The Bankrupting of American Healthcare:
$20 Billion, Many Lives Lost Each Year
Cost Analysis Details Startling Waste

Perverse Heart Health Practices Enrich the Few and Condemn the Many

A great debate is raging in America today regarding the bankrupting of the American healthcare system. As costs go up by double-digit percentages, fewer people can afford healthcare. Those who can afford it spend an increasingly greater portion of their disposable income to maintain it. It is predicted that, at the current rate of growth, healthcare costs will balloon to absorb 20% of American Gross Domestic Product (GDP), about 4 trillion dollars, in the next ten years¹. Such a trend cannot be maintained and will indeed bankrupt the American healthcare system if it continues unabated

However, there is an even more perverse angle, an ethical bankrupting, when considering the cost of heart healthcare. Effective treatment tools and powerful strategies for the prevention of heart disease are available. Yet the great majority of cardiologists, along with institutions such as major heart centers and the American Heart Association, do little to promote these practices, preferring to silently keep Americans sick so they will continue to require expensive interventional procedures and drugs to stay alive.

The following is a thumbnail exposé that examines the financial and ethical impropriety of the American heart healthcare system. It is accompanied by a financial analysis that finally puts a hard number on the financial cost.

Heart Disease is America's #1 Health Problem and Health Cost

According to the American Heart Association, cardiovascular disease affects one-third of all Americans and accounted for 36.3% of deaths in 2004 (the most recent year available)². The Agency for Healthcare Research and Quality (AHRQ) places heart disease as not only the highest healthcare cost category (10% of all health costs), but also as the fastest growing (45.6% growth between 2000 and 2004)³. Not surprisingly, the AHRQ also placed heart drugs at the top of the prescription drug spending list, topping the next closest drug class by 29%. This ranking was exclusive of anti-cholesterol drugs. Together, these two drug classes accounted for 30% more spending than the other top drug classes combined.

The tremendous cost of heart care is driven by a quiet conspiracy of ignorance, public demand, and an exquisitely tuned scientific and industrial machine that churns out remarkable drugs and procedures capable of pulling lives back from the precipice of death. It is only natural that the public would want, and pay any price for, such miracles. What is unnatural is for the traditional medical establishment to allow the public to teeter on that precipice in the first place, all while the public remains ignorant and all too often for the sake of profit. When a hospital builds and heavily promotes a new "heart center," expenses have to be recovered somehow. When we hear young cardiologists lament, "I have to find a way to do more procedures," we should begin to worry.

The implication is ominous. Heart care is already the single largest healthcare category with a projected growth rate that threatens to consume outrageous portions of the American healthcare budget. Traditional medicine remains entrenched in a practice that is, at best, old and inefficient and at worst, driven disproportionately by profit. With such a voracious appetite for healthcare dollars, can it be long before the entire system collapses under its own weight?

Crash and Repair

The "dirty little secret" surrounding the outrageous rise in the cost of heart care is a failure for the medical community to embrace groundbreaking advancements in the understanding and prevention of heart disease.  When applied to heart care, the old adage, "An ounce of prevention is worth a pound of cure" could be more appropriately re-scaled to, "A gram of prevention is worth a metric ton of cure."

Imagine that instead of promoting the use of seatbelts to reduce the incidence of life-threatening and traumatic crash injuries, the government mandated that trauma centers be built every ten miles along interstate highways.  The convoluted reasoning would be that, with all the modern advances in emergency room treatment, just think of how many lives could be saved if more people could get to the operating room and in less time (frequently touted in heart center ads as "door to balloon time"). This can be best characterized as the "crash and repair" model for heart care.

That perverse and cost prohibitive thinking is exactly what is being promoted by the traditional medical establishment.  Recently, a prominent cardiologist and Fellow of the American College of Cardiology wrote an opinion piece calling for the "greatest push in the history of American cardiac medicine" in order to "improve accessibility to primary percutaneous-based intervention" given the "Improved pharmacologic therapy, better stent platforms, and the advancement of wire technology."⁵  In effect, the call was to build more facilities, train more personnel, and provide greater access to surgical procedures rather than focus on prevention.  The aforementioned cardiologist is also the co-director of a statewide pilot project for primary angioplasty.  A coincidence?

Clearly, like a seatbelt, preventive measures for heart disease are far more cost effective and extract a far lower toll in human suffering than the "crash and repair" approach.  So, one must ask, "What drives the traditional medical community to favor this patently irrational strategy?"  Is it ignorance of equally impressive advances in preventive medicine?  Is it fear of losing the prestige and motivation of being characterized as life-saving heroes?  Or, is it the fact that selling $10 "seatbelts" is not as profitable as selling $100,000 surgical procedures?

The Truth About Modern-Day Heart Disease Prevention

Cynics may come to the conclusion that doctors are allowing patients to become ill to ensure a steady supply of customers for high-priced heart care drugs and procedures. Remember, someone has to pay for all those shiny new heart centers.

Modern-day prevention is predicated on a new understanding of heart disease as a chronic disease that only becomes symptomatic after years of silent festering. It is estimated that 48% of all Americans suffer some degree of coronary heart disease. It has also been discovered that the overwhelming percentage (>90%) of heart attacks occur at arterial sites harboring this "silent disease" and are undetectable using traditional diagnostic methods such as stress testing. The technological development of tools to detect this earlier, chronic form of coronary heart disease is poised to put an to end the “crash and repair” paradigm of care. In fact, the public now has access to remarkable advancements in heart disease prevention that are readily available for significantly less cost than traditional "crash and repair" healthcare.

Advances in CT heart scanning provide a fast, relatively inexpensive, and non-invasive method of detecting and tracking silent heart disease decades before expensive "repairs" are required. Combined with modern approaches that include blood lipoprotein analysis, modest life-style changes, dietary supplements, and judicious use of prescription agents, most heart disease can be reversed, stopped, or slowed to a point where a normal-length, quality life span can be enjoyed without the need for surgical procedures or extensive drug regimens.

In addition to improving the length and quality of human life, the prevention model is radically less expensive. Given that heart disease is, and will continue to be, the highest cost segment of health care, any serious discussion about saving the American healthcare system from bankruptcy would be most productive if focused on this segment of healthcare costs.

Defining the Hard Costs

A cost per patient model was developed using 40 variables derived from American Heart Association occurrence data, clinical observations from a typical cardiology practice, and typical medical procedure and drug costs. The standardized population used for these calculations are males aged 40 to 59 followed over a 12-year period, representing a population segment for which reliable epidemiological data is readily available. The default medical procedure costs used are based on published averages. Costs for workdays lost and death/replacement will vary from company to company and represent typical estimated cost.

A cost comparison algorithm and calculation tool was developed to process the data. A functional copy of the tool appears at the conclusion of this report along with a table defining the algorithmic variables and assumptions used. Cost data for different regions, corporations, etc. can be modified using this tool to generate custom cost comparisons and "what if" scenarios. The savings generated represent the total costs saved over a 12-year follow-up period for the target population.

The traditional "crash and repair" model uses standard stress testing to identify at risk patients and then calculates the cost to "repair" them.  This method results in more "crashes" because stress testing is only effective at detecting advanced heart disease.  The prevention model uses heart scanning to identify at risk patients decades before they "crash"  and are in need of "repair" (i.e. require extensive surgical intervention and drug treatment).  Even though preventive maintenance costs are slightly higher, this cost is dwarfed by significant reductions in surgical intervention and follow-up care costs.

The Cost Savings of Heart Disease Prevention

The cost comparison tool calculates a potential savings of over $630 million ($53 million per year) per 100,000 persons achieved by using modern prevention techniques in place of traditional cardiac practice. The US Census Bureau estimates (2006 projection) that there are approximately 41 million males aged 40 to 59 (the target population used in the comparison algorithm). This translates to a total savings of over $246 billion dollars over 12 years (over $20 billion per year). It is important to keep in mind that this figure is only for males aged 40 to 59 and does not include any other segment of American society. Adding males over age 59 (a group in which most heart attacks and other cardiovascular events occur) and all women would likely increase these figures several-fold.

The implications are clear. A heart disease prevention philosophy is financially, ethically, and socially superior to the current state of heart healthcare in America. Adopting these precepts is an essential first step in solving the growing problem of burgeoning healthcare costs and the societal damage inflicted by allowing a correctable disease to progress to the point where death or irreparable damage occurs.

Article References:

1. Borger, C., et al., "Health Spending Projections Through 2015: Changes on the Horizon," Health Affairs Web Exclusive W61: 22 February 2006.
2. American Heart Association. Heart Disease and Stroke Statistics (12-18-2007 Update).
3. Agency for Healthcare Research and Quality. "The Five Most Costly Conditions, 2000 and 2004: Estimates for the U.S. Civilian Noninstitutionalized Population," March 2007
3. Agency for Healthcare Research and Quality. "The Top Five Therapeutic Classes of Outpatient Prescription Drugs Ranked by Total Expense for Adults Age 18 and Older in the U.S. Civilian Noninstitutionalized Population, 2004," December 2006
5. Melissa Walton-Shirley, MD, FACP, FACC, "It Should Be the Right of All Americans to Have Primary Percutaneous-Based Intervention for Acute Coronary Syndrome" WebMD, Medscape Today, June 4, 2007

Enter Total number of persons in sample population:
Traditional Cost	Prevention Cost	Cost Savings

Cardiac Health Care Costs for Traditional Heart Care
Cost Category	Percent	Persons	Cost
Stress Testing 1
Stent Procedures 2
Bypass Procedures 3
Lost Work Days 4
Heart Attacks 5
Stent Procedures 6
Bypass Procedures 7
Deaths 8
Lost Work Days 9
Drug Therapy 10

Cardiac Health Care Costs for Prevention Program
Cost Category	Percent	Persons	Cost
Heart Scan 11
% w/Positive Scores 12
>=90th Percentile Score 13
Stress Testing 14
Stent Procedures 15
Bypass Procedures 16
Lost Work Days 17
<90th Percentile Score 18
Stress Testing 19
Stent Procedures 20
Bypass Procedures 21
Lost Work Days 22
1-100 Raw Score 23
Stress Testing 24
Stent Procedures 25
Bypass Procedures 26
Lost Work Days 27
Drug Therapy 28

Cost Assumptions
Item	Cost
Heart Scan 29
Stress Test 30
Stent/Angioplasty 31
Heart Bypass Operation 32
Heart Attack 33
Drug Therapy, Standard 34
Drug Therapy, Prevention Program 35
Death/Replacement Cost 36
Lost Workday Cost 37
Days Lost for Stress Test 38
Days Lost for Stent 39
Days Lost for Bypass 40

Copyright 2007, Track Your Plaque.