Health Care: Is More, or Less, Better?

As I ponder how rising health care expenditures will affect our society and our politics, and wait with baited breath the Supreme Court ruling on Obamacare, I have come across 3 articles in the New York Times on health and health care spending which seem to take contradictory trajectories.

In Let’s (Not) Get Physicals, Elisabeth Rosenthal cites many common medical tests which are either too frequent, unnecessary, or cause problems. She cites as overused or unnecessary prostrate specific antigen blood tests, routine EKGs, annual PAP smears, and the annual physical. Noting the Americans spend twice as much per person as other countries on health care, she mentions a 2009 study which pointed to “unwarranted use of medical care” as the largest component of our overspending. There has been a movement to reduce the amount of (unnecessary) health care we consume, and this article is another example. It feels almost like evolutionary adaptation; the information indicates that consuming less health care is actually healthier for us, but the net effect would be to reduce the unsustainable health care spending which will ruin our society and nation.

Turning to the business section, however, we get A Geneticist’s Research Turns Personal, where Michael Snyder, a geneticist sequencing his own genome discovers he is at high risk for Type 2 diabetes, and has himself monitored for molecular changes which detected when he actually developed the disease. The early detection has allowed him to contain his diabetes before it would have required more extensive treatment, allowing him to treat himself through diet and exercise rather than medication. The article quotes professor of genomics Dr. Eric J. Topol, “This kind of granular information will one day allow doctors to manage illness in an altogether different and precise way.” Dr. Snyder, noting that he does not fit the profile for a diabetic, indicates that he wouldn’t have otherwise had his diabetes detected early, since he only sees his doctor for a physical exam once every 2 or 3 years.

The New York Times Magazine section enumerates a series of innovations coming soon in Rejoice! A New Day Is Here. Among the innovations are a small sensor you wear on your head while sleeping which can diagnose diseases like schizophrenia, Parkinson’s, depression, or Alzheimer’s in the brain, allowing for earlier treatment. Also included in the list is a blood test for depression. The idea is that medical innovation will allow us to more closely monitor for disease, and detect and treat earlier.
Dr. Snyder’s experience, and the promise of medical innovations, seem to, and probably in fact do, contradict the prescription in Elisabeth Rosenthal’s article that we need to consume less health care. Much of the excess health care we consume is in extra testing, much of which is unneeded, and leads to false positives, which require more testing and intervention. The testing itself is not without risks. It may be that we can tailor tests to individuals, the promise held out in Dr. Snyder’s case, and this will allow us to test and deliver medical care in ways that are cost-effective. It may also be that this level of testing will increase the level of false positives that require even more testing, and merely increase medical costs.

There are two contrasting views of medical care in these articles. One is that we can better ensure health, and ultimately decrease costs, by practicing preventative medicine. The other is that medical care treats diseases, and we should generally restrict our consumption of medical care to when we have diseases to treat. To combine these into the most effective, as well as cost-effective, medical care will require a better grasp of where we waste our health care dollars, and where we could direct them to best benefit.