Within twelve hours of granddaughter Lily's birth, we knew she might have a hearing problem. Within two weeks we knew she did. She had hearing aids almost immediately. After several anxious months for genetic testing and many visits to specialists, we knew that the mutation causing her hearing problem was not one of those which would have also meant heart and eye problems; moreover, there is a good chance that her hearing won't degenerate further and that she won't need a cochlear implant – if she does, we'll know it in time to act before she misses any significant part of the aural world.
When we went to California last month, Lily was 14 months old; she is talking! She greeted us by name (learned on Skype, of course). Her favorite game is to repeat what you say to her. Wow! Priceless? No, all parts of this miracle cost money. It costs money whether paid for directly by her parents, paid through insurance, or paid by the state.
This post is NOT about who should pay for this care; it is about why it is entirely reasonable that an increasing percentage of our gross national product and an increasing percentage of our wallets should go for health care. Even if we didn't have the distortions of third party coverage, government participation, an artificial doctor shortage, unhealthy lifestyles, and a convoluted payment system, we would be and should be paying more for health care than we were in the past because medicine can do more than it ever could before. Medicine is a greater value than ever.
Medical technology is responsible for many of the advances in medicine and medical technology benefits from Moore's Law, which observes and predicts that the price of electronics declines by 50% every 18 months.
How did the screeners know that Lily had a hearing problem? She couldn't tell us, obviously. They made a sound in each of her ears and used an instrument to "listen" for corresponding brain waves. The non-invasive precise detection of a minute signal and distinguishing a particular neural response among the cacophony of waves in a newborn's brain would have been impossible a generation ago and unaffordably expensive a decade ago. Now the electronics are cheap enough to be part of standard screening and travel around hospitals in a small box. A generation ago Lily's parents wouldn't have known about Lily's hearing problem until she had already missed years of speech and the associated neural development. The cost to her and to society would have been much greater than what we pay today for the equipment that made this test possible and all the experimentation that allows us to interpret brainwaves. But the cost of this screening adds to the cost of medical care.
Similarly the genetic testing which made it possible to isolate the precise cause of Lily's problem is only possible because cheap computing made it possible to decode the mysteries of the human genome – another example of Moore's Law at work. A generation ago, though, there would have been no cost for genetic testing because it was simply impossible to do – its price was infinity. As genetic testing gets to be a greater and greater value, we do more and more of it. Just like we spend more on computing and communications than we used to BECAUSE the unit prices for both have gone down.
Today many men have their prostates operated on by doctor-controlled robots. The robots are expensive, but the precision of surgical robotics results in less incontinence and other side effects from the operation.
We have a drug to relieve the agony of gout. It's much more expensive than leeches. Worth more, too.
The point is that rising expenditures on medicine are an indication of the greater value that medicine and medical technology have for individuals and society and not just a bad news story. Yes, the United States spends more on health care than other developed countries, but the lion's share of advances in medicine are made here as well. When the rich and powerful need specialized care, they're very likely to have their private jets take them to the Mayo Clinic. When well-to-do Canadians get tired of waiting in line for treatment, they come across the border to the US. In a sense, the rest of the world gets a free ride on what we pay for medicine. (I know that our overall public health measures like life-expectancy and infant mortality DON'T support the thesis that our more expensive care is better – but I think these are distorted by both demographics and bad lifestyle choices).
Because medicine is so important – increasingly important – it is crucial that we keep trying to make each intervention less expensive. It is strange, to me at least, that an MRI is billed at thousands of dollars and that the cost of these electronics don't seem to have followed Moore's Law down (to be speculated on in a future post). But, as each medical intervention gets cheaper, the percentage of our budgets that we spend for medicine is likely to go up because medicine will be a better and better value. Yes, we need better lifestyles, a rational billing system, more doctors and/or less procedures which require MDs; and, yes, we will have to admit that ability to pay limits the care that we get both individually and as a nation. What would be a tragedy is a solution to the problem of who pays for medicine which means that breakthroughs like Lily's neonatal and genetic screening don't happen anymore and the cost of medicine is reduced by eliminating its potential to further improve our lives.