COMMENTARY

Ruminations on Healthcare Spending

Allan M. Block, MD

October 12, 2022

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

What could you do with $18 billion?

Dr Allan Block

I could pay off my mortgage roughly 60,000 times, or take my wife on a never-ending world cruise so we don't need a mortgage, or at least hire someone to clean my pool regularly so I don't have to.

A recent report from the OIG found that, in the last 3 years, the Centers for Medicare & Medicaid Services spent $18 billion on drugs for which there's no proof of significant clinical benefit.

That's a lot of money on things that may or may not be placebos, some of which are WAY overdue on Food and Drug Administration–mandated efficacy studies. A few have even been on the market so long that they've become equally unproven generics.

Now, if you put this in the big picture, that immense amount of money is still only 2% of their total spending in health care. Hell, probably at least 2% of my personal spending is on pointless things, too. So, realistically, you could say 98% of CMS spending is on worthwhile care, which is as it should be.

But the bottom line is that $18 billion is still a lot of money if it's being spent on fruitless treatments. I'm sure it could be better used in many other programs (refunding it to taxpayers comes out to maybe $55 for each of us, which probably isn't worth the effort).

As pointed out in the movie "Dave," shoving that kind of money in even a low-yield savings account would generate at least $180 million in interest each year.

That's a lot of money, too, that could be used for something. Of course, no one in the government thinks that way. That's why we all loved the movie.

The problem is that the phrase "no proof of significant clinical benefit" doesn't mean something doesn't work. It just means we aren't sure. Some of those people on one of these drugs may be getting benefit – or not. After all, the placebo effect is remarkably strong. But if they are helping someone, who wants to be the one to tell them "we're not going to pay for this anymore?"

Another issue is this: Let's say the drugs only work for 10% of the people who take them ($1.8 billion worth), and for the other 90% it's iffy ($16.2 billion worth), but the latter want to stay on them anyway, just to be sure. Do we cut them? Or just say that $18 billion is too much money when only 10% are being helped, and cut them all off? I'm sure we could use the money elsewhere (see "Dave" above), so let them find a way to work it out with the manufacturer. The greatest good for the greatest number and all that jazz.

I don't know, either. Health care dollars are finite, and human suffering is infinite. It's a balancing act that can't be won. There are no easy answers.

Block has a solo neurology practice in Scottsdale, Ariz.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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