Innovation, influence and business in America's medical cities.

Highlights of the important and the interesting from the world of health care:

The contradiction of medical technology: Technology is supposed to–and usually does–make every industry more efficient, adding productivity and reducing costs. So why doesn’t it work that way in health care? For example, a state audit in Massachusetts found that a 20 percent increase in the costs of imaging technology over a two-year period was a significant driver of increasing health costs in the state, to say the least. Wired Magazine’s Thomas Goetz attributes this paradox in health technology to the concept of scalability– the idea that, over time, technology gets cheaper, better and therefore more accessible. Examples of this concept can be found everywhere, from cell phones to GPS devices.

Yet scalability hasn’t come to medical technology yet, at least in any significant way, Goetz writes. He cites two reasons: a lack of price transparency in medical technology and the continued reliance on experts to operate the technology. Both combine to keep prices high. The good news, though, is that this is changing. Goetz cites as an example a Cleveland Clinic-Microsoft collaboration in which patients with chronic conditions used Internet-connected software to record and share with doctors key pieces of health data such as blood pressure. It’s this change–putting cheap, scalable technology into the hands of patients, instead of expensive technology in the hands highly paid experts–that will drive the health technology revolution (we hope.)

How much medicine do we want in our lives? In an L.A. Times op-ed that deserves more attention than it’s gotten, an internist and Dartmouth professor describes how two “fundamental life events”–birth and death–have come to be more and more dominated by medical care that hasn’t really helped. It’s just made things more expensive. H. Gilbert Welch, the author, calls this trend toward more and more care the “medicalization of life.”

To cite a concrete example, examine the late-pregnancy ultrasound test. In 2001, less than half of all maternal-fetal medicine specialists used the test, while today nearly all do. This despite the findings of an independent panel that stated the tests don’t “confer benefit on mother or baby.” The tests are intended to find “minor anatomical abnormalities” associated with genetic disorders in babies, however those abnormalities are 30 times more common than the disorders they’re associated with. Those two factors combine to create a lot of unnecessary worry and extra testing, essentially causing more harm than good. As Welch writes, it’s time to make serious changes to the way we think about health care, and that starts with asking “Why?”

There are many areas in which medical care has a great deal to offer. But it has now gone well beyond them. There may have been a time when the words “Do everything possible” were indeed the right approach to medical care. But today, with so many more possibilities for intervention, that’s a strategy that is increasingly incompatible with a good life. We all need to be a little more skeptical and — to really be healthy — willing to ask “Why?”

We’ll say it again because it can’t be said enough: Health reform will cut the projected budget deficit over the next 20 years. That can be said definitively–or as close as we can possibly get to “definitively”–because the nonpartisan Congressional Budget Office says the reform proposal would cut the deficit by $138 billion over the next 10 years, and far more during the next 10. To put that $138 billion number in perspective, it’s peanuts compared to the total deficit projected over that period. In 2010 alone, the deficit is projected at $1.1 trillion. So it can absolutely be argued that reform doesn’t do enough to control health costs, or that it doesn’t even do all that much, but to say that we can’t “afford” reform, as opponents often claim, is just plain wrong. Health care in the U.S. will still be too expensive once reform passes, but it’ll be slightly less expensive than it would’ve been without the health overhaul. That’s not perfect, but it’s a start.

Meanwhile, the blog Movin’ Meat points out a little-noticed provision of the new reform bill: It boosts Medicaid payments to primary care doctors. Most docs will no doubt say Medicaid payments are still too low, but–much like health reform itself–small, incremental steps are better than nothing.

Photo from flickr user digital cat