OPINION -- At the cancer center where I worked for 22 years, we took pride in the good care we gave patients and in the technology that helped us provide that care. Our staff at the cancer center was and is excellent, caring, and effective at controlling cancer and relieving symptoms caused by cancer. But there is a dark side to this story.
Love of technology is part of our American culture. We expect that technology should always be able to make our lives better and even save us from suffering and death. At the cancer center we were steeped in technology. Each new advance in computerized planning and radiation treatment captured our imaginations and reinforced our feelings that we were helping our patients more as we implemented these new techniques year-by-year. In addition we knew we needed to stay competitive with cancer centers in neighboring communities.
At some point I began to realize a disturbing unintended consequence of what we were doing. Between 1996 and 2006 the cost of treating prostate cancer increased from $24,000-$66,000. Did the improvements in our care justify tripling the costs? We could not show improvement in survival or commensurate reduction in side effects with the improved technology and added cost. Furthermore, there is a growing question of whether we should even be treating most men prostate cancer. The U.S. Preventive Services Task Force in May 2012 concluded probably not.
Our overuse of lucrative procedures and our love affair with technology that can triple costs of treatment has a direct effect on insurance premiums. With the increase in cost, we began seeing more patients coming to the cancer center with neglected and advanced cancers. The high cost of care was discouraging prudent care decisions by our patients. They would simply live with pain or other ominous symptoms until a crisis occurred. They would come to the emergency room with bleeding, bowel obstruction, or airway obstruction because of neglected cancers.
We would then invest extraordinary efforts and our high technology into attempted rescues of these patients. We usually failed to control such cancers. Had these patients been able to afford health insurance and receive medical attention several months or years earlier, the patients, their families, and our society could have avoided considerable suffering and cost.
We lack a science-based system that informs the public and allows it to use public money prudently, to assess and control the use of these high cost, often unnecessary, and sometimes harmful procedures. Ironically, rules in Medicare and the Affordable Care Act prohibit the use of scientific data such as quality-adjusted life years to determine what will be paid for.
Healthcare industry lobbyists have inserted these prohibitions into law as a way to keep science from interfering with their incomes. Public money spent on these expensive services is money diverted from primary and preventative care and non-medical services which are basic determinants of health (education, public health measures, social services, etc.).
Fee-for-service incentives reward providers for doing more procedures, and so in the United States we do lots of expensive procedures, many more than patients truly need. Nationally we do five times the number of coronary stents that other countries do, and we have no better outcomes.
We use unnecessarily expensive radiation therapy techniques and robotic surgeries to treat patients with prostate cancer who may not need treatment at all. We often depend on revenues from these lucrative procedures to subsidize the money-losing but vital services in a hospital such as the ICU and ER.
But under our current market-driven healthcare system, even all the overpricing, overusing, and cost-shifting does not keep hospitals in the black. Hospitals feel they need also to develop for-profit enterprises such as fitness centers and property management enterprises to keep from going into the red. These can be seen by the community as the equivalent of high-stakes bake sales, and they are controversial because they have little to do with maintaining a useful community healthcare program and may compete with local businesses.
To stop this spiraling use of extravagant technology, cost shifting, and unseemly entrepreneurism I suggest that hospitals be managed as public utilities. We expect the hospital and its important services to be available to us when we need them. We expect to pay the nurses and the housekeeping staff each day. We should pay ahead like we do for the fire department, the police department, and public schools.
Why should we seek the needed revenue from people who are ill enough or worried enough to accept expensive surgeries, imaging studies, or pharmaceuticals? Why should we depend on marketing techniques, lucrative hip and knee prosthesis placements, gratuitous coronary stent placements, and the overuse of intensity-modulated radiation therapy to finance our hospitals? Why should college students subsidize our hospitals through their room rent in a hospital-owned apartment complex? Why should people who use a hospital-owned fitness centers subsidize our next visit to the ER or ICU? I admit that in the 2013 market-based healthcare industry we have to do these embarrassing maneuvers in order to keep our hospital doors open. But they are not sustainable, logical, or defendable ways to finance healthcare.
It is time for Americans to step back and assess what our values are. Do we value technology, miraculous rescues, and “the market” more than we value the general welfare and health of the population? Our undiscerning fascination with technology and income creates suffering and death for those who are thereby priced out of healthcare.
To solve many of the above problems Healthcare for all Oregon, a coalition of 80 organizations, is moving ahead for universal, everybody in and, nobody out, healthcare. In the 2013 Oregon Legislative session Rep. Michael Dembrow of Portland and 22 other legislators sponsored HB 2922 which would create such a system. The bill is scheduled to be reintroduced in 2015 and may be referred to the voters in 2016. Please learn more about Health Care for All Oregon at www.hcao.org.
Dr. Michael C., Huntington was the medical director of the radiation oncology department at Good Samaritan Hospital and then Samaritan Regional Cancer Center in Corvallis from 1984 to 2006. Since his retirement he has joined with several other physicians and other activists in Corvallis to engage colleagues and the public in discussion about the urgent need for healthcare reform and helped form the Mad As Hell Doctors who toured the U.S. in September 2009, California in 2010, and Oregon in 2011. He was President of Health Care for All Oregon and the Health Care for All Oregon Education Fund in 2012.
