split between employer and employee) is about $12K. That’s a drop in the bucket compared to the fact that the owner of my company makes 700 times my salary instead of 17.
To assign medical care as a massive reason why “families struggle today” is bogus. It is certainly true in many cases, and is a factor, but in my opinion, for the vast majority of familes its one of many line items. Placing the emphasis on medical costs and treating it like a cost we can’t control and might be worthwhile like this allows other factors—such as the tremendous upward movement of wealth—to slide by scot-free
WyldPirate
@patrick II:
This. This. This.
This is the driving factor behind why we went to public utilities, public schools, police enforcement, military, etc.
Mr Furious
@Zifnab: I think this point—debt service—is a much bigger factor to most families than medical costs.
DBrown
Part of the cost is due big Pharma – for example, with coverage, a standard statin costs about a $1/day (just the copay) but simple Mg (as MgO @ 2x the FDA daily requirement) will provide similar LDL reduction (but incredably, significantly increase the HDL by 20 -50%, something a statin can’t do) for about $0.07 – $0.15/day. Which does the Med exstablish push? There are a lot of proven treatments that are over the counter (Niacin, Omga-3, Alpha-lipoic acid) but do MD’s use these instead of the very high end, ultra costly meds big Pharm pushes on us?
Mr Furious
And of course, the debt service problem goes right back to the fact that we are expected to pay for more things now than in the 50s, and pay more for the bills that did exist then, on not much more money.
WyldPirate
@Mr Furious:
The problem is that even the fucking premiums are cost prohibitive for many families even if the insurance is available.
I worked for a state government in the South. My premiums were covered by the state. Had I had children or a spouse that needed coverage, the premium would have cost nearly 6K per year out of pocket and this was before copays, deductibles and all the other happy shit. Until ACA, fugeddaboutit if you had someone with a “pre-existing” condition.
Taking a 6K chunk out of someone making a 40K per year before tax income is a huge deal.
edited to fix formatting foul-ups
Mr Furious
Not saying they’re not a factor. But the healthcare costs arent the big problem in the equation. The bigger issue should be that you are only making $40K.
WyldPirate
@DBrown:
Both Zocor (simvastatin) and lipitor (atorvastatin). are generics. My simvastatin costs $3/month.
Good point about the Magnesium. I’m going to have to look into that. Niacin did wonders for my HDL, too.
Barry
@Dennis SGMM: “A minor correction from an Old Guy: credit cards didn’t exist but most department store chains offered revolving credit plans. They amounted to pretty much the same thing as a credit card.”
And I’ve heard of this mentioned as a problem in the Great Depression – as people’s incomes dropped, and deflation hit, their debts did not deflate.
Mr Furious
State employee benefits with that shitty of coverage is fucking crime, btw. The best healthcare coverage I’ve ever enjoyed was courtesy of the State of Michigan, and it kicked ass whether single, married or family.
Again, the fact that your job offered a crap contribution to your insurance courtesy of what is probably a GOP gov’t in a right-to-work state that directs the state’s coffer upward and out to business is the problem.
It’s happening live and in living color in Wisconsin right fucking now.
MarkJ
@Svensker: A couple of years ago I saw a doctors billing sheet for various procedures, including an appendectomy, which in inflation-adjusted terms was, if memory serves, roughly $500. I’m not sure this was a particularly risky surgery even in the 50s, nor did the techniques they used back then result in serious long-term debilitating side effects.
My memory of the inflation adjusted price may be off. It may have been closer to $1,000 or even a few thousand, but either way, good luck getting an appendectomy for anywhere near even $5,000 these days. They probably run $20,000 plus despite the fact that there hasn’t been all that great an improvement in patient outcomes.
Roger Moore
@MikeJ:
Some of this, though, is that the bills are grossly misleading. They represent the cost that somebody would pay if they were paying out of pocket and actually wound up paying all their bills. Most people will either have some form of insurance, in which case the insurance company has already negotiated a reduced price with all the providers, or they’re poor enough that they’re likely to skip out on their bills. Those bills are best seen as the medical provider’s negotiating position rather than something they’re actually expecting to collect.
WyldPirate
@Mr Furious:
true. It’s still a big deal for a family with an income of 80K, though it can rapidly become a problem if they have to use the healthcare they are paying exorbitant prices for.
The point is that the “freefist” of the market is fucking people over from both ends paying for the insurance and paying salaries so that healthcare is a “problem” for about 80% of Americans and a good 90% if they get seriously ill.
Stillwater
James Hanley has a good post discussing some of this stuff. His view is that the middle class isn’t shrinking (spending power based on 1950’s values has actually increased) but it is harder now to live what constitutes a (culturally defined) middle class lifestyle.
One thing I would say about this, and one even he concedes, is that over the same time frame there is increasing income disparity. Most of the income gains have accrued to the upper 10% of income earners. So in a relative sense, the middle class is shrinking (ie., the absolute value of income share has decreased since 1950).
What this means isn’t exactly clear, of course, and there appears to be a lack of compelling data to make a clear cut case that the middle class is worse off – given the cultural expectations entailed by progress – today than it was 60 years ago. (If someone knows of a good paper arguing for this, please link it).
My own take on it would be that absolute measures of standard of living – based on the CPI and inflation – are an overly narrow measure of quality of life, and presuppose that middle class living is best understood as ‘disposable income after meeting basic needs’, or in short, luxury items. But we all know that what was once just a luxury item can be viewed as a necessity as culture changes. And I also think that the trending of greater income inequality is a more important measure than it’s critics will allow.
Stella Barbone
@WyldPirate: Mag oxide is the active ingredient in Milk of Magnesia. Take enough of it and you’ll lose weight too … the hard way. Be careful with magnesium, if your kidneys aren’t perfect. Weight loss (the usual way; eat less, exercise more) is the best way to lower LDL.
Pangloss
I was under the impression they bartered with chickens.
DBrown
WyldPirate – do look into the Magnesium, the results are extremely good (and safe but loose stool can be a problem; some types are better but it depends on the person) but if you take a statin with high dose niacin, keep a very close eye on your liver – those two ‘drugs’ can be very toxic (I learned the extremely hard way and I was being tested for that issue monthly!) For me, the Mg has done as well as the statin so I gave up the statin; adding niacin with the Mg, I doubled my HDL and don’t have to worry about liver failure.
If you are having any build up of plaque, I have info on how to possibly reverse it (fully) but that I will only talk about in a private e-mail since this is an experimental treatment (very cheap and available to anyone, however) but could be dangerous.
Good luck and I hope the best on your recover from the effects of the MI – remember, heart mussel does grow back slowly!
WyldPirate
@Stella Barbone:
Appreciate that, Stella.
I hadn’t heard that about the LDL-lowering effect of magnesium before. I was checking out a few journal articles/studies. seems sort of sketchy so far as the doses required seem large 4 grams/day in one.
I don’t need magnesium, but was just curious. My cholesterol levels are excellent now between the better diet, statins, niacin and lots of aerobic exercise.
DBrown
By the way, I use less than a gram of Mg a day and I got a 40% increase in HDL and 60% decrease in LDL; is that dose your niacin dose (most people use 2-3 gm as I understand.)There is the link for the Med paper on Mg (http://www.jacn.org/cgi/content/full/23/5/501S ) This explains both how and why it works. The Wiki under “HDL” has the referance if this link doesn’t work.
WyldPirate
@DBrown:
Thanks for the good wishes, DBrown. I was very fortunate with my MI. I had a STEMI in my RCA that they got a stent in right away. A month later I had bypasses on the RCA where the stent was placed, and major blockages in the LCAD and circumflex. Two echocardiograms later show no real damage and the troponin levels were not elevated after the MI as they got the stent in evidently as the thing was just forming a a fresh thrombus around the stenotic region of the RCA.
I was a lucky puppy and fortunately didn’t ignore the symptoms like many and got quick care.
I’m not really convinced that the statin is responsible for my lowered LDL. Hard to say, really, but I was on it for a month between the stent emplacement and the bypass and the LDL dropped little despite a radical change in my diet. We maxed out the statin dose and I’ve been exercising like a madman for over a year now. Frankly, I think the mad loss of weight, better diet and lots of exercise has done as much or more to lower the LDL than the statin has.
If I had insurance now, I would be tempted to go off of, or greatly reduce the statin, for three months and see what changes that caused in LDL levels. I’m not wholly convinced that it is having that big of an effect and as you say, statins can be rough on liver function. Fortunately, I seem to tolerate them pretty well.
MobiusKlein
@MarkJ:
Are you sure that patient outcomes are not better now than in the ’50s?
The improvements in abdominal surgery are not minor. Laparoscopy allows a much less invasive procedure – no more full belly opening up, quicker recovery. Ultrasound and CT scans allow more accurate diagnosis. Improvements in anesthesia have reduced OR mortality as well.
Is it worth the price? I’ll let you decide that.
matryoshka
@Svensker: Birth is an interesting area of medicine to look at when discussing costs. C-section rates are way, way up since the 1950s and NICUs are dealing with babies who would have died even a decade ago. The trend toward medical intervention in birth has been driven by political and financial forces, as well as whiz-bang technology that once it exists, must be justified. While most women would have normal births if left to their own devices (heaven forfend), the AMA has spent a fortune of time and money to keep midwives marginalized and to play on women’s fears of what can go wrong with birth and babies to keep their hand in the birthing business. Ironically, obstetricians pay such high insurance premiums that some are driven out of that particular practice! Oh, the ironies of the modern age.
DBrown
WyldPirate – please do not stop the statin for three months! I was forced to do exactly that and I got a stent as a result (learned a very painful point there.) Yes, I’m now off the statin but the Mg with Niacin has fully done the job with benifits no statin can match (far greater HDL which you should know is #1 way to reduce risk for heart issues AND for me,no more liver failures (they are bummers!))
Very glad all is looking so good and hang in there!
WyldPirate
@DBrown:
Thanks for the paper link, DBrown. I’m going to look into it, for sure. I try to stay on top of all of this stuff and have a very jaundiced eye when it comes to ridiculous claims
I’ve gotten my LDL down to 72 mg/dl (80% drop) from the physical, dietary changes along with, perhaps, the statin activity and raised my HDL from 17 mg/dl to 45 mg/dl with the 500 mg/day niacin and exercise, etc.
DBrown
WyldPirate – wow, your HDL increase was amazingly good! LDL also looks very good. The Mg/Niacin doubled my HDL to 66. Please read the paper and also, don’t forget a gram of omega-3/day. For people with stents, a safe extra blood thinner like omega-3 can really help prevent thrombous (I hope I spelled that right.)
You are doing really great, but be careful and don’t drop the statin without a test within the month. You can get blockage far, far faster in a graft than an artery (like in three months!)
WyldPirate
@DBrown:
Thanks. I’m not going off the statin or anything, just a bit curious as to why I showed no real improvement in LDL levels in a month’s time being on a midpoint dose for simvastatin. The confounding factor is that I couldn’t exercise much at all because I had some major blockages that needed bypassing and I hadn’t lost much weight in that interim.
The reason I wonder about the statin efficacy is that the drug works on an emzyme called HMG COA reductase which is the rate-limiting step in cholesterol biosynthesis.
It turns out that there are different isoforms of the HMG COA enzyme since we are genetically different and some are not response at all to the LDL-lowering effects of statins. This is why some people can get big shifts downward in LDL with tiny doses (which means the statin is inhabiting the enzyme very effectively) and some folks with other forms of the enzyme or essentially unresponsive to statins.
The same sort of thing goes on with the blood thinner Plavix that is given to a lot of heart patients. Plavix has to be c9onverted to an active form by one of the cyctochromeP450 enzymes in the liver. It turns out that a substantial number of people don’t have the correct isoform of the enzyme to convert the Plavix so it will work, so they are simply not benefitting from taking a very expensive drug at all. The only way to determine whether you have the right or wrong form of the enzyme is via genetic tests which few docs do due to the cost.
The Other Chuck
Medical care is expensive. That’s why civilized countries pay a respectable chunk of their GDP for it, instead of fucking BOMBS, or literally hundreds of military bases worldwide.
Actually we not only pay for those bombs and bases, but an even bigger chunk of our GDP for medical expense, mostly because this country by design bases its fiscal policy on things like health care on the equivalent of frequenting shady payroll loan joints. You could not design a more idiotic system, which I suppose is why we have legions of idiots defending it.
WyldPirate
@DBrown:
Sorry you had to learn that lesson the hard way, DBrown. That warning about not dropping the statin was one of the first things out of my cardiologist’s mouth on my discharge day after the stent emplacement.
Just for prudence sake, the surgeon when he went in and fixed my other blockages, went ahead and bypassed the stent, too.
Hope you are doing well and it sounds like you are. Keep up the good work. You really don’t want to get your chest cracked open if you can help it. It isn’t a bit of fun.
DBrown
By the way, statins also prevent CoQ-10 production in the liver which is, as you know, is a critical enyme for mussel energy use. As an aside, many countries require that C0Q-10 be combined with a statin for this very reason. It made a world of difference for me and increased my energy levels like crazy (when using a statin) and even slowed the rate of liver damage caused by the statin(for me and yes, there are med papers on all this.) Might want to try that since a lot of people now use it for that exact reason.
Jager
@stuckinred: My Dad had his first heart attack in ’59 and he was told to stay in bed for at least 6 months, no exercise and no diet restrictions. The only thing they told the old man that made any sense was to quit smoking. By the end of the first year after his heart attack my Dad had gained 45 lbs!I have no idea how he made it for the next 20 years, the 3rd heart attack finally got him at 59.
Don K
@WyldPirate:
And it wasn’t until the 70’s or sometimes the 80’s when department stores and gas companies accepted MasterCard/Visa/Amex in addition to their own cards. My Mom had a wallet full of cards just to cover the department stores she might shop in in the Philly area (Strawbridge’s, Bamberger’s, Wanamaker, Gimbels, Sears, Penneys).
Back to the topic, cancer care back in the day often consisted of exploratory surgery and either an attempt to remove the cancer surgically or else “closing him back up” and expressing condolences to the patient. A few years back I had surgery on my left middle ear that almost completely restored my hearing. Until fairly recently, the surgery for the problem I had would have been quick and not terribly expensive, but would have left me completely deaf in that ear.
So yeah, there are lots of good reasons health care is more expensive than it used to be, and lots of reasons (but no good reasons) why it has gotten more expensive more quickly in the U.S. than in other comparable countries.
someguy
@WyldPirate:
So we’re fixing it by creating a single national market for health care meeting specific regulatory requirements, one size (really three sizes) fits all? Seems to me if you were one of those market fundamentalists you’d be in favor of much more widespread competition. I think you would be completely wrong to think that way and that federal regulation will be much improved and realize efficiencies, but what we’ve had in the insurance market for dozens of years is a botched regulatory effort, with greatly varying state-by-state standards and ridiculous transactional costs, and legally dictated cost shifting itself being a huge problem. You’d be right to say the states with a little help from the fed fucked it all up, but I’ve practiced insurance litigation, the state regulatory scene is anything but a laissez faire free market. State/corporate cartel, protectionist arrangement, heaps of misguided well-meaning but counterproductive efforts… very little is free about the business end of health care.
chopper
@Don K:
well, you also have to remember that while care for more extreme cases and conditions has improved immeasurably, and care for chronic conditions has improved, so has the number of americans with chronic conditions.
if we were a society based on healthy lifestyles and preventative care, our health care costs would be far more manageable despite crazy advances in technology regarding MIs and the like.
RobZ
I recommend Dr William Davis’s(Milwaukee cardiologist) blog http://www.heartscanblog.org/. Not a big fan of statins. Not a big fan of the American Heart Association’s recommended diet either.
Factoid: Fat Albert, at one time the world’s heaviest rhesus(70 lbs) ate nothing but an American Heart Association recommended diet.
http://www.nytimes.com/2011/02/20/health/20monkey.html?_r=1
Dr. Davis’s #1 recommendation is to restrict wheat intake. Not easily done!
Martin
@DBrown: Actually, not just a big pharma graft problem. When medicinals and supplementals were taken out of FDA authority, doctors got very skittish about recommending them not knowing what the patient might end up with. If you recommend a non-FDA regulated supplemental and what the patient buys ends up being shit and they die, the going to get your ass sued off for not recommending the slightly more expensive, but FDA regulated drug. It’s a situation where deregulation increased everyone’s pharma costs by making the low-cost items too risky to prescribe, even though they were lower cost.
drkrick
@Svensker: Just found the hospital bill for my birth in a major NE city in 1958 – 5 day stay, delivery room, anesthetic, lab, “special drugs,” “beads and certificate” and surgery of the Hebrew persuasion – $149.25 ($1,140 in 2010 dollars).
Ailuridae
@WyldPirate:
Sorry but suggesting that private for-profit insurance and doctors compensation are driving health care costs comparably borders on fucking insane. Yes, insurance companies are unnecessary middlemen but, no, insurance companies are not driving cost increases.
BH in MA
Let’s not forget the fact that today the person is likely to survive, return to work and go on earning an income, paying taxes and supporting his family for another decade or more. Furthermore, most of the 100K cost would likely be covered by some kind of insurance and as a result the family’s finances would probably not suffer a crippling blow.
I really think a major part of the difference is housing. After my parents married, my mother kept her job for one year to save up the $5000 down payment on a 24,000 house (3br ranch with 1 car garage on 1/4 acre near the highway). My dad was earning 10k at the time. Fast forward 30 years to 1993 when my wife and I were house hunting. We were both college educated and 28 years old – same as my parents in 1963. By coincidence their first house had changed hands recently and I could look it up in the “recent sales” database. In order for my wife and I to be able to a)come up with a 20% down payment in one year by saving one spouse’s salary, b) have one spouse stop working to start a family, and c) get a mortgage that is 200% of the working spouse’s salary we would have to be earning a combined $185,000. The house had sold for 275k meaning one spouse would have to earn about 75k in order to save the 55k down payment while the other spouse would have to earn 110k (half the 220k mortgage). In 1993, that level of income would have put us into the top 5% and this was for a 3 bedroom ranch in a Boston suburb. Not a “top 5%” kind of house by any stretch of the imagination. In 1963 my father was earning around 150% of the median income for massachusetts while my wife and my combined income 30 years later was about 135% of median income. Our places on the income curve weren’t radically different but the only way would have been able to afford that house was if someone handed us $100,000.
Batocchio
True, but the cost would be moot with universal health care. The system would still have to address costs, but the burden of emergency care wouldn’t bankrupt a family. As most readers here know, universal care is cheaper and better overall.
Glen Tomkins
Most people who come into a hospital with an MI don’t need any sort of intervention beyond that clot buster. You get the CABG or stent only if the MI proves to be just the “foreshock” and you have proximal high grade blockages that threaten that “the big one” is imminent.
So sure, one in a hundred or one in a thousand need the $100,000 treatment. You really, really do not want the $100,000 treatment unless you really need it to save your life, because a CABG, even if things go perfectly, exacts a horrible human cost.
The problem of out-of-control costs is not the big ticket items, and least not in and of themselves. Your CABG, or your liver transplant, or your bone marrow transplant, all ration themselves, because you would accept these horrible alternatives only in those rare instances when you have a life-threatening problem that happens to be treatable with one of these high-intensity interventions. Most of us will never see that rare combination of two rare pre-requisites.
The problem is that, compared to other countries, we systematically overuse interventions right across the spectrum of intensity. And then we end up paying more per such intervention than those countries that use them less often. You’ld think we’ld at least get a volume discount.
The problem is that we measure once and cut twice, per the old surgival maxim, rather than the right way, measure twice, cut once. Oh, that and we tolerate cartels among and between the big providers and the insurers.
It’s a wonder costs aren’t even more out of control.
mclaren
Is there any hard statistical evidence showing that overall survival rates from MI have increased at all since the 1950s?
I don’t believe there is.
As far as I know, narrow measures like “survival for 30 days after the initial MI” are up by somewhere around 18%, but surviving for 30 days means nothing. How many MI patients survive for 5 years after the initial heart attack?
As far as I can ascertain, the 5-year survival rate after an MI is incredibly low and hasn’t changed since the 1950s. Moreover, the 2-year survival rate after the second MI is essentially nil, and has never changed.
Stents don’t change that. Clot busting drugs don’t change that. AFAICT no current treatment changes that 5-year survival rate. The only current medical treatment that I know of that changes the 5-year survival rate for heart disease is heart transplant, and then only for chronic heart disease.
Most medical treatments today are scams. They improve short-term survival times (24 hours after initial injury, 30 days after initial crisis) but do nothing at all to improve the long-term survival rate (2 years, 5 years).
The only exceptions appear to be exotic cancers, particularly cancers involving very young children, and catastrophic injuries like transected aortas. Put a dacron graft on a transected aorta and you’ll definitely save that person. But this is a wildly unusual injury you’re only likely to get in a massive car crash.
For the kinds of diseases most people suffer from, like diabetes or a heart attack or a stroke or cancer, the long-term survival rate hasn’t changed one iota since the 1950s. The treatments have become exponentially more sophisticated and more expensive but the long-term survival rates have scarcely changed for 60 years.
mclaren
Incidentally, the long-term survival rate (5 years) after heart attacks is incredibly poor — about 50%. This suggests that spending a lot of money on sophisticated treatments is a complete waste.
Nobody wants to talk about it, but at some point we’re going to have to start dealing with the issue of rationing care. There are an incredible number of wildly expensive treatments today that in some cases are known to prolong a patient’s life statistically by only a couple of weeks. That’s the kind of money that even a wealthy society like America can’t afford to spend.
Here’s the source for that 50% mortality rate within 5 years of a heart attack.
Mark D
Fixed that to represent actual reality, based on the fact my spinal fusion in 2005 (a much less complex procedure than that needed to fix MI) cost about $220,000 total.
Granted, with insurance I only paid around $2K, but if I hadn’t had that coverage … well, we’d be bankrupt, homeless, and gawd knows what else.
So, yeah. Health care costs suck.