The kindest cut
June 28th 2010, 16:35
In these austere times, President Obama's Congress and the fledgling UK coalition government are casting around furiously for ways to trim their bloated deficits. Yet, in the midst of all this slashing and burning, healthcare is the area that clearly remains a no-go zone.
In the UK, although Prime Minister David Cameron has been combing through the UK's lb156 billion budget deficit for savings, he remains committed to apportioning even more money to the UK's National Health Service. Spending is expected to rise every year for the NHS, commensurate with inflation, during his government.
Today, the NHS costs taxpayers about lb100 billion each year. That's about 10 times what was spent (in real terms) in 1948, when it started with a budget of lb437 million (which translates to about lb9 billion in today's money). Furthermore, the NHS has recently hugely overspent and is itself estimated to be in debt for lb7 billion.
Part of the reason for the vast budget increase has to do with recent modernization efforts. However, by the NHS' own reckoning, one-fifth of the total budget-or lb20 billion-is spent on prescription drugs. Of the total lb100 billion NHS cost, 12 per cent (lb12 billion) is being spent on new drugs-many of which are merely 'me-toos' of earlier drugs.
Meanwhile, the US spends some $2 trillion on all forms of health-care-more than the entire Third World debt combined. Once Obama's healthcare plan comes into effect, it will cost lb700 billion more per year.
Universal healthcare is still a cherished ideal. Although the British NHS and the Obama plan are laudable, the problem isn't the principle-it's what the money is being spent on.
In our cover story this month, publisher Bryan Hubbard found that even doctors are now complaining that enormous numbers of expensive procedures and drugs are useless, dangerous, or both. US experts are even asking doctors to nominate their top-five useless treatments, and many are balking at having to keep the list so short.
Topping the list is a wide range of high-profile drugs for a range of diseases from arthritis to ADHD. Despite the claims and the invariably high cost, most of these medications are not safe and have never been proven to work. Also, many of the high-tech, so-called 'miracle' treatments most beloved by hospital doctors, such as angioplasty, not only have no proven benefit, but often can kill the patient. In addition, in most cases, the big expensive tests-mammograms, biopsies, electrocardiograms, X-rays-cause or spread cancer and don't even spot anything useful.
The problem is not simply a waste of lives and money. Useless medicine requires even more expenditure to clean up the mess-$77 billion in extra costs every year in the US alone, as reported in 2000 by the American Medical Association. But because healthcare for all is such a lofty notion (and such a political hot potato), healthcare is never called to account for its expenditures. The National Audit Office readily admits that it never audits whether patients ever get better.
Yet, by asking this simple question and acting on the answer, both Cameron and Obama could make the kindest cut of all.