Dr. Larry Chiaramonte
The American health care system has been on an unsustainable course. While most of the debate has concentrated on big fixes, there clearly exist in every specialty individual “fixes” that could collectively save the country as a whole, and millions of individual patients, a great deal of financial and personal misery. An example of this was the Op-Ed piece in the New York Times by Richard J. Ablin, the man who discovered prostate-specific antigen, an enzyme made by the prostate, which became the basis for a test administered to 30 million American men at a direct cost of $3 billion. But this is just the tip of the iceberg, because it results in billions more in unwarranted treatment and the medical consequences, such as impotence and urinary disruptions, affecting 47 men for every one whose life is saved.
In the field of allergy, the same law of large numbers also applies. The American Academy of Allergy and Immunology estimates that expert care for moderate and severe asthma can reduce hospitalizations for asthma by an average of 77% and can reduce emergency room visits for asthma by an average of 53% and save as much as $1.3 billion in annual direct costs for hospital and emergency care costs.
They estimate that current patterns of care for asthma accounts for: 5,000 deaths per year–1 death per 2,400 asthmatics per year; hospitalization 500,000 per year–4 admissions per 100 asthmatics; emergency care –1,500,000 per year: 12 ER visits per 100 asthmatics, plus millions of school and work absences, and limitation of function. (more…)
What does this mean to the individual child with moderate or severe asthma? Referral to a specialist, “might be accompanied by an increase in medication costs of 6-24%, but expert care would be expected to save approximately $1.3 billion [$1.8 billion today] in direct costs for hospitalization and ER visits (the reduction expected if patients at risk were referred for expert care).”
Or take immunotherapy, which is only available from specialists: “Immunotherapy can be expected to reduce the need for medications for allergic rhinitis or asthma, or both, by more than 50%. Current total direct costs for immunotherapy at Emory University in 1996 average approximately $800 for the first year [$1083 now] and $170 for the next 2 to 4 years [$236 now]. After 3 to 5 years, immunotherapy usually is halted. Clearly, the costs of immunotherapy are soon balanced by large reductions in costs for medication.”
The late Senator Everett Dirksen used to say of the federal budget, “a billion here and a billion there—pretty soon you’re talking about real money.”
The point is this—we have billions and billions of dollars of waste in our health care system because we let it operate on automatic pilot, and still it adds up to the 37tth best health are in the world.