“The dirty little secret of public health finance is that cigarettes are a very cost-effective killer. Living longer is great for society but a disaster for government programs.”
“If just a few of the promised technologies come on line, then Medicare and the entire society could face substantially increased health-care spending. We need to worry not only about the demographic risk [posed by the aging of the baby boomers], but also the risk of developing new technologies that appear to break the bank.”
“That's true even for people with chronic illnesses like asthma, diabetes and heart conditions. When people have to pay more, they are less likely to adhere to their regimen.”
“[Another question is how to change incentives for developing the technologies in the first place.] In the automotive and consumer-electronics industries, there are incentives to develop good, cheap DVD players or good, cheap cars, ... When it comes to medical technology, there is no incentive to develop something that's pretty good but less expensive because the people who are buying it don't pay for it. It's not surprising that everyone wants a Cadillac instead of a Hyundai.”
“[One important question is who would use the technology.] How do we make sure that we get the technology in the hands of the patient for whom it's most valuable? ... The general story for all of these things is they get really expensive when you start doing them for large swaths of the patient population.”
