Can we really afford any more medical advances?

[FireStarterRN, BSN, RN]

Medicine has come up with more wonder drugs, procedures, technologies than ever before. All of it very expensive, too. It all comes at a big price. It's becoming more and more difficult to deliver it to everyone.

Have we gone as far as we really can practically manage, without going broke? More and more can be done, but will it end up bankrupting us? Obama is talking a lot on controlling Medicare costs before it goes bankrupt.

There's a lot of talk of how socialized medicine, universal coverage, is our salvation. But, is it really? I seriously doubt it.

How much does one MRI machine cost? Astronomical. Think of all the other expensive machinery in the hospital. And, at what cost is the regulatory burden? Then add in all the other costs. After that, figure in a bunch of heroic new surgeries and treatments. How about surgery on babies in the womb? Genetic manipulation, cloning body parts, new expensive treatments for AIDS patients with drug regimes totaling in the tens of thousands a year. Then add on all the new dialysis patients expected in the wake of our obesity/diabetes epidemic.

I don't think we can afford much more of this.

[BroadwayRN, ASN, RN]

For those of us who need it, no we cannot afford to be without the medical advances and I am pleased that research and medical advances are continuing. I think think while your post is thought provoking it sounds like you're only talking about money. I could be wrong. If I am, sorry.

[CathyLew]

I think as long as you see people paying big bucks to get elective things done... Im thinking cosmetic elective surgery. Then you can't ever really say life saving technology shouldn't be developed.

Its the cost that has to be controlled. Supply and demand. Can it really cost that much to run an MRI machine? Or is it because they are few and far between. The waste comes from the cost to the patient who comes in with a particular pain, they do an X-ray...the radiolgist says its inconclusive, and they suggest a Cat Scan...the CT report says sutch-and-sutch, recomend follow up with an MRI. Now that is three tests, all escalating in price. And the insurance company wants pre-aproval before they do it, or they won't pay.

Health care wouldn't be so expensive if it wasn't for the ambulance chaising lawyers. The cost of malpractice for Dr's and hospitals is outrageous.

[Ginger's Mom, MSN, RN]

I say we can not afford not to.

For example, when I started nursing many patients where bed bound with diseases like RA and MS with new drugs these patients are still independent with their ADLS and working.

When I was first a nurse and a patient had abdominal pain, they went for an emergent Laporotomy. Now with CT scans and MRIs this is not the standard of care.

Laporscopic surgery has reduced surgical stays so surgery that required weeks to recover only need days.

[VickyRN, MSN, DNP, RN]

Excellent topic. The latest projections are for Medicare to become "insolvent" (aka, broke) somewhere around 2019. That's 10 years from now! Yikes!

We need to be spending our public healthcare dollars on PREVENTION and promotion of healthy lifestyles. It's not enough increasing the average life expectancy. We must increase the quality of life as well. What good is it living to old age, if the years are not that "golden," and one is patched together with all sorts of medical devices and one must take multiple medications or endure multiple treatments just to survive?

I think this video sums it up better than I can express it here (well worth the watch): [YOUTUBE]

[/YOUTUBE]

[llg, PhD, RN]

I think we need the wisdom to use our science for the benefit of society. It's up to make wise choices -- as individuals and as a society -- about the use of our scientific advancements.

That's why I am a big proponent of providing everyone (and certainily all healh care professionals) with a strong general "liberal arts" education that includes the study of the humanities, social science, etc. as well as the basic science and technology skills necessary for a specific job role.

[SuesquatchRN, BSN, RN]

We have to stop keeping the living dead alive. Three strokes, no mentation, and INR's thrice weekly, blood thinners, anti-seizure meds, beta-blockers, yada yada yada - when do we let people go?

[BroadwayRN, ASN, RN]

Can it really cost that much to run an MRI machine? Or is it because they are few and far between.

Yes it can and they don't make as much as you might think. My grandfather had 2 MRI's and medicare only reimbursed the hospital $600 for both scans. The hospital had to write off several thousands of dollars. The hospital still had to pay their employees, their utilities, and other related items at the usual rate, not a hugely discounted rate. MRI's are not few are far between, at least not in NY. If you go to an orthopod, very likely he's in a group that owns their own scanner, every hospital has at least one, then there are stand alone outpatient imaging centers.

When I was first a nurse and a patient had abdominal pain, they went for an emergent Laporotomy. Now with CT scans and MRIs this is not the standard of care.

Laporscopic surgery has reduced surgical stays so surgery that required weeks to recover only need days.

Exp laps are far more expense, time consuming and risky than a CT of the abdomen. In the ED they order alot of CT abdomens. Rarely does one show a need for surgery. Mostly the diagnoses comes back as a kidney stone, ovarian cyst, colitis, constipation, pancreatitis etc, without the need for any surgery. Putting someone to sleep is risky and expensive especially when you don't know what you're going after, which most of the time is nothing that can't be treated non-surgically

We have to stop keeping the living dead alive. Three strokes, no mentation, and INR's thrice weekly, blood thinners, anti-seizure meds, beta-blockers, yada yada yada - when do we let people go?

Sue, ITA with you! I have seen so many patients come in from LTC's, have been bedbound by strokes etc...and they come to the ED to r/o another stroke? I mean what are they going to do about it? Yep, another stroke, prognosis unchanged. Keep alive as long as possible even though they are 02 dependent, have a feeding tube, no quality of life, can't communicate, have bed sores, but yeah we do have to know if they've had another stroke. Not to mention the patient having to go through needle sticks, being slid around on a back board for various procedures like CT's and/or MRI's, being sedated for the MRI because they need to hold completely still, it makes me want to gag everytime I deal with those poor living dead who just need to be left alone to die.

Where I see alot of waste is people coming into the ED who fell just that day and their knee hurts and they demand an MRI which is always negative. People think they need immediate and complete treatment for everything that makes them have a little owie. I shouldn't be complaining, they keep me employed.

[burn out]

I am sure when Salk developed his polio vaccine, and Pasteur developed penicillin and homogenized milk people wondered how in the world would the amount required to vaccinate every person, produce enough antibiotics to treat every person, and how do to treat all that milk from all those cows for all those people was considered quit a financial and heroic challenge. Where would we be today if the challenge was not taken up? We owe it to future generations to continue to pick up the gauntlet and overcome our challenges...that is why the human race has survived..it is all about survival not just of one person but the whole of mankind.

[BroadwayRN, ASN, RN]

Awesome post Burnout!

[FireStarterRN, BSN, RN]

I'm talking about financial REALITIES. The Polio vaccine was small potatoes compared to the expenses of modern medicine today. Anyone familiar with me here knows I'm not all about money, I think that's a very unfair accusation.

Our system is in many ways very egalitarian. It's nonjudgmental almost to a fault. We are pouring money down the drain in many cases, such as on the end of life care that Sue describes. Hemodialysis is another example where it is provided to anyone who needs it, in spite of their level of compliance or potential outcome.

That's not so in most nations that have socialized medicine. The UK rations dialysis.

Financial realities don't go away with heartfelt wishes for Peace on Earth and Open Heart Surgery to all. All these new medications, techniques, discoveries cost big bucks!

[morte, LPN, LVN]

I am sure when Salk developed his polio vaccine, and Pasteur developed penicillin and homogenized milk people wondered how in the world would the amount required to vaccinate every person, produce enough antibiotics to treat every person, and how do to treat all that milk from all those cows for all those people was considered quit a financial and heroic challenge. Where would we be today if the challenge was not taken up? We owe it to future generations to continue to pick up the gauntlet and overcome our challenges...that is why the human race has survived..it is all about survival not just of one person but the whole of mankind.

actually pasteur invented his procedure for wine, it damages milk......besides milk is not a natural food for an animal other than the intended species....or beyond toddlerhood.....

and yes...some of these procedures that were developed more with younger healthier trauma patients in mind do not need to be applied to the over 80, comatose patient.....