One Miracle, Many Doubts

A feat of heart surgery sharpens the debate over benefits and costs

  • Share
  • Read Later

(4 of 8)

The number who could benefit from artificial or transplanted hearts is usually estimated at 50,000 per year, possibly 75,000. Multiplying 50,000 cases by an average cost of, say, $150,000 per operation comes to a breathtaking total of $7.5 billion annually.

In theory, even such a cost is quite feasible in a trillion-dollar economy. For the Federal Government, the gigantic bill would represent only about 3% of the budget deficit, the price of three Trident submarines, or about half of what is spent annually on bridge and highway repair. And until fairly recently, the ideal of good medical care for every citizen was proclaimed to be a top national priority. "The fulfillment of our national purpose," Congress rather grandly declared in 1966, "depends on promoting and assuring the highest level of health attainable for every person."

Realistically, however, the question is not how much the U.S. could theoretically afford to spend but how it should apportion the resources available for medicine. Those resources, though not unlimited, are enormous. After a generation of rising costs, the U.S. now spends more than $1 billion every day on health care, 10.8% of the gross national product. Once a country spends more than 10% of G.N.P on health, says Robert Rushmer, a professor of bioengineering at the University of Washington who has studied medical costs in Europe, it begins imposing restrictions on who gets what. "We have to come to grips with the fact that our technical abilities have outstripped our social, economic and political policies," says Rushmer.

"But where has all the money gone?" asks one of Rushmer's colleagues, James Speer, a professor of biomedical history at Washington. "We are not living all that much longer. These expenditures can't be understood in the health of people, but in the creation of a very large industry." Harvey Fineberg, dean of Harvard's School of Public Health, attributes fully one-third of the past decade's increase in Medicare costs to the increased use of high-tech medicine, particularly surgical and diagnostic procedures. "I don't mean to downplay the bravery of this individual," Fineberg says of last week's artificial-heart recipient, "but someone has to speak up for the thousands of people whose names are not on everybody's lips, who are dying just as surely as Mr. Schroeder, and whose deaths are preventable."

Rina Spence, president of Emerson Hospital in Concord, Mass., estimates that the bill for Schroeder's operation represents 790 days of hospital care at her hospital, or full treatment for 113 patients for an average stay of a week. "That's what is in the balance," she says sternly.

  1. 1
  2. 2
  3. 3
  4. 4
  5. 5
  6. 6
  7. 7
  8. 8