With this essay we embark on a journey through the world of medical cost. In my last essay, I argued that while our government struggles to create a system that pays for the healthcare system we have, the true problem is the outrageou
s cost of that system, not how we pay for it.
Today, we will examine the surgical equipment industry, and how expensive i
nnovation and technology is valued over actual contribution to patient outcomes, and how every incentive exists to make medical equipment as expensive as possible.
A few years ago, I was involved in a project with a number of students from Georgia Tech’s biomedical engineering department. I had an idea to solve a basic problem in laparoscopic surgery, and these students were charged with c
reating a prototype solution to the idea. We came up with an elegant solution to an issue that occurred in every laparoscopic surgery in this country, and eventually the students presented this idea as their senior project for their degrees.
Subsequently, I approached my University’s Technology Transfer department (the group that helps faculty to commercialize their ideas.) We went through a process of idea disclosure with the hope that the University would help me to bring this idea to market. In the end, though, it fizzled. They said they weren’t interested in developing the idea. So I approached several industry groups. Again, no interest. Over time I talked with three different groups that develops ideas, and no one was interested.
The kicker of all of this is that the lack if industry interest had nothing to do with the utility of my invention. In fact, all parties agreed that the idea was great and the solution was elegant. They also agreed that they could imagine the device in practice. The problem wasn’t that the device wasn’t a good one, it was that the device was too simple, and too inexpensive to manufacture. I had imagined a device that would probably cost about 5 dollars in every surgical pack. In the end, the development market had little interest in such a device, given what it costs to develop bring a device to market and the likely payout at the end. This thing actually saved money in time and in replacement of more expensive equipment already in use in the OR. But what I found out was that there wasn’t much interest in devices that causes industry to make less money.
Having been a physician now for 16 years, I have had a first hand view at the variety of healthcare reforms and regulation put into place over that time. Most recently, the Affordable Care Act has been at the center of our attention, but it is by no means the only thing the government has done over that time.
Today, President Trump and the Republicans are working to repeal the Affordable Care Act, and possibly replace it with something else (Something Great if you listen to Trump.) I have mixed feelings about this. I think that the ACA did some good things, but also got some things wrong. At its fundamental core, by forcing all people to buy healthcare through a private insurer (albeit through a government funded network), it was trying to create universal coverage. Unfortunately, the ACA struggled to get healthy people who would pay more than they consumed to enter the system, thus creating a system where there were often more claims than premiums.
As a young physician, I was taught that when a patient presents with a ruptured ectopic pregnancy and was hemodynamically unstable, the correct course was to perform a laparotomy for immediate control of the bleeding. At that time (around the year 2000), complex laparoscopy was not really in wide practice, a
nd a physician who suggested that they could control bleeding laparoscopically as quickly as they could via laparotomy would have been met with skepticism. In some cases, a physician suggesting a laparoscopic approach to the problem might be blocked by the atten
ding anesthesiologist, who often holds veto power over certain surgical decisions. The idea was that the bleeding needs to be stopped quickly, and the way to do that is a laparotomy.
But over time, our ability to do things quickly and effectively via laparoscopy has changed, and I think our understanding of hemodynamic instability in young women has changed as well.