Health Care in Crisis: Needless Costs, Needless Deaths
Editor's Note: This is Part Two of a five-part series on the health-care crisis.
Sandra Bogan and Southwest Airlines (LUV) have enjoyed a long business association. On the airline's first day of operation in 1971 she served passengers as a flight attendant—and still does: Bogan holds the distinction of being Southwest Flight Attendant No. 1. She was divorced with three children to raise when she met and married soul mate Tom Bogan, a soft drink executive, in the late 1970s. Although Sandra continues to fly, Tom retired to enjoy an active life with their children and grandchildren. As Sandra recalls, Tom was always on the go; even at 82 he gladly hauled the grandkids around to their activities, fully enjoying retirement.
Until March, that is, when he was diagnosed with diabetes—and soon after, with renal failure. In his youth, Tom smoked and drank, but Sandra had terminated those habits 31 years earlier, when they married. In the spring, Tom was set up to perform home dialysis but, as stepson Lance Anderson said: "The decline in his health was unbelievably quick."
Doctors said Tom Bogan's best hope to recover any sort of normal life would be a quadruple bypass to unblock his arteries. Without the operation, they warned, he was within months of the end. Fully informed of the risks entailed by his other medical problems, Tom agreed to the operation.
It was performed at Baylor Medical Center in Grapevine, Tex. But while the operation was deemed a success, Tom picked up an infection in the hospital and passed away eight days later. The bills totaled $183,679. In spite of the tragic outcome, Sandra Bogan has nothing but praise for the hospital, the cardiologist, and UnitedHealthcare (UNH).
Near-Absolute Faith in Medicine
Mike Russell's eclectic life once included owning the Kansas City Business Journal, but he is best known as the creator of the Book of Lists, a business directory sold by many business journals across the U.S. He and business partner Dan Carney, one of the founders of Pizza Hut—now owned by Yum! Brands (YUM)—purchased and operated KGBS 1190 in Dallas until 1995, when they sold the station to Salem Broadcasting. Russell pursued other publishing ventures until earlier this year, when he found himself struggling to catch his breath. Tests showed he needed an aortic valve replacement.
Russell agreed to the operation, assuring his wife and business associates that it was nothing to worry about—a commonplace and routine operation. But something went terribly wrong during the operation that Friday in Kansas City. Two days later, Mike Russell was gone at the age of 69.
Venie Biggers, 73, was a housewife in North Richland Hills, Tex. Husband Bill was an air conditioning repairman. Venie was unique: She had never smoked in her life, nor even had an alcoholic drink, tea, or coffee. Despite this almost Puritanical regimen, Biggers six years ago was diagnosed with cirrhosis of the liver. Although it cannot be medically proven, her husband believes the problem started back in the 1970s, when Venie was treated for rheumatoid arthritis with injections of gold sodium thiomalate. That treatment is no longer used—possibly because one of the listed side effects of gold injections is liver dysfunction.
Operating with Poor Odds for Comfort
Like Russell, Biggers had started complaining of a lack of energy a few years ago. Although it could have been a symptom of her cirrhosis, her doctors found problems with her aortic valve and recommended its replacement. In June of 2007 she entered Medical City Dallas, but complications followed primary surgery. A second operation was quickly performed to correct leakage around the graft site, but Biggers' blood ammonia levels spiked and then she suffered several minor strokes. Needless to say, the prognosis was poor. So when neurosurgeons suggested further operations to correct the secondary damage, Bill Biggers made the hardest decision of his married life and said no to the operation. Venie Biggers lapsed into a coma and passed away six weeks later. The bills came in at $854,000.
At first blush one might reasonably question why heart operations would even be attempted on individuals of an advanced age with other serious medical problems. Most would assume that even if the primary operation had been successful, the individual's other medical issues could bring into question whether they could recover sufficient health to lead a relatively normal, comfortable life.
It might be a mere cost-benefit equation to most people. But when the families tell their stories, one hears the sadness that fills their voices when they speak of the moment that they lost hope that their loved ones could be healed. For these survivors, it was a near-absolute faith in modern medicine that led them to make decisions that ended in tragedy.
Heart Operations: Most "Are at Best Unnecessary"
It is operations such as these that have sent U.S. health-care costs soaring out of control, certainly when compared to those of other industrialized nations. Dr. Ralph Rashbaum, a renowned back specialist with the Texas Back Institute in Plano, frequently speaks on this issue. Rashbaum is a physician who believes surgery should always be the last resort to correct medical problems—often counter to what the public wants to believe. People are convinced that somehow the miracle of modern surgery can cure all ills.
Rashbaum also knows the other key reason why U.S. health-care costs are so outrageously high. Some 80% of all spending on health care goes to only 20% of the public—in the last two years of their lives. Representative Michael Burgess (R-Tex.), a physician, seemed to agree with Rashbaum's analysis of the problematical costs for health care: "I hope we could use this opportunity to educate patients and families of risks before and after illnesses."
As for the costs and risks involved in heart operations, Dr. Michael Ozner, author of The Great American Heart Hoax, lays out the problem: "More than 1.5 million Americans undergo angioplasties and coronary bypass surgeries annually in the U.S." While in many cases these operations save the lives of the patients, he estimates that "70% to 90% of these procedures are at best unnecessary."
Why does he say that? It's been proven in numerous authoritative published studies that bypass operations and angioplasty have never been shown either to prolong life or prevent future heart attacks.
That hasn't been made clear to the public. Americans undergo these operations seven times as often as patients in either Canada or Sweden. When Dr. Ozner lists possible fatal side effects of open-heart surgery, he includes those that took the lives of Bogan, Biggers, and Russell.
Cheaper Alternatives Can Work Better
How could this be such a problem? Dr. Ozner admits that these procedures do save many lives. But for many others, long-accepted medical treatments and lifestyle changes can be equally or more effective in facilitating a patient's long-term recovery.
It's partly due to our faulty memories that we can't accept that not all medical procedures are necessary. We forget that 40 years ago many individuals suffered heart problems, or outright attacks. In the days before stents, bypasses, and angioplasty, the survivors were simply given medicines to alleviate or reverse the problems. My own father lived for 24 years after his heart attack in 1966 and was deemed healthy enough to be returned to flight status in the U.S. Air Force.
Today, America's moral dilemma lies in the high price of trying to save the unsavable life. Some may cynically suggest that this is only because doctors and hospitals want to increase their incomes, but the vast majority of physicians are far more honorable and dedicated than that. In the three cases listed in this column, each patient was given the opportunity to turn down the operation and was fully informed of the potential risks. All chose to undergo the procedure.
Government Could Invite More Spending
Nor will federalized health care fix the issue of high costs. It will simply transfer them. It won't correct the inherent financial waste in the system because we cause much of it. When it is our lives—or those of loved ones—on the line, most of us will demand increasingly expensive care, no matter how many studies and statistics show it likely will not be a long-term cure.
As mentioned in the first column of this series, our already broken health-care system will rapidly be devastated as nearly 80 million baby boomers head toward retirement. Aside from the incalculable misery that inadequate health care can cause, the greater danger is that we could divert so much into expanding expensive health care that we could ensure the U.S. economy's destruction.
Our current standard is to try to save the unsavable at the end of their lives, but that is not the standard in other developed countries. Nor do they debate the consequent moral dilemma. This is likely the primary reason that U.S. health care is in such serious trouble.