NINETEEN
Calculating the Impact
What is the impact of the implant revolution? Comprehending the reach of
medical devices in our world requires a full accounting of the costs, a
consideration of the number of operations, and a tabulation of the total
number of devices implanted every year.
Turn on a televised political debate and you will hear about the
“massively inefficient” US medical system, so described because of its
“runaway expenses.” This focus on costs is critical, especially because
Medicare spending is part of the enormous direct, or mandatory, spending
that is considered an entitlement for US citizens. The US government
spent $692 billion of our dollars on Medicare in 2016, which was a 9
percent increase over 2015.^1
Importantly, “inefficient” can be different than “costly.” Do we decry
the costs associated with building (and rebuilding) municipal airports
because modern jet airplanes need longer runways? Do we complain about
the new costs of visually stunning LED flat panel televisions in relation to
our grandparents’ radios? Of course, we all complain about the
expenditures in our public and private lives, but we gladly pay for home
Wi-Fi, smartphones, and drive-through coffee shops—modern
conveniences we can’t imagine living without.
The real question is, how much are we willing to pay for healthcare? As
was outlined in chapter 12, no member of Congress could have possibly
guessed what was brewing in the minds of scientists and physicians in
- In 1967, the first full year of Medicare and Medicaid
implementation, total federal spending on Health Services and supplies
was less than $10 billion, with $5.5 billion allocated on hospital care^2
($38.4 billion in 2015 dollars).^3 Who could have dreamed that annual