Kryptonian Medicine

Iguana Don: All right, for those of you joining us at home, the office, or wherever you read your internet interviews, this is part deux of our discussion of health care- which began with a “one thing you could fix” kind of question. We spoke for a moment off the record- full disclosure: through a bathroom door, and I’ve learned to never have burritos before an interview- but I’d like you to nutshell everything we talked about.

Superman: I suppose, and I don’t know that I was clear enough, that what I was getting at was putting science into our application of medicine. Science goes into developing all kinds of new understandings and treatments, but for whatever reason, science doesn’t seem to be applied to the administration of medicine. We don’t have good, hard data on what forms of treatment work best, and under what circumstances. For just about any ailment there’s a number of different treatments, and, with the exception of generics, it really isn’t a po-tay-to po-tah-to difference between them.

ID: Let me be clear: are you saying that maybe people aren’t worth what we spend on medication?

S: I’m saying that if a name brand pill will cure a patient in three days instead of four, but costs twice as much, it would be worth asking as a nation if our money’s better spent saving twice as many people a little more slowly. And even that’s probably a bit of a mischaracterization, because most generics are just as effective.

The main issue I see, and the waters are further muddied by lobbying and direct-market advertising of medications, but there’s a whole ocean of pills, and we test them to make sure they’re effective at what they’re aiming to do, and we monitor and label them for side effects. But what we haven’t done previously is comparative studies. Sure, atorvastatin might carry some negative side effects like headache, weakness and chest pain, but if it has twice as good an outcome as another drug, that’s what could make a huge difference. And it isn’t just in savings in unused medicine and procedures, but by getting things right the first time, by getting people the best possible care early, we’re preventing more expensive procedures, like a bypass, later on, and likely helping people live longer, happier lives

ID: Okay, time for you to be a bastard. You’ve told me all the “if I were God of health care,” pie in the sky changes you could bring about, but what’s the one hardest thing about health care?

S: It’s a resource, and no resource is unlimited. There can, should, and must be some form of limits on how we utilize health care. I think effectiveness studies are a good first step- though I can’t honestly believe that the insurance industry hasn’t been doing this all along as a cost-effectiveness measure- that in and of itself is proof of a poorly competitive industry. But I think there are likely tough questions ahead. I think rationing is something that insurers currently do, and who amongst us haven’t heard horror stories of after-the-fact denial of claims? But we may be butting up against the glass ceiling of what we can afford to pay for health insurance.

Premiums have virtually doubled since 2000; they’re predicted to double again by 2020. The average American premiums cost $7900; most people never see that cost, because a lot of that tab is picked up by their employers- and I’m going to ballpark this, since the figure I have is actually for a family- but in the last ten years workers picked up an extra $600 more on their premiums. Most employers say they’re tapped out, so if costs do double by 2020 to $15800 per person, then that whole $7900 increase will fall on the workers.

To put it another way, world per capita GDP per day is about $20. The American premiums per person per day amounts to $21.65- we’re already spending more on our health care than many people in the world have to live on every day- so there’s already rationing- just right now, it’s being rationed to the US and other wealthy nations. And I don’t mean to be playing the fear card, here, but as the US faces more competition from emerging economies like India and China, and if health care costs continue to rise- how much longer do you think we or anybody will be able to afford health care?

To bring back up prevention and healthy diet for just a moment, obesity-related disease costs the American health system about $90 billion dollars a year, of which about half is already covered by Medicare and Medicaid- in part because obesity is more prevalent in the poor and elderly. So if we were able to curb that, we’d be nearly halfway to paying for the admittedly modest reform efforts Obama is pursuing. Closely related to obesity is diabetes. Diabetes costs about $116 billion per year, again, about half of which is covered by the existing government programs. It’s true, diabetes is a bit stickier- since there are other factors including genetics at play, but if we could eliminate a significant portion of new diabetes cases through better diet counseling, just between those two preventative health efforts, we could pay for the Obama plan. And that’s ignoring that diabetes is credited with the loss of $56 billion in lost productivity due to increased usage of sick days- that’s money that would be helping the economy, a portion of which would return to the government in the form of taxes.

Sorry about the barrage of figures- I’ve obviously been researching for a story Perry has me writing. But what I’m trying to illustrate, and hopefully the science geek love of numbers my father gave me doesn’t obscure it too much, is that there has to be some limit. It might come down to the fact that we’ll be forced to decide between paying for a heart transplant for a 40 year old patient versus a 90 year old- but that’s a decision forced on us by higher costs- it’s the same decision private insurers would be forced to make, as well- though personally I think the decision is always best left in the hands of doctors whenever possible. But there is a line- there has to be. The difference is, I’d like to make that decision, since I’ve no profit motive at all, and no ulterior motive save for seeing the people I care about protected. Failing that, I think I’d prefer a nonprofit motive to a profit one, when it comes to making this hard decision.

ID: How much of your stance here is affected by your cancer?

S: That’s a very fair question- though of course I’m sure you know it’s the old journalistic ethics question: how biased are you? And of course, the honest answer to that question is I don’t know. You can never be sure, because it suffers from the observer effect as much as anything, but yes, absolutely, dying makes me realize that, particularly the slow, ponderous death from cancer is not something I’d wish on even my bitterest enemy. I think we can fix our health care system, but I do think the clock is ticking- and even if my prognosis is wrong systemically, the clock is ticking for people out there, whose lives could be saved or made drastically better.

We’ll be trying to bring you a new section of the interview every Tuesday. Some of the questions have already been prepared by the interviewer, but to ask Superman a question, leave a comment or send an email to DeathofSuperman@gmail.com.