Friday, May 29, 2009

-Healthcare costs

John at Cosmic Variance just wrote a dangerous (in my opinion) entry on healthcare. It is true that healthcare is very expensive (particularly in the US) and that having for-profit insurance companies sounds like a big conflict of interest, however, this topic is nowhere close to being a simple one.

Insurance companies often deny a procedure or treatment based on many different, and some times stupid (see here), reasons. Most likely, the motive behind the rejection is to increase profits by cutting down on expensive procedures. One side of the issue that is NEVER discussed is why the procedures are so expensive in the first place. Note that this has nothing to do with the insurance companies, a non-insured person can go to the doctor and pay out of pocket just to find out that a (typical) 45-minute MRI scan costs around $800, and this is probably on top of the cost to just get to see the doctor. Wikipedia even quotes a much higher cost (~$4000). According to the typical cost of the equipment mentioned on wikipedia, at $800/patient the $3 million investment would be recovered in about 4000 patients. Certainly doctors scan way more than 4000 in the lifetime of the MRI machine. MRI centers can probably get their investment back in one year (at 45-min/scan, they can do 10 patients in an 8-hour long work day. If they open for 300 days that is 3000 patients/year). In this case, I don't see the insurance companies abusing the patient, it's more like the doctors performing the procedure are overcharging for it.

Some people argue that doctors have to charge that much given the fact that they come out of school with a significant amount of debt. While this might be true, I don't see why medical school has to be so expensive. It doesn't really require that much more time to become a medical doctor (even with a specialty) than to become a professor in science (5 years of PhD, 3-5 years of postdoc experience). So why is one much more expensive than the other one? and why do medical doctors expect to make so much money when they get out of school? Maybe if the cost to become a doctor is cut down it will be more affordable for a patient to get treated. However, it's possible that it is too late for the US to make changes in this area; the culture of medical school is probably too ingrained in the people when you have many students going (or at least trying to go) to medical school just to become rich afterwards.

Can we do something as scientists? Well, for one, we not only need to be working on getting new technologies, but also on making the currently available ones way cheaper. This last point might sound more like engineering, but I still feel scientists can do a lot more to help on it.

Everybody (yes, even terminal patients) should get whatever treatment/procedure could possibly mean recovery, even if only temporary. Reducing costs by cutting treatment to terminal patients and instead offering counseling, as John suggests, is the wrong way to go. It is no different than insurance companies denying care because they think it will not matter at the end. We need to find other places to cut costs while at the same time we increase treatment to current patients and extend it to new ones.

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