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Smart Bombs: Profit arteries still clear

News of former President George W. Bush’s stent procedure provides a jumping-off point to discuss a couple of health care issues.

The clogged artery was discovered during a routine examination, which included a stress test. That’s interesting on two fronts. First, it’s unusual to have an annual stress test, which entails walking on a treadmill as cardiac functions are monitored. Second, the practice of stenting when patients haven’t reported pain or any other signs of distress is controversial. Bush apparently had no symptoms.

I’m not presuming the former president received unnecessary care, but stenting is a medical practice that has been overused in the United States. Bush’s care should not be viewed as something all patients should expect.

More than 1 million stent procedures are performed each year, at a cost of $30,000 to $50,000 each. The problem is that standard drug treatment, which is much cheaper, works just as well, according to a review of controlled trials. The author of that analysis, Dr. David L. Brown, told the New York Times that more than half of patients get the stents before trying the drug therapy.

“In many hospitals, the cardiac service line generates 40 percent of the total hospital revenue, so there’s incredible pressure to do more procedures,” Brown said, adding, “When you put in a stent, everyone is happy – the hospital is making more money, the doctor is making more money – everybody is happier except the health care system as a whole, which is paying more money for no better results.”

Paying more money for no better results.

That would be an apt slogan for health care in the United States, where, according to the international Organization for Economic Cooperation and Development, we spent $8,238 per person on medical costs in 2012, compared to the next highest-spending country, Norway, at $5,388 per person. To add insult, we get no better outcomes across a range of key indicators.

Studies show that as much as one-third of medical care is unnecessary, and the needed care we do receive is poorly coordinated, which squanders about 30 percent of that spending, according to the Institutes of Medicine.

I’d go on, but I feel my blood pressure rising.

Diminishing Returns. Say, didn’t you used to be the Internal Revenue Service scandal? You know, the biggest bombshell to hit the nation’s capital since Watergate?

Wall Street Journal columnist Peggy Noonan wrote a scathing column on it in May titled “This Is No Ordinary Scandal.” Sure isn’t. If it were, it would dominate the headlines with new developments exposing a deeply rooted executive branch. Maybe it died off as Congress geared up for its five-week vacation. That would make sense since the House of Representatives was its sole source of fertilizer.

Noonan and others have already placed IRS-gate ahead of Iran-Contra, Clinton’s impeachment and even Benghazi, which is a really high bar in conservative circles. If so, it truly is no ordinary scandal.

Trail rage. My son is learning to drive, and I’m trying to explain the reality that otherwise reasonable people can turn into spittle-spewing maniacs when they get behind the wheel. His father excepted.

Was it like this with horses? Did riders flip each other off? Did they trample pedestrians? Did the horses have rump stickers (“If you can read this, you’re trotting too close”)? Were these lines heard:

“Where’d you get your license? The Last Chance Saloon?”

“Mr. Fancypants took the whole railing when he tied up his Appaloosa!”

“Turn signal would’ve been nice!”

“A Pinto? Really?”

“Was that pony made in America?”

“Hey, your blinkers are on!”

Associate Editor Gary Crooks can be reached at or (509) 459-5026. Follow him on Twitter @GaryCrooks.