A fundamental truth is something that you always want to think about clearly. Every such truth has consequences – some we are happy about, some we are not so happy about, but we have to live them with anyway. The facts are not always easy to live with unless or until we think them through and come to terms with them. Then, we still may not be terribly happy with the outcome, and while we may not be any happier, at least we understand it better.
One fundamental truth with which Americans are presented is the increasing cost of health care. While the are efforts to try to reduce or minimize these costs, it’s likely that such efforts will not have great success. It’s worth thinking about why the cost of health care is steadily rising in the context of what we are getting for the increase costs. You should note that this is a big subject and that only a few partial answers can be developed in any given post – and then only in the limited context of specific questions posed. Thus, the question is one that I will try to come at from a number of directions.
First, we have seen from experience that medical care for battlefield injuries of a serious nature has improved the prospects for survival substantially over the last century. While exact numbers are hard to dig through and compare in detail, it is generally true that medical care given to serious casualties, who field medics are able to get to and stabilize until a full medical team can give that wounded soldier attention, has resulted in vastly improved survival rates over the last century. Survival has gone from something like 20 percent in World War II to about 80 percent in Iraq. Increased survival includes many more cases of serious head injuries and more serious injuries that those that might have occurred in previous conflicts. The techniques of trauma surgery and other pre- and post-operative care have notably improved over time. Survival from 20 percent of cases to 80 percent of cases carries an additional burden on the costs of medical care.
In this case, many additional veterans will return home requiring major continuing medical care, in some cases with added costs well beyond those associated with civilian post-operative care. The growing ability of medical care to allow some people to survive who might have otherwise died will inevitably increase costs. Improved and more costly procedures are required to bring about survival, then there are to costs associated with convalescence during both a critical post-operative period and also later when continuing or chronic care may still be required. Even though long term survival may not be assured, lifetime costs for such patients surviving and recovering from extremely serious injury are clearly going to be much greater than those of the general population not suffering such injury.
The question we ought to ask here is: Are we sorry that we have brought the medical arts to a level where most of the soldiers experiencing serious battlefield trauma have the chance to survive it? The costs to the society are certainly great. Those surviving serious injury in Iraq may have lifetime medical costs in the range of several billion dollars or more. In many cases, they may not function as well as they did prior to their service and may contribute less to the net productivity of the nation, but it’s hard to imagine any noncombatant citizen begrudging a surviving veteran an opportunity to try live well beyond what used to be but is no longer a life ending battlefield injury.
So, here we are. The country, indeed the world, has worked hard and long to advance medical art and science to a point where survivability from serious traumatic injury is not routine but far improved over what it used to be over less than half a century. Those who are not involved in military actions also experience serious traumatic injury and they are also the beneficiaries of new medical advances as they come on line. Generally, others experiencing medical issues also benefit more generally as new medical advances may apply to their cases as well. This includes everything from advanced robotic surgery to the use of a large number of non-invasive diagnostic procedures which have the potential of subsequent medical treatment strategies as more and more diagnoses become clearer and fewer exploratory approaches to treatment are required.
To be certain more expensive machines and procedures add costs, but weighed against the benefits we are more than well compensated. Who pays the extra costs and who is compensated and at what rate for years and years of study that bring the miracles of modern medicine to us is something we have to work on, generally with less complaining than is currently engendered. Still, we need to lay out the rules. That has been done to some extent country by country, but we have serious issues arising as the world is increasingly divided between the haves and have-nots.
We have as many as 2-3 billion people in the world trying to live on about $2 per day. Perhaps as many as 20,000 to 30,000 per day die from lack of access to medical care. This, to be sure is a challenge for now as well as for the future. We have reasons for the rising costs of medical care whether it’s applied the critically injured patient or to the standard care that every human being deserves and ought to receive.