When one looks at US Health Care from a global perspective, the numbers are not pretty. Compared to other industrialized nations, the US spends way too much money on healthcare but has some of the worst outcomes. Where the US shines though is in cancer care, where only Japan and Sweden do better.
The mortality from ischemic heart disease is especially galling. Looking at 2013 figures, the US mortality is about 128/100000 (0.128%) versus 35/100000 (0.035%) for Japan. Out of 12 nations looked at, the US did only better than New Zealand. This is however easy to explain when one looks at the lifestyle choices of most Americans versus the Japanese as well as access to primary health care in both nations.
In spite of these discrepancies, those of us who work in the system see the effort that most healthcare workers put in daily to achieve good outcomes. Every now and then, some of these outcomes makes one think of a miracle. Someone may even wonder if a Deity has a hand in these miraculous outcomes. Yet if one sits back and analyzes what it took to achieve some of these really amazing outcomes, one sees the expenditure of something more than just faith and prayers.
Now imagine a 60-year-old man, who is a smoker, obese, with uncontrolled diabetes and high blood pressure. He shows up in an ER with an ST-elevation myocardial infarction and is looking rather bad. In less than an hour, a top-rate cardiologist has him in the cardiac catheterization unit and diagnoses severe 3-vessel disease and congestive heart failure that needs surgery. In no time, the cardiac team is ready and the poor fellow is the operating room getting prepped for coronary artery bypass surgery. He has the best cardiac surgeon in the hospital, an excellent cardiac-trained anesthesiologist, a tip-top perfusionist and just amazing nurses and scrub techs. Surgery goes well but his left ventricle has taken a hit so he ends up needing an Intaraortic Ballon Pump (IABP) and then a Left Ventricular Assist Device (LVAD) to make it out of the operating room. The team is worried about his prognosis.
In the intensive care unit, he is cared for by a cardiac nurse with awesome experience and nursed around the clock. A well-trained lntensivist hovers over it all.
The patient stabilizes. The LVAD and IABP are taken out a few days later. About a week later, he is out of his induced coma, has no other complications and is extubated. On post-operative day 8, he is in a chair, looking like nothing happened. His family, expecting the worst now look at him like he is Lazarus walking out of the tomb. He is a miracle!
Which brings me to that something other than faith – Money! This poor man was saved because there were resources to save him and those resources were bought with and paid for by money. He lives in a society that can buy him a miracle! Sure, the prayers of his family may have improved his outcome but those same prayers will be of no use if he had this myocardial infarction in a Third World country!
Now let’s look at the cost of this miracle (these are averages):
The ER visit cost about $2000.
Diagnostic Cardiac Catheterization cost about $2600.
Cost of coronary bypass surgery is about $70,000 to $200,00 (with his complications and assist devices, more like the upper end).
ICU stay cost about $10,000 a day for the ventilated patient, so about $80,000 in his case. I have not even added the cost of the LVAD and IABP.
The above charges are mainly hospital charges. Drugs are not included. Neither are some personnel and ancillary charges.
This was one expensive miracle, only possible in the developed nations of the world. Even in these countries, one has to ask if it is really feasible to spend so much resources on one person. Most people would want such care for themselves and family members if ever in such a situation. Who wouldn’t? is it feasible though in the long term? Can any nation afford this, even the mighty USA?
A British economist, Lionel Robbins, once gave the classic definition of economics. He stated that “it was the study of the use of scarce resources which have alternative uses.
I borrow that definition as I ask the question:
“Can we continue to use the resources we have, which may not be scarce but could have alternative uses, to achieve these medical miracles without any consequences?”
Most patients do not really care but I think we as providers should. Even in the US, nothing last forever.