Dr. Dr P.J. Devereaux is a lead investigator in a study that looked at the ability of a commonly ordered blood test for congestive heart failure, or fluid on the lungs, to predict cardiovascular events in the 30 days following noncardiac surgery. He remarks: “I think people are going to be very surprised at how much the event rates really are increasing,” he said. “Because we’ve gotten really good at treating acute coronary syndromes in the emergency room and chronic heart failure and serious arrhythmias, patients who would have died 15 or 20 years ago are now living long enough to get bad hips, bad knees, and colon cancer, and they’re all going to surgery at much older ages with higher burdens of underlying vascular disease.” 

This will sound familiar to those who have read my earlier dissertation on the ills of the health care system, and is evident to all of us in the system and anyone who has seriously thought about the future of health care. The only bottom-line truth? Death is cheap. Managing illness is not, and will be less so the more success we have. That doesn’t mean we can’t mitigate the (fiscal) damage. We have to. Will we have the courage to make the value judgments needed for a cogent plan or put together some hodge-podge in the dark of night? 

I fear we’re moving in the direction of the latter approach. Keep your eyes on the headlines.


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