July 26, 2010
Obama's Herd Health ProgramBy Heather McCauley
While the health care debate rages on, few seem to have noticed a functioning American health care system that has operated successfully for decades. Patients enjoy a spectrum of choices ranging from plain vanilla to cutting-edge. Practitioners openly discuss expected outcomes, complication rates, benefits, and costs ahead of time. Fees, established entirely by the marketplace, are reasonable enough so that everyone who truly seeks care can obtain it, and the lifespan and quality of life are excellent and improving every day. This system is veterinary medicine.
It is important to recognize the two major divisions of veterinary medicine.
In companion animal medicine, care is paid for with the pet owner's discretionary income. Owners -- the clients -- make decisions regarding the pet's care -- the patient -- based on finances, emotional attachment, and their personal philosophy about pets. For some, it's "just a dog," while for others, the family dog is considered a member of the family. More than a few spouses are careful not to probe too deeply about their own rank in comparison to a beloved pet.
Large animal medicine takes a different tack. These animals are used for industry -- food production, breeding farms, racing, and so on. (The lines are blurred in some cases, such as horses that are really pets, and greyhounds used for racing.) "The client" here is the manager, producer, or trainer, while the "patient" is the dairy herd, the swine operation, or the overall breeding potential of a winning stallion. While humane treatment is an important factor, the goals are maximizing performance, productivity, and profit. Large animal medicine focuses on designing a Herd Health Program, where the outcome of an individual case takes a backseat to the cost and benefit for the overall group.
An individual's value to the herd determines what level of treatment that individual receives. If Henrietta the Holstein has an infected udder, she might respond very nicely to some antibiotics...but if Henrietta is getting along in years, and perhaps her milk production isn't what it was, and now her milk will have to be discarded for several weeks due to the antibiotics it contains -- or, Heaven forbid, perhaps the worst has happened and she didn't manage to have a calf this year -- well, how to put it delicately? Henrietta is going to be culled.
Veterinary medicine has been quietly demonstrating how a mostly "pay-as-you-go," transparent, easily understood, and competitive free-market health care system works, and it works pretty well. You might protest that human medicine is different, more complicated, more expensive. True, and let's take a look at that for a moment.
A few years back, a consumer magazine ran a large piece questioning the cost of veterinary care, featuring a couple that spent $4,000 on chemotherapy for their dog. A far better question, had the reporter been doing a proper investigative job: Why did it cost only $4,000 for a chemo regimen that lasts a year? Further, what would a year's worth of chemotherapy for a Boxer-sized human with lymphoma cost? What accounts for the difference?
The drugs used are similar, and sometimes identical. The amounts may even be comparable (a large dog can easily be bigger than a small human), the doctors involved have similar years of training at similar (and in some cases, the very same) institutions, and many of the veterinary protocols have been borrowed from human medicine. Outcomes can be quite comparable when the difference in lifespan is taken into account. Yet the costs are light-years apart.
There are some obvious apples-to-oranges comparison problems that affect costs. For starters, most human patients would demand better sleeping accommodations than the average animal hospital provides. There is less sub-specialization -- a veterinary surgeon thinks nothing of doing an orthopedic procedure on a 175-pound Great Dane and a delicate esophageal repair on a 6-pound poodle in the same morning. Also, veterinary medicine has, for most of its history, been largely unnoticed by the malpractice and insurance industries.
Yet clients are often surprised by the availability of specialists in almost every area you might find in human medicine. There are veterinary dentists, surgeons, ophthalmologists, oncologists, dermatologists, radiologists, and cardiologists. Testing common in human medicine, such as MRI, CT, ultrasound, and endoscopy, are now common in veterinary hospitals. While the prices for this kind of care are not cheap, they are a fraction of their human medicine counterparts.
Veterinary medicine could prove to be a surprisingly informative model.
...Particularly if you happen to be an elderly dairy cow with declining milk production stuck in the upcoming Herd Health Program that is ObamaCare.
How to best spend the health care dollar? Well, if it's my dollar, I get to make the call. But if it's somebody else's dollar, I guess that person has the right to spend it on a more productive cow.
I'm pretty sure M.D.s do not think of their current patients as a lumbering herd of Holsteins, but you can bet the future health care decision-makers will. The "Herd Health" paradigm will become the new norm.
Oh, and were you feeling sorry for poor, dispensable, used-up Henrietta? Consider that it takes very, very few bulls to generate the replacements for a productive dairy, so she's still better off than Tom, Dick, and Harry. You don't want to hear what happened to them.
...Which makes this aging herd member feel a bit mooo-dy.
Heather McCauley is a doctor of veterinary medicine.