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Medical Innovations Can Come At A Cost


This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel. As we've been hearing in this half hour, the U.S. health care economy is huge and complex: one job in eight, 17 percent of gross domestic product, $2.7 trillion.

It's also dynamic. Back in the 1940s when health insurance became a common fringe benefit of employment to beat the war time wage freeze, here are some things that a doctor could not do for you: give you a new hip, knee, kidney or heart, take a three-dimensional picture of what's happening inside your body, prescribe a drug to control your cholesterol or cure you of cancer.

There's been a consequence for all that progress, though. The quick embrace of innovation has driven up the prices that hospitals charge insurance companies who, in turn, raise premiums for the rest of us.

And not every innovation is equally efficacious. Sarah Varney of member station KQED in San Francisco tells us about one gizmo, a robotic surgeon, which has become commonplace.

SARAH VARNEY, BYLINE: The operating room at the UCSF/Mount Zion Medical Center in San Francisco looks like a video arcade plunked down in a NASA control center.

DR. KIRSTEN GREENE: This is OR 11. It's the robot OR.

VARNEY: Dr. Kirsten Greene, a urologist, introduces me to a much loved member of her surgical team.

GREENE: This is the robot right here. You can see it's the da Vinci (unintelligible) four-arm robot, which just means if you count the number of arms, there's actually four of them and that's the dual console system over here, so if you come over this way...

VARNEY: The console where the surgeon controls the robot is some 10 feet away from the operating table.

GREENE: I know this kind of looks like old 1980s video game consoles, but it's actually fairly high tech.

VARNEY: Greene leans over and looks into a set of black goggles. During, say, a prostate operation, the goggles give her a 3D view inside her patient. She controls the robot's camera and four arms using little joysticks and foot pedals.

Unlike manufacturing plants that often replace humans with robots, in the operating room, robots have become an extra set of hands, really expensive hands. Surgical robots can cost up to $2 million, plus pricey maintenance fees. Dr. Greene says the robot is worth it.

GREENE: I think it's great for patients. It's minimally invasive. It's less blood loss. It's faster recovery. Cosmetically, it's nicer, if people are concerned about that.

VARNEY: Surgical robots became widely popular about five years ago, mostly because surgeons like Dr. Greene loved using them and touted their benefits, but after researchers studied thousands of robotic surgeries, it turns out that, but for a few exceptions, surgery outcomes weren't any better and patients' recovery time wasn't any shorter.

Still, that wasn't enough to stop hospitals from engaging in a really expensive game of keeping up with the Joneses.

GREENE: If you don't have it, I think it would be a really big problem, but I think everyone just assumes you have it because why wouldn't you? You know, it's like having blood or beds or lights in your OR now. You have to have a robot.

VARNEY: In the San Francisco Bay area alone, there are at least 20 of these robots. At about $2 million a pop, that's $40 million. But insurers typically won't pay more for a robotic surgery or for the newest kind of MRI or CAT scan. So, instead, hospitals recoup their costs by charging insurance companies more for everything and that's how you get a $20 aspirin and the world's highest health insurance costs.


VARNEY: This robot is the latest model. Dr. Greene says it's like driving a Ferrari compared to his predecessor dubbed the classic. The classic, she says - and she thinks of him as a guy - is like riding a lawnmower.

GREENE: We still use it, but it's kind of a rock, paper, scissors about who has to use the classic versus the new one.

VARNEY: And, like last year's iPhone, you can sometimes buy a used robot on the Web. For NPR News, I'm Sarah Varney. Transcript provided by NPR, Copyright NPR.

Sarah Varney