The problem seems to be that excess health-care cost is completely impersonal, while the idea of me, or my loved ones, not getting some expensive medical care is intensely personal. So when the fearmongers go to work, it's no contest.
A possible antidote for this impasse is provided by Drs. Richard Young and Jennifer DeVoe, from the family medicine programs in Fort Worth and Oregon, respectively. In a recent paper, they calculated what would have happened to average household income in the United States had we been able to constrain health costs to the general level of overall inflation between 1996 and 2010.
Drs. Young and DeVoe assumed that the savings in lower health costs would have been passed on to families in the form of additional income. This assumption makes general sense if we use employer-based health insurance as a model. To an employer, wages and benefits are interchangeable, so money added to benefits to pay higher insurance fees is money not available for wages.
The doctors conclude that, if health-care costs had increased only at the rate of the consumer price index during the last 15 years, the average U.S. household would now enjoy an extra $8,410 in annual income, or almost 14 percent more than actual income.
We have a pretty good idea of where all that extra money in health-care costs is going. Recent estimates from many sources all agree that about 30 percent of our present health-care budget goes toward tests and treatments that (based on the best scientific evidence) don't benefit patients.
So imagine that we had a plan to identify these no-benefit procedures. The usual pushback is, "Wait a minute -- maybe somebody with a sheet of statistics says this won't benefit me, but how do I really know? Shouldn't I have this test or treatment, just in case it works?"
So now, thanks to Drs. Young and Devoe, we can personalize this. On one pan of the scale, put that "just in case," the very small chance that a procedure thought to be non-beneficial will actually help any individual patient without causing a lot of harm instead.
On the other pan of the scale, put the extra eight grand that your family could be earning every year.
Once we've made both pans of the scale equally personal, I suspect that the majority of Americans would judge that the extra money in the bank is worth much more to their family's well-being than the distant chance that a medical procedure will help them when all the scientific evidence says it won't.
And maybe that's a better way to talk about how to approach reining in out-of-control health costs.
Dr. Howard Brody is director of the Institute for the Medical Humanities at UTMB