Improve U.S. Medicine and Spare Our Children’s Necks and Futures

Critical care came about because of resort to tracheotomies in 1952. Now, children are unnecessarily getting tracheotomies because of critical care. Tens of thousands of, very often, unnecessary tracheostomy tubes are put through the necks of children and older people who don’t want them and never need them for only being too weak to breathe [1-5]. This is instead of using more humane and affordable noninvasive methods and extubating children to them when necessary. Preventing invasive airway tubes potentially saves over $500,000 per person per year in nursing costs alone with potential to save many billions nationwide. This is only a small part of what is possible. Unfortunately, the system is such that there is little incentive for anyone, but the patient, to keep people healthy and necks to stay free from invasive tubes. That is not the case elsewhere since our papers and books are translated into Spanish, Japanese, and French [6]. There is less money to waste in South and Central America where there are centres that also spare necks from invasive tubes. Why shouldn’t the U.S. have a medical system that costs the federal government 1 or 2% of GDP, as it does in some other countries where people live 5 years longer with medical systems rated by the WHO in the top 10, as opposed to ours rated 37th. It seems that no one in Washington is interested in potentially saving a few trillion dollars per year, as would occur if we gradually modified our system in favor of accountability and responsibility for all concerned, as elsewhere [7].

The U.S. medical system is bankrupting our children’s futures and unnecessarily harming quality of life. We are now paying over $1 trillion of our 4 trillion income tax dollars for only interest on the current federal debt of over $36 trillion and this is now increasing by almost $2 trillion per year. The question is not if we will default on our federal loans but when. And, this is only the beginning, because with new drugs regularly being approved by the FDA and costing 2 to 4.3 million dollars for single injections, and with half the country overweight, diabetic, or pre-diabetic and demanding $1000 per month medications to lose weight, medical costs are now said to be tripling as if $5 trillion per year isn’t bad enough! One injection for metachromatic leukodystrophy, for example, is $4.25 million, for Elevedys for a single muscular dystrophy $3 million, and such expensive drugs continue to be regularly approved by the FDA. United Health Care is already declaring bankruptcy because it cannot keep up with expenses despite its premiums increasing by over 20% per year. Literally, all 170 million American tax payers have to pay $260 per year for 1 in 40,000 to receive one injection for metachromatic leukodystrophy, $600 per year for 1 in 10,000 with a single muscular dystrophy to receive 1 injection, and there are many other drugs being prescribed for the latter condition also costing hundreds of thousands of dollars per year. None of these injections cure disease and most only slightly slow down their progression. There are now medical conditions where people receive 3 or more million dollar plus medications. Ancient Chinese proverb, “If you continue in the direction you are headed, you will end up there.” That is bankrupcy.

In my opinion, the only way to avoid default, and to put us in the black by up to $2 trillion per year is to stop living beyond our means, and, especially, to revamp our medical system by principles gleaned from others that are better. We can either explain this to Washington how to do this now, or they will be able to read about it in an upcoming book, possibly after the default. We can only “make America great again” by returning to accountability and responsibility in our medical system and otherwise for our children’s present and futures.

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1. Bach JR (2017) Noninvasive respiratory management of patients with neuromuscular disease. Ann Rehabil Med 41(4): 519-538.
2. Bach JR, Gonçalves MR, Hamdani I, Winck JC (2010) Extubation of unweanable patients with neuromuscular weakness: a new management paradigm. Chest 137(5): 1033-1039.
3. Bach JR, Sinquee D, Saporito LR, Botticello AL (2015) Efficacy of mechanical insufflation-exsufflation in extubating unweanable subjects with restrictive pulmonary disorders. Respir Care 60(4): 477-483.
4. Bach JR, Tran J, Durante S (2015) Cost and physician effort analysis of invasive vs. noninvasive respiratory management of Duchenne muscular dystrophy. Am J Phys Med Rehabil 94(6): 474-482.
5. Bach JR, Gonçalves MR (2023) Compendium of Interventions for the Noninvasive Management of Ventilatory Pump Failure: for Neuromuscular Diseases, Spinal Cord Injury, Morbid Obesity, and Critical Care Neuromyopathies. Second Issue, Lightning Press pp. 706.
6. Bach JR, Gonçalves MR (2023) Compendio de Intervenciones para el Manejo No Invasivo del Fallo Ventilatorio Para Enfermedades Neuromusculares, Lesiones de la Médula Espinal, Obesidad Mórbida, Deformidad de la Pared Torácica, Neuromiopatía de Cuidados Críticos, y Otros Trastornos Neurológicos y Pulmonares. Prado Atlagic FD, Heurta A 2023: 1-796.
7. Bach JR, DeLisa JD (2014) An alternative view on medical care delivery: a commentary. Am J Phys Med Rehabil 93(12): 1095-1099.