Why the cost of delivering medical care is bankrupting America - one example

In my previous post I discussed Dr. Marty Makary's book Unaccountable about what goes on behind the scenes in American hospitals. One of the issues he raises is the number of unnecessary or unwarranted procedures that are done on patients. In his aptly numbered chapter 11, entitled "Eat What You Kill", he describes the excesses of a system in which the doctor has become more a salesman than a primary healthcare provider. One result of this business model is that many procedures such as back operations, spinal fusions and angioplasties are done to excess, with huge costs to the system.

To support this Dr. Makary cites a 2012 study, entitled "Appropriateness of Percutaneous Coronary Intervention" (PCI, or more commonly known as angioplasty). The study found that in the space of a little over a year (July 2009 to September 2010), there were altogether 500,154 such operations, of which 355,417 (71.1%) were for acute indications (such as myocardial infarctions and unstable angina) and 144,737 (28.9%) were for nonacute indications, which I imagine means that the patient was experiencing symptoms, but not in distress or imminent danger.

Of the latter group, surgery for nonacute indications, "72,911 PCIs (50.4%) were classified as appropriate, 54,988 (38.0%) as uncertain, and 16,838 (11.6%) as inappropriate."

In short, that's almost 17,000 unnecessary operations, and almost 55,000 questionable ones, for a total of 72,000, all in the space of 15 months.

Out of curiosity, I next went on Google to find out how much an angioplasty costs. I found this topic discussed at angioplasty.org. The numbers varied wildly. One quoted price was this:

About the cost of angioplasty and stenting in the US based on medicare payment: Cardiologist fee: $838 for one vessel, each additional $233 Hospital fee: $10,371-$18,227

Then a man from Texas spoke up and said he paid $101,000.00 and it was worth every penny. Other people chimed in with numbers in the vicinity of $50,000 to $90,000, and people from outside the US gloated that theirs was free (in Canada) or a few hundred euros for the hospital stay (Ireland).

At any rate, the reason I bring these numbers up is to point out that those 72,000 unneccesary or questionable angioplasties from July 2009 to September 2010 cost Americans anywhere between $720,000,000 (if you calculate $10,000 per procedure) and $7,200,000,000 (if you calculate $100,000). That latter figure is $7.2 billion, by the way. Now add in all your unnecessary back operations and spinal fusions at $12,000 a pop, give or take a few thousand, and you have numbers for unnecessary or questionable surgeries that are not just in the stratosphere, but way beyond, hovering somewhere around Jupiter if not out of the solar system altogether. No wonder America is in danger of going bankrupt.

PS: And the true shocker is that according to a recent study angioplasty for these nonacute patients (who had stable angina or narrowed arteries) was no better than optimal medical therapy and lifestyle change. The study found that

getting angioplasty and a stent to hold open a narrowed artery didn’t offer any extra protection against a heart attack, stroke, hospitalization for acute coronary syndrome (the umbrella for heart attack and unstable angina), or premature death ... If you have chronic angina, it’s worth giving medical therapy the old college try. One of the findings from [the study] that surprised even researchers was how effective medical therapy was at relieving angina and improving quality of life. You might be surprised at how well exercise, a better diet, and medications can make you feel. If, after six months to a year, your angina is still bothering you or keeping you from doing activities you enjoy, angioplasty or bypass surgery are reasonable next steps.

If that is indeed the case, then the number for unnecessary angioplasties may be a lot higher than 17,000.