Much is being written about the ever increasing cost of health care in the US, especially compared to the rest of the developed world.

As a nation, we spend nearly 16% of our GDP on health care.  All estimates predict that this amount will continue increasing unless costs can be controlled now.  Hence the passage of the Affordable Care Act.  Not only was it designed to extend coverage to more people, but make no mistake, it wants to do it at a cheaper cost.

Cutting the fat and leaving the lean in health care is much like going on a diet.  The math is simple; take in less and/or burn more calories.  Health care math is similar; spend less and/or take in more money.  The ACA is attempting to do both.  In this analogy, the dieter, or the taxpayer/economy, is going to be a mere anorexic shadow of its former self.  The government plans to extend this coverage to 35 million plus, currently uninsured individuals, while slowing the rate of health care expenditures.  This means that as providers we will be receiving less (again) for the same amount of work, while we get taxed at a higher rate to pay for what we are not receiving ourselves.

So many people complain about their health care that it makes me wonder whether or not they would like to return to “the good ol days” when a physician made house calls, patients paid with chickens, pies, etc..  Oh, and don’t forget that a lot of people died from their diseases.

Back ”in the day” when there was no such thing as “modern” health care, people accepted the fact that death was a part of life and that certain diseases or conditions were uniformly fatal.  Prior to 1923 when Banting and Best discovered, and Eli Lilly mass produced insulin, all type I diabetics died from diabetes within a few months to years.  The treatment at that time was a low carbohydrate diet that allowed the person to live but with the knowledge that death was soon coming.

Alexander Fleming discovered penicillin in 1929 but it wasn’t isolated until 1940 as a potential antibacterial agent.  It was produced  in quantity just in time to save countless lives during WWII.  Penicillin was used to treat routine bacterial infection, diphtheria, syphilis and tuberculosis.  Certainly a miracle drug if there ever was one.

Patients with kidney disease also anticipated a slow death, but not always so painful.  Hemodialysis was first used in a laboratory setting in 1913 on dogs but not perfected for human use until 1945.  Advancements since that time have made dialysis more efficient and available to many more people.  In the US alone there are approximately 400,000 people on hemodialysis.  The most, if not all, are receiving Medicare benefits to pay for this service at a cost of $55,000 per year per person. That’s 2.2 billion!

Something as simple as the annual flu has wreaked havoc on humans as long as we have inhabited the earth.  The ability of the influenza virus to undergo change and merge with other strains of virus made sure to cause much morbidity and mortality over the millennia.  First described by Hippocrates in 404 B.C., and recently causing worldwide scare as the swine flu in 2010, influenza continues to cause tens of thousands of deaths annually and many more during pandemics.  One can only imagine the number of deaths we would see yearly without the availability of the annual trivalent flu vaccine.

Mechanical ventilation and the modern intensive care unit became a standard of care after the “iron lung” was replaced by the more efficient positive pressure ventilator came into widespread use.  Over the years, the use of vasopressors, powerful broad spectrum antibiotics, in depth understanding of the physiology of stress and its effect on the human body have meant that even the most ill patient has a chance of beating death.

The cost of care is directly related to the advancements we have made in medicine over the past century.  The real change in the ever increasing costs of care is related to our refusal to accept that death is a natural part of life.   Along with that denial is the need to hang on at any cost.  Most of our health care dollars are spent in the last two years of life, many times in futile efforts to restore someone to a previous level of functioning.

As a nation we view health care and insurance as a right, an entitlement.  As such, it falls under the auspice of the federal government to manage.  In other countries the health care rationing you hear so much about has more to do with trying to make sure that the scarce resource of health care is being utilized where it will have the greatest benefit, have the largest impact and most efficient.

We aren’t ready to accept “rationing” just yet and that means costs will continue to rise or many, many people will be unhappy with their health care entitlement.

“Doc B” is a physician who blogs at One Doc’s Opinion.

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