Excess & Deprivation, Again
posted by Frank Pasquale
In an age of fractal inequality, we shouldn’t be surprised when international patterns of distribution begin to reproduce themselves inside nation-states. Consider the American health care system, which Enthoven and Kronick deemed a “paradox of excess and deprivation” back in 1989.
Exhibit E for excess is Shannon Brownlee’s book Overtreated, which argues that “We spend between one fifth and one third of our health care dollars . . . on care that does nothing to improve our health.” One reviewer notes that “too much medicine — for many patients, much of the time — is doing serious damage to the nation’s health:”
Many treatments that have become widely accepted in recent years — including proton pump inhibitors for ulcers, arthroscopic knee surgery for arthritis, hormone replacement therapy for menopause and high-dose chemotherapy for breast cancer — “have ultimately been shown to be unnecessary, ineffective, more dangerous than imagined, or sometimes more deadly than the diseases they were intended to treat.”
Meanwhile, good luck to you if you happen to have an emergency near the cash-strapped Grady Hospital of Atlanta:
A third of the ambulances need to be put out of their misery, said Astria L. Benton, a paramedic supervisor. Every week or so, a vehicle simply gives out while in transit, and Ms. Benton prays that the patient will not die before she can orchestrate a rescue. . . . The orthopedic department has a waiting list for elective procedures that one doctor quantified as “infinity.” Its doctors intermittently instruct other departments to not send them patients.
Note that only “Fulton and DeKalb counties . . . — and none of their suburban neighbors — make annual appropriations to the hospital’s budget for the care of indigent residents, even though two in 10 Grady inpatients and one in 10 outpatients arrive from other counties, often by ambulance.” Perhaps the suburban counties’ residents’ anti-tax fervor arises in part from a deep desire to keep the money necessary to pay for the types of treatments Brownlee describes.
January 19, 2008 at 4:16 pm
Posted in: Health Law
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