``..All of the gee-whiz, very expensive therapies becoming available, and which in fact do keep people from dying early deaths or leading needlesslly incapacitated lives, do indeed need to be rationed..'' JJ
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Why? And why are they so `expensive'?
What needs to happen is that the system has to be streamlined of its utterly byzantine paper and profit trail, made more `efficient' as the neolibs like to say. The sheer quantity of paper (work) and non-medically related exchange relations performed is truly mind boggling---generated costs performed by insurance and government service delivery systems that are completely irrelevant to the individual's health or medical needs. Ironically, sitting in front of a computer angsting over billing procedures while nibbling cheese fried pork rinds with extra salt and washing it all down with corn based sweetener sodas probably creates more triple bypass surgeries than such work bills for.
My theory as to why there is an epidemic of fat and heart problems is a high pressure sedentary work life. Who goes down to the basement to find files, walks upstairs to the managers office for a confab, walks to lunch as the main meal of the day a few block down the street and then over to the park to people watch? Who takes a half hour nap during their two hour mid-day break like civilized people used to? High stress, high fat, high sugar, high salt, poor sleep, long commutes, etc creates the supersize problem, which in turn super-feeds the super size problem.
Anyway, the medical field I think is moving away from bypass to roto-routers, coiled stints, shunts, and other less invasive, and theoretically less expensive alternatives. The costs are shifting away from labor intensive bypass surgery to more techno solutions done with scopes and catheters. The imaging systems and techno do-hicky costs are vast and the equipment is mostly leased so procedures costs are devoted to paying the equipment rentals. Why rent? Maintenance agreements, upgrades, and replacements, mean less in-house technical staff, etc. Every piece of gauze, every sterile wipe, every needle, and half the tools are one-use disposable wildly expensive pre-packaged gold. Take a relatively simple thing like a plastic cylinder with a rubber end that fits a small spray can of albuterol (an asthma medication). Seventy-five dollars!
At one time, hospitals were essentially factories with full kitchens, industrial laundry rooms, sterilization and packaging rooms, steam boilers, and large industrial maintenance staffs with shops. All or most of that is gone, replaced with outside contracting, rental equipment, and disposables. All of that was replaced on the theory that it was more cost effective for the hospital as a business facility. Sure it was more cost effective for the hospital, but not for the cost of the care, which was duly transferred over to the patient bill.
CG