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Treating heart disease

The Affordable Care Act recently upheld by the Supreme Court extends health care coverage to over 30 million uninsured Americans, but it actually does very little to make health care affordable. Since 1970, health care spending has grown 9.8% annually, more than twice the rate of inflation. Medical costs now consume 17.3% of our gross domestic product. That’s $8,086 for every American or about twice as much per capita as most developed countries spend. Although we pay more for medical care than any other country, America currently ranks 19th in the world in preventable death, 26th in life expectancy, and 31st in infant mortality.

Our more-is-better approach to health care is not only failing to make us healthier, it’s threatening to bankrupt the nation. If medical costs continue to skyrocket, American industry will become increasingly uncompetitive; the government will run up increasing deficits as it struggles to fund Medicare, Medicaid, and the new subsidies that are part of the Affordable Care Act; and millions of Americans will delay or forego necessary care because out-of-pocket medical costs will become unaffordable.

The trillion-dollar question is how can we reduce unnecessary medical spending so that we can afford to provide affordable, high quality health care to all Americans? A number of recent studies estimate that a third of all health care spending is unnecessary and that if we could eliminate wasteful spending, we could save over 800 billion dollars a year. Since every dollar of so-called unnecessary spending is a dollar of income to a health care provider, reigning in health care spending is much more easily said than done. We examine this pressing medical, ethical, and financial challenge by examining the way we treat America’s number one killer, heart disease.

Patient Profiles:

Jimmy Ku is experiencing shortness of breath, and because of a family history of coronary artery disease, he meets with Dr. David Tobis, an interventional cardiologist at UCLA Medical Center. The patient is presented with two options: watchful waiting with drug therapy or cardiac catheterization to better diagnose any possible blockages in his coronary arteries. Worried about his symptoms, Mr. Ku chooses catheterization, and the procedure reveals that his arteries are all clear with no signs of any significant blockages.

John George, a patient of Dr. Revenaugh at Intermountain Medical Center, has an angiogram revealing significant narrowings in his coronary arteries. While he was on the table, he has to forcefully persuade his cardiologist not to insert stents to open up his blocked arteries. The procedure would require Mr. George to take blood thinners for the rest of his life, and because of his history of internal bleeding, he was eager to explore alternatives. Dr. Revenaugh orders a nuclear stress test, which reveals that Mr. George has good blood profusion under stress, and that no invasive intervention is appropriate. Instead, Mr. George continues medical therapy with statins.

Jerry McKibben is on a ski vacation in Park City, Utah, when he has a massive heart attack. His wife performs life-saving CPR, and the EMT crew is able to shock his heart back into a normal rhythm when they arrive on the scene. Mr. McKibben is rushed to Intermountain Medical Center, where interventional cardiologist, Dr. Edward Miner performs a cardiac catheterization, which shows two major blockages in his coronary arteries. Although Dr. Miner feels he could have easily inserted stents to open up blood flow to the heart, he wants to give Mr. McKibben the choice between a stenting procedure and coronary artery bypass graft surgery (CABG). In light of his problem with previous internal bleeding, Mr. McKibben is worried about the risks of taking blood thinners if he opts for stenting. He decides to undergo bypass surgery, and we film his operation, recovery, and ultimate discharge.