The Engine That Could

If there is a health care crisis in Arizona, someone forgot to tell Phoenix city officials.

In their desire to attract a critical mass of people downtown, they are pursuing a grand vision of transforming the new bioscience campus into a mega-hub of hospital, research and medical teaching facilities similar to the Texas Medical Center in Houston, which comprises over 40 institutions.

Big dreams, big plans, big money. Health care as the economic engine that could.

Meanwhile, you would think the health care system is coming apart at the seams, judging from a breathless recitation of problems. Pick your favorite here: soaring health care costs, rising numbers of people without health insurance, workforce shortages, undocumented immigrants receiving free care, crowded emergency rooms, cost shifting, stratospheric drug prices, razor-thin hospital operating margins, an oppressive regulatory climate, ridiculously high medical liability insurance premiums, an aging population, excessive use of expensive technology, not enough of the right information technology, greedy insurance companies, greedy physicians, oppressive administrative overhead, medical errors, and of course spoiled consumers used to getting anything they want, anytime they want it, and having someone else pay for it.

So what do city officials know that the peddlers of health care doom donít?

History, thatís what. With a few exceptions, the list of todayís health care flash points reads like a chapter from the 1970s, when the system was also perceived to be in a state of crisis. Then annual health care costs were under $100 billion and represented about 7-8 percent of GDP. Thirty-some years later, costs are up around $1.5 trillion and 15 percent of GDP.

They could well reach 18-20 percent of GDP in another ten years or so, a reasonable prediction that presumably does not escape the notice of business developers and city planners.

The imperative of economic growth trumps the logic of health. On the one hand, we seek ways to stay healthy and lower health care costs by staying out of the system. On the other, we seek ways to bring people into the system and grow the industry with evermore profitable and effective products and services. There are economic incentives on both sides of this equation, but so far Americans have demonstrated a genius for translating every desire into a need, every need into a demand, every demand into an economic transaction, and every economic transaction into a tsunami of rising expectations.

Itís not that we donít know how to stay healthy and lower costs. Itís that we canít afford to slow down the health care economic gravy train.

People will continue to place their bets. New hospitals downtown mean that more beds will have to be filled. A new downtown medical school depends on a growing demand for more physicians. In a climate of large federal budget deficits, more research labs will compete for federal grants, and more private companies will look for medical investments with a large economic payoff.

But where will the payoff come from? Who will be able to afford high tech health care in the future? What about balance and sustainability? What about people who are economically poor, homeless or disabled? What about the need for investments in education, transportation, public safety, arts and culture, and other parts of the community?

What about public health?

One day the health care bubble will burst. Thatís what many said back in the 1970s, the 1980s and the 1990s. Thatís what they continue to say today. The Phoenix downtown developers are betting the pundits are wrong, and history is on their side. Itís a bit of a leap to imagine a downtown Phoenix medical campus ever approaching the scope of something like Houston — and itís fraught with all sorts of economic and political pitfalls — but itís not outside the realm of possibility.

Still, when you envision a future where a quarter of the population and economy is involved in some way with health care, and when you think of the determinants of health, and what we are perfectly capable of doing on our own to keep ourselves healthy and out of harmís way and expensive care, itís hard not to have this nagging thought:

Our public priorities are insane.

Feedback? Send it my way: Roger.Hughes@slhi.org.
*The Drift reflects the views of the author, and does not represent the official view of SLHI’s Board of Trustees and staff.