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Send to a FriendSome time ago, while perusing the Sunday papers, I came across two articles that were ironic in terms of the socioeconomic paradox that exists in the financing of high technology health care in this country. In the National News Section of the New York Times, there was an article bemoaning the fact that the nation, and especially the business community, is facing sharp increases in healthcare costs in 2001, primarily due to increasing technology and labor costs, especially our valuable but shrinking nursing services. On the very same day, an editorial in the Boston Globe entitled "Skimping on Treatment" highlighted a recent Harvard School of Public Health article suggesting that patients who have heart attack symptoms do not receive enough high technology care in terms of emergency angiography and angioplasty.
These articles are ironic in terms of the public and the media's perception of this high tech health care paradox. The American public, including the media, would like the ultimate best and most advanced healthcare, but are simply confused as to why it is so expensive and who should pay for it.
About the same time I read these articles, I was conversing with a banker friend about an article that appeared in the Boston Globe commenting on the 1% profit margin of the Partners Healthcare System (Partners is a healthcare system involving the Brigham and Womens's and Massachusetts General as their flagship hospitals). He commented, "why do your healthcare systems really need a profit margin?" I told him somewhat incredulously that these monies not only fund the huge hospital budgets, but support under-insured patients and finance new therapies not yet approved by the FDA (nor reimbursed by HCFA, but are the cutting-edge technologies that patients desire).
Recently, we had, as guest speaker at our Cardiac Surgery Grand Rounds, Doctor Timothy Gardner, recently the Chairman of the Professional Affairs Liaison Committee of the AATS/STS, and current President of The American Association for Thoracic Surgery. In his discussion, he made a very interesting comment about the origins of Medicare. Before Medicare there were really two classes of healthcare in the United States, as there are now in most of the developed countries in Europe. There were "public wards" in almost every major teaching hospital in the country, where care was primarily administered by the resident staff but supervised by the faculty, and there were "private wards" with care administered by private staff physicians. When Medicare was introduced, the government felt that they wanted to elevate the care of all patients to one class--that of private-type insurance. This goal, which has been achieved, has made the public expect the highest level of care for every member of the family. It is certainly a goal we should strive for, but the public must be made aware of what it costs to achieve this goal.
As cardiothoracic surgeons we are caught in this paradox of high tech healthcare every day. We should increase the information-flow to the public through our organizations and representatives, as well as making a personal effort at every opportunity to explain why these paradoxes exist.