I love my iPhone. Along with being my phone, it’s also my bank, my weatherman, my newspaper, my calendar, my map, and now, my personal assistant. But despite it’s many uses, I understand it can’t solve all of my problems — it can’t cook my meals or clean my clothes. Some things I just have to do the old-fashioned way. That's how it is with technology — it’s great for some things, failing miserably at others.
Health is one of those things technology is not so good at.
To say America has a health problem would be an understatement. When looking at measures that compare health between different populations, like life expectancy and infant death, the U.S. is among the worst in all high-income countries. In 2008, more babies per capita died before their first birthdays in the U.S. than in 29 other OECD countries — only Chile, Turkey, and Mexico fared worse. Then there’s the fundamental inequality that shapes health in America. The average African American man in an urban slum, for example, can expect to live a life 15 years shorter than his Asian American counterpart. Adding insult to injury, on average, we pay nearly twice as much per capita for health care as people in comparable countries.
Like most problems, we have attempted to solve this one by throwing more technology at it. The latest and greatest diagnostics and treatments, we think, will surely fix our problems. But technology won’t solve our society’s most pressing health care issues — even worse, our over-reliance on it may actually exacerbate them.
Take, for example, the CT scan — hailed as a breakthrough in medical imaging. While certainly cutting-edge and important for diagnosing relatively rare diseases, this test has the potential for severe overuse. In fact, because of the high doses of radiation it emits, studies show that overuse of CT is likely to cause up to 29,000 new cases of cancer per year. At upwards of $3,000 per scan, unnecessary tests aren’t even cheap. So our society pays a huge financial price for the overuse of CT scanners — not to mention the cancer it causes.
The problem with health care technology isn’t the technology itself — CT scanners certainly serve a purpose — but the political economy that dictates the ways in which that technology is deployed. In our system, technological advances aren’t intended to improve efficacy, equity, or cost-effectiveness, per se, but rather to raise profits for the corporations that produce them and the practitioners who use them.
To illustrate the perverse incentives our over-reliance on technology precipitates, among the key drivers of CT overuse are doctors who own their own scanners. Able to bill for both their consultations and the scans they order, they have every incentive to order needless scans — increasing costs while subjecting their patients to harmful, cancer-causing radiation. And patients, who of course want the “best” care (and assume more is better), don’t have the knowledge to discern between necessary diagnostic tests and those performed to puff their doctors’ bottom lines.
CT is one of many examples where our over-reliance on technology in healthcare has lead to skyrocketing costs with little return in health improvements. It’s no wonder that health economists have concluded that medical technologies are to blame for up to 75% of growth in our health care costs.
What’s more, as insurance premiums have exploded to cover these rising health care costs resulting from our dependency on technology, our system has priced the poorest Americans out of health insurance. In this way, our insistence on medical technologies has also exacerbated deep health inequalities in our country.
Are there some technologies that have saved lives and money? Sure. But they’re the exception, not the rule. Take, for example, electronic medical records (EMR) systems. Why were they adopted? Not because they improve quality of care while lowering costs (which they do). Rather, because they cut doctors’ operating fees and increase their profits. While some technologies may have positive externalities with respect to efficacy, equity, or cost-effectiveness, it’s the bottom line that ultimately dictates technological development and adoption. And unlike EMR, in most cases, profitable technologies only marginally improve (or even harm) population health while jacking up costs and obliterating equity.
It’s hard to believe that technology won’t, yet again, be the answer to our problems — just like it’s sometimes hard to believe that my iPhone can’t feed me. As a society built on the principles of progress rooted in technological advancement, reckoning with our inability to depend on technology to bail us out of this health dilemma isn’t easy. As Daniel Callahan, the renowned bioethicist writes, “[B]ecause of our bemusement with technology, resistance to change will be formidable … Liberals will oppose it because … they are … children of the Enlightenment, wedded to endless scientific progress and technological innovation. Economic conservatives will oppose it as an interference with market freedom and consumer choice.”
In the end, addressing the foundational issues of efficacy, equity, and cost-effectiveness in our health system will require us to beat our addiction to technology and to start doing some things the old-fashioned way. Perhaps exercising, eating healthy foods, and putting an end to tobacco once and for all might be good places to start?
Photo Credit: joncallas