Health Costs Could Bury U.S., Warns `Duty To Die' Theorist
BOSTON, Mass. - Health care costs in the United States are the world's highest, are rising at three times the rate of inflation, impair global marketing efforts and have little effect on the nation's overall health, according to Richard Lamm, the three-time governor of Colorado who gained national attention in 1985 when he was quoted as saying people have 'a duty to die.'
Mr. Lamm - currently director of the University of Denver's Center for Public Policy - described the U.S. health care system as one based on absurd policies and senseless priorities that can, if unchecked, wreck the nation's economy.
'We can't afford to let any segment of our economy grow at the rate that health costs are going to grow,' he said, during John Hancock's recent Client Conference on Health Care Policy.
'Health care costs have increased three times faster than inflation in recent years and it's getting faster,' he added.
American goods and services, he said, are 'burdened' by health care costs, which he said add $700 to the costs of an American automobile but only $200 or $300 for a German or Japanese auto.
Mr. Lamm said one study predicts health care costs could equal the Gross National Product by the year 2055 unless a 'new ethic of restraint' is adopted.
'It's my thesis that whatever we do, we have to realize we can't give everything that medical science has developed, in its genius, to everybody,' he said. 'We have to develop an ethic of restraint, a concept of appropriate care, of cost-effective medicine.'
While acknowledging that there are 'unmet needs,' he said the country must 'make hard choices.'
'Welcome to the new world of tradeoffs,' he said. 'We have to ask ourselves, how do we improve preventative versus curative medicine? Improve the quality of life versus the extension of life? Young versus old? High cost procedures for a few versus low cost procedures for the many?'
Mr. Lamm cited the aging of America and 'the aging of the aging' as a stiff challenge for the health care industry. The fastest growing group in the United States are those over 85, 'and we don't know how to run a society with an average age of St. Petersburg, Florida,' he said.
In an appeal for a rational use of resources, Gov. Lamm said, 'we have to recognize we can't give presidential health care to all Americans.'
Mr. Lamm said he 'spent the summer asking why it is that we spend so much on health care, yet our statistics [on health] are the worst in the industrialized world?'
Most of the problem, he said, 'lies outside the health care system. Any society with our drug use, gun laws and automobiles is going to have a higher health burden. It's because of habits - alcohol and drugs and tobacco that cause us to die before our time.'
Mr. Lamm said there is no correlation between what society spends on health care and how healthy it is.
'The reason Americans are living longer is refrigeration, soap, sanitation [and] screens to keep mosquitoes out,' he said.
Mr. Lamm said that nations offering access to basic health care to all, but not exotic surgical procedures, have healthier populations than America. He called for access to basic health care, limits on marginally useful procedures and a consensus on priorities.
'When you look at American medical care, you realize we're doing more and more for fewer and fewer people to less and less benefit,' said Mr. Lamm. 'We spend about 70 percent of our hospital costs on about 7 percent of our people,' he added, referring to the elderly.
'No other society takes 96-year-olds with congestive heart failure from nursing homes to die in intensive care units,' he said.
'There are so many things we do that are marginal, we have to ask, is this really worth doing?' he added. 'In American medicine, Can Do' has become `Must Do.' We invent a machine, then we must use it. Invention has become the mother of necessity.'
Mr. Lamm cited the case of a woman in Washington, D.C., who has been kept alive, though in an irreversible coma, at a cost of $250,000 a year since 1953 - 'That in a city with an infant mortality rate that compares to a Third World nation.'
Mr. Lamm did not restrict his criticism to health care for the elderly, also taking aim at the infant population.
'We spend $2.5 billion a year on neo-natal care intensive care - an average of 137 hospital days at $157,000 per infant,' he said. 'We take neonates and fly them to million dollar neo-natal care units. These are babies born to women we didn't bother to give pre-natal care to. That's absurd health policy.'
Mr. Lamm was also critical of duplication of technology in competing hospitals, too many hospital beds, too many physicians and too much bureaucracy.
'For every contact in the health care system, we produce 10 pieces of paper,' he said. 'We add four white collars to the system for every white coat. Nationally, 26 percent of health costs are bureaucracy compared with 11 percent in Canada.'
