On Monday, the New York Times reported on the controversy surrounding Intuitive Surgical Inc.’s “daVinci” robotic surgery system — a product that allows doctors to “conduct” surgeries remotely on a console while robotic arms scale and translate their movements onto the actual patient. While high-tech systems like this are supposed to make procedures safer and more efficient, the daVinci lawsuit — which centers on a patient who eventually died from complications arising from the system’s use — reveals that a combination of factors, such as inadequate product testing and aggressive marketing strategies driven by profits, often undermine that goal.
That’s a frustrating reality for health care reform advocates on the lookout for effective methods of cutting national health expenditures while improving patient care. Although innovation in health care technology had undoubtedly improved lives and made care more efficient in the aggregate, as demonstrated through breakthroughs like vaccines and birth control, it has also accounted for at least half of the increase in health care spending in the last 70 years. While that may sound counter-intuitive at first, a quick dive into America’s health care culture shows why it’s not — and why innovations like “robot doctors” aren’t actually lowering health care costs:
1. It’s almost impossible to tell how much various health care technologies actually cost.
One of the most persistent problems in the American medical industry is rampant health care price opacity. Time Magazine’s recent investigative look into Americans’ sky-high medical bills revealed what many already suspected — that the prices of various medical products and services are essentially arbitrary, fluctuating wildly from one hospital chain to another and even more wildly between different geographic regions.
Since there isn’t an easily-accessible national database of medical devices and their prices, manufacturers can pitch their products at varying rates to hospitals and jack up prices with relative impunity. Those inflated costs are then passed on to consumers by providers looking to recoup their money — and since patients tend to trust their doctors and not know much about the intricacies of health care device markets, they don’t ask too many questions when they’re left to pick up an enormous, generally non-itemized tab at the end of a hospital stay that gives them no information about why they’re being charged what they are. Thus, price gouging and a general lack of perfect information in health care allows expensive consumption to continue unchecked.
2. “Newer” health care technology doesn’t always mean “better” health care technology.
Back before the initial explosion of health care technological innovation in the early 1900s, Americans didn’t really need to purchase health insurance because care was generally an affordable commodity that could be procured through bartering or just paying cash. The onset of more complex treatment methods pushed care prices higher while improving health outcomes — but only to an extent. A major drawback to a world in which technology increasingly reigns supreme is the tendency to assume that all new, flashy technologies improve efficiency and outcomes. As the various mishaps surrounding the daVinci surgical unit show, this simply isn’t true. In fact, a February study of daVinci’s use in hysterectomies concluded that the machine did no better than conventional surgeries while raising prices by over 30 percent.
This isn’t to say that health care technology can’t be a boon — it just depends on what that technology is being applied to. For instance, one study found that “the benefits due to additional life expectancy resulting from treatments for heart attacks, cardiovascular disease, and low birth weight infants is greater than the increase in costs” and “that improved treatments for cataracts and for depression have improved quality of treatment at no additional cost, and have resulted in expansion of treatment to additional people, with benefits greater than costs.” By contrast, “spectacularly pricey procedures, like proton beam therapy for prostate cancer… have no demonstrated benefits over lower-tech alternatives.” Put another way: you can use a $400 printer to print black-and-white text on plain paper — but you won’t get anything more out of it than if you’d just used a $40 printer, instead.
3. Device manufacturers and doctors both have incentives to cheat the system — and they do.
Another shortcoming of rapidly progressing health care tech innovation is the relatively low scrutiny that some products undergo due to FDA regulatory loopholes. For instance, the Times explains that daVinci was pushed into the market through the process of “premarket notification,” which allows products that manufacturers claim to be similar to other devices already on the market to bypass rigorous safety trials. Sales teams from Intuitive then pushed the daVinci systems into providers’ hands by aggressively pursuing their business, assuring doctors that they were experts on the new robotic surgical techniques and that such techniques were preferable to more “old school” practices like laparoscopic surgeries. Emails between Intuitive employees show that the company went so far as to reduce mandatory safety training requirements for surgeons using daVinci in order to drive sales.
It’s not difficult to figure out why biotech companies such as Intuitive engage in such shoddy marketing practices that drive up costs while not improving patient health — but why do doctors and providers follow suit with them? The answer, unfortunately, is much the same for both industries: money. Social insurance programs such as Medicare offer robust reimbursements for procedures on a fee-for-service basis — i.e., the more expensive tests and procedures that a provider conducts, the more it is reimbursed by insurance. That propagates a culture in which doctors “self-refer” their patients for unnecessary testing and “upcode” the cost of their Medicare patients’ services in order to return a profit. Ironically, there is also early evidence that one technology that is supposed to curb health care costs and is encouraged by Obamacare — electronic medical records — may actually have the unintended consequence of making it easier for doctors to engage in fraudulent practices.
None of these problems will necessarily proceed in perpetuity. Efforts to shift American health care away from a fee-for-service “sick care” system towards one that relies more on preventative care and prospective, bundled payments could go a long way towards reversing the existing culture. But in the meantime, Americans may do well to approach robot doctors and other flashy medical innovations with several grains of salt.