- The Washington Times - Sunday, November 15, 2009


As the world accelerates technology solutions for everything from education to commerce to environmental health to economic growth, our president is focused on government centralization and traveling back in time to “reform” American health care.

The defining characteristic of the world’s improved medical care over the past half-century is innovative medical technology, a fact that most doctors and patients understand. And amidst all the talk from Congress about the urgency of health reform, the fact that Americans enjoy unrivaled access to the latest lifesaving medical technologies remains an unspoken endorsement of America’s health system.

Yet a key tenet of the Democratic and administration plan for forcing down health costs is restricting access and denying utilization of medical technologies. Restricting access by reducing government insurance payments from the growing millions shifted onto those plans; by cutting Medicare, which already shows the highest refusal rate of claims, more than the demonized private health plans; and by adding millions more Americans to Medicaid, a plan that reimburses doctors and hospitals at below-cost rates, already freezing out access for patients.

Americans know what happens when governments gain more control and try to reduce health costs forcibly. Access to medical technology is severely restricted, dangerous delays in diagnosis and treatment become routine, scandalously outdated equipment is relied upon, innovative drugs are unavailable, and patients ultimately suffer worse outcomes.

We see it in Canada, where necessary technology for safer diagnosis and treatment is severely deficient (ranking 19th out of 27 Organization for Economic Cooperation and Development nations in MRI and 21st out of 28 in CT scans), and that which does exist is scandalously out of date. (One-third or more of most modern imaging technology is years beyond its recommended time for replacement.)

We see it in Great Britain, where National Health Service patients suffer shamefully long waits for diagnosis and treatment because of technology’s limited availability (months longer than Americans for diagnostic MRI scans and often years longer for life-changing surgery for hip replacements and cataracts).

We see it in Western Europe, where patients die earlier because of less access to safer innovative, technology-dependent procedures (less than half of interventional radiology procedures per million patients compared to the United States) and far less access to new drugs known to cure life-threatening diseases. (The United States has been the country of first launch in nearly half of all new cancer drugs in the past 11 years, more than triple any country in Western Europe.)

Government efforts to limit use of tools like medical imaging will undermine the remarkable achievements in most serious diseases, such as:

c Stroke, one of the leading causes of death and the No. 1 cause of disability in the United States, at a cost of more than $50 billion per year. Performing immediate CT scans on all patients suspected of stroke not only improved patient outcomes but also led to overall cost savings from shorter hospital stays. In the past decade, guided by CT and MRI, new lifesaving treatment unblocking arteries supplying the brain in acute stroke patients has saved lives and dramatically improved quality of life for survivors, so that “following immediate stabilization, imaging takes precedence over time spent sorting out clinical details” (Journal of the American Medical Association, 2000).

c Cancer, with 1.5 million new cases in the United States to occur in 2009 alone, is a disease for which MRI has become a game-changing tool, accurately predicting whether cancer surgery would be curative or would fail. PET or PET-CT imaging changed treatment in more than one in three cancer patients (2008 National Oncologic PET Registry (NOPR). In cancer patients, doctors rely on imaging to detect disease earlier, provide more targeted therapy and often eliminate the need for exploratory surgery.

c Acute appendicitis, a routine disease but a medical emergency, a disease that without today’s full access to imaging would be diagnosed the way it was 40 years ago - when mortality was high and surgical exploration showed the wrong diagnosis in 15 percent to 20 percent of cases. CT, with 95 percent accuracy, has revolutionized the diagnosis of this curable disease. A recent study showed CT excluded appendicitis in 52 percent of patients when appendicitis was considered “probable” and in 60 percent of patients when appendicitis was considered “very likely.”

c Epilepsy, a debilitating neurologic condition affecting millions of American adults and children, would be thrown back into the dark ages without access to sophisticated MRI for both diagnosis and treatment guidance. Considered an essential part of the “minimum standards” for adult epilepsy care, MRI is also recommended for all children younger than 2 with new-onset epilepsy and all children with localized epilepsy in official guidelines issued by the International League Against Epilepsy.

High-tech medical imaging, repeatedly vilified by medically naive politicians, specifically has increased life expectancy here in the United States. Frank Lichtenberg (National Bureau of Economic Research, 2009) showed that life expectancy increased more rapidly (and mortality rate declined more rapidly) in those states in which advanced imaging procedures increased more rapidly. Beyond the fact that MRI and CT were overwhelmingly identified by more than three-fourths of leading doctors to be the No. 1 most important medical innovation in improving patient care over the prior decade, and disregarding how imaging has revolutionized the care of so many disabling disorders, the additional use of sophisticated medical imaging can actually decrease the costs of patient care in a number of important clinical settings.

These cost savings arise from shorter hospital stays and quicker return to work for patients; elimination of unnecessary tests for excluded diagnoses; and elimination of painful, dangerous and costly side effects from alternative surgical diagnostic procedures.

Turning back the clock on America’s extraordinary medical care by empowering Washington bureaucrats to arbitrarily restrict the use of advances like imaging, toward the care of decades past, by mimicking the government-dominated, technology-deficient health systems of Europe and Canada will inflict irreparable harm on Americans and their families and will be one the most misguided government acts in history.

Scott W. Atlas is senior fellow at Stanford University’s Hoover Institution and a professor at the Stanford University Medical Center in Palo Alto, Calif.

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