Jambalaya

Robert Centor (DB's Medical Rants) has commented again on the phenomenon of rising healthcare costs and suggests three possible contributory perspectives:

1 ...costs are artificially inflated each year - so that the medical establishment can make more money

2 ... the overhead of doing business is increasing - due to malpractice costs, the costs of federal regulations and the cost of labor

3 ... some costs come from new technologies

Another way of looking at it that we have much more sophisticated (therefore expensive) investigations and therapeutic interventions to offer to an expanding and ageing population, whose expectations in turn are much higher yet probably less realistic. The great bulk of healthcare expenditure goes on bringing us into this world, and seeing us out of it. There is much futile expenditure at the end of life that arises from unrealistic demands and mismatched expectations. Whenever I was asked, as Medical Director of our institution, where we could make 'savings' (aka 'cuts'), I would blithely suggest that we withdraw 'futile and ineffective' interventions, only to be met with disbelieving stares.

Ivan Illich, who once castigated the medical profession for being a positive threat to health, was rather more contrite when he pointed out in a later article in the BMJ that, in effect, as a society we have forgotten how to die. Death has become not so much medicalized as systematized — it is nothing more than a 'system failure'. "Today, it is not sophisticated terminal treatment but lifelong training in misplaced concreteness that is the major obstacle to a bittersweet acceptance of our precarious existence and subsequent readiness to prepare for our own death".