Giving thanks for medical advances
We Americans love to complain about the cost of medical care and prescription drugs. This week after Thanksgiving, let us pause to give thanks for the amazing advances in medical care and prescription drugs in the last 50 plus years.
In 1965, President Lyndon B. Johnson and an overwhelmingly Democratic Congress (295 to 140 in the House and 68 to 32 in the Senate) finally passed Medicare. President Harry Truman, almost 20 years earlier, had started the fight to deliver medical care for every American 65 and older.
In 1965, medical care was very basic, limited and, therefore, relatively inexpensive.
About that time my 51 year old father suffered his first heart attack. As I recall, the cost of his health care was low because after a few days at WCA Hospital in an oxygen tent, his treatment consisted of baby aspirin, several months of bed rest, and nitroglycerine tablets for angina pain.
Heart bypass surgery and stents had not been developed yet. There were no effective blood pressure medications. In fact high blood pressure was not viewed as treatable until 1991. There were no cholesterol medications (statins were not in use until 1987).
Carotid artery surgery would not become common until the 1970s. Pacemakers were not in wide use. Wilson Greatbatch of the University of Buffalo did not patent the first implantable pacemaker until 1959.
Since there was little a heart doctor could do for a patient, health care for a cardiac patient was relatively cheap. Long term results, however, were not great. My father died of his second heart attack at age 66 in 1981.
In 2022, unlike in 1965, our doctors have a large number of drugs and treatments available to help us avoid ever having a heart attack or stroke.
Prescription drugs to help keep our bad cholesterol and our blood pressure under control, while sometimes expensive, keep most of us from suffering a devastating heart attack or stroke, which are both an expensive tragedy for the individual as well as a huge loss of a healthy person for the community.
Prescription drugs to control our blood sugar, for example, help to avoid the many serious consequences of uncontrolled diabetes.
A big part of the high cost of Medicare is the cost of medication. Unfortunately the Congress, until this year, for many years had never allowed Medicare to negotiate drug prices with drug companies. Even with the new law passed in 2022, the pharmaceutical industry, a huge source of campaign contributions, succeeded in limiting the number of drugs for which Medicare can negotiate prices. Apparently because of the power of Big Pharma, every Republican Senator opposed even these limited prescription drug changes.
Hip replacements and knee replacements were unknown in 1965. In 2022 they are common but expensive. By 2030 it is predicted more than 3,000,000 knee replacements will have been performed. These joint replacements give millions of Americans pain relief and a much better quality of life.
The high cost of these surgeries explains part of the high cost of medical care in 2022 compared to 1965. The average cost of a total hip replacement ranges between $31,000 and $45,000. In 2020 the average cost for a knee replacement was between $30,000 and $50,000.
The detection and treatment of cancer was primitive in 1965. Over the last several decades public and private investment in healthcare and pharmaceutical research has resulted in tangible advancements and improved treatments.
My wife’s mother died of uterine cancer in 1960 at the age of 47 despite what was considered aggressive treatment at the time. Today, because of early detection and treatment options, the five-year survival rate for uterine cancer that has not spread outside the uterus is 95%.
There was no such thing as a colonoscopy in 1965. It was not until 1985, when President Reagan had a life-saving colonoscopy, that the nation became aware of the procedure.
In 2022, over 15,000,000 colonoscopies will be performed. Each test reduces the risk of colorectal cancer deaths by over 60%. On average a colonoscopy costs at least $1,250.
In 1965 there was no mammography. Finally in 1969, dedicated mammography became available. Since 1989 and as of 2020, breast cancer death rates have declined by 43%. The decline is attributed mostly to early detection and treatment options.
Obamacare (The Affordable Care Act) requires health plans to fully cover the cost of a screening mammogram every one or two years for women over 40.
None of this is to minimize the financial pain to an American without health insurance of a single drug that might cost $6,000 or more per year. While Medicare, Medicaid and Obamacare cover more Americans than ever before, our healthcare “non-system” still leaves some Americans out in the cold.
I doubt most Americans would want to be living back in “the good old days” of 1965 when medical care was basic, limited and cheap. In 2022 medical care offers Americans both longer life spans and an improved quality of life.
This is something for Americans to give thanks for this Thanksgiving week.
Fred Larson is a 1976 graduate of Yale Law School and a retired Jamestown City Court judge.