Every year a silent killer threatens more American lives than cigarette smoking and opioid addiction combined. It lurks behind premature deaths attributed to cardiovascular disease, cancer, COVID-19 and obesity.
The Grim Reaper here is a healthcare finance system perversely designed to limit access to quality care.
No, this is not about failure to provide urgent or emergency care as needed. Rather, this finance regime outright denies and rations medical interventions on the basis of poverty, race, ethnicity and gender — then covers its tracks by offering no accounting of the health effect of its rules and procedures. At its core, our system is a machine dedicated to mitigating financial risk rather than patient risk of debilitating illness and premature death. It’s long past time to correct this misbegotten set of priorities and biases.
When Americans visit the doctor or the emergency room, they probably do so in the expectation that our healthcare system is designed to help them enjoy high-quality long lives. That’s wrong. Much of the system is designed to elevate their risk of dying young.
Consider that in order for Congress to vote on a change in healthcare law, the Congressional Budget Office must “score” it for its hit on the federal Treasury. CBO is blithely indifferent to whether the change might lead to longer and better lives.
For example, the American Diabetes Association and the American Heart Association, among others, regularly calculate the effect of several highly recommended preventive measures aimed at cardiovascular disease — monitoring blood pressure for diabetics, for example, and cholesterol levels for those taking such medications such as statins. More widespread monitoring could substantially reduce heart attacks and strokes. But let’s let CBO sum it up: “Some types of preventive care may increase longevity. Of course, that effect reinforces the desirability of such care, but it also could add to federal spending in the long run: Social Security outlays rise when people live longer, and Medicare outlays may rise.”
Get it?
CBO isn’t the villain here. It’s simply doing the job Congress assigned it. Nor is it unique. Myriad federal agencies evaluate healthcare regulations and programs in areas from prescription drug coverage to performance-based hospital payments. In all cases, they do essentially the same thing: they manage financial risk by elevating patient risk.
These healthcare financing policies mean that 14,000 people die of hepatitis C every year because we won’t pay to cure them, which we know how to do. African-American men experience 30 percent more heart disease deaths than Whites because financing policies limit their access to care consistent with clinical guidelines. The average life expectancy for a sickle cell patient is 42-47 years because we have failed to invest in treatments. We have screenings for colorectal cancer, but policies block their use to the extent that this cancer kills more Americans each year than any but lung cancer. We’re on the verge of introducing early detection screening that can check for 50 types of cancer with one blood draw. Yet it will take an act of Congress and a maze of regulations before it becomes available to the American public.
Meanwhile, the FDA has just approved a treatment that could slow or even halt the progress of Alzheimer’s in millions of Americans — and Medicare has just decided they can’t have it because it would cost the government too much money.
Something tells me they won’t be able to keep it away from people with the coin to pay the $28,000 a year it costs. I don’t know any more than you about the medical records of such billionaires as Jeff Bezos or Elon Musk, but if they’re not using a tiny fraction of their wealth to obtain access to diagnostics and treatments like these, they’re crazy.
This inequity neatly summarizes the deliberate discard of the lives of Black, Brown and poor people as a result of our approach to healthcare financing. This problem has persisted for decades in the form of disproportionate infant and maternal mortalities, higher prevalence of end-stage renal disease, diabetes amputation, poor cancer survival, and the failure to ensure that minority Medicare beneficiaries have access to flu and pneumococcal vaccines.
We have reached an inflection point. We are mastering the science that will take us to the limits of human longevity. But we can’t get there without a healthcare finance system in which high quality and long life are the priority.
