When it came to the economics of health care, the message heard from the big shots in the field couldn't have been more blunt. America spends more on health care than any other country in the world but the pay-off is marginal - its citizens don't live any longer than people in Canada or Britain.
"We're not getting extra value for the extra money we spend," said Stuart Altman, an economics professor and specialist in national health policy at Brandeis University. "We are out of balance. We spend money on research and education that is very questionable."
It was another sobering night at the Martha's Vineyard Hebrew Center Summer Institute. The facts as laid out on a big screen in the main hall were staggering.
The uninsured in this country now number 44 million. America spends 14 per cent of its gross domestic product (GDP) on health care. That's a big slice of the pie, at least 50 per cent more than any other nation. And there seems to be no end in sight for the runaway spending.
"It's the one Olympic event we always win," said Mr. Altman.
Costs are skyrocketing, panelists pointed out, thanks to a variety of factors. Emergency rooms are flooded with people, according to Mr. Altman. But that's just one part of the problem. James Mongan, president of Massachusetts General Hospital, painted the rest of the gloomy picture.
Labor shortages in the nursing field, for example, are fueling higher wages. Physicians are hiking up fees, and more are opting for high-profit specialties and turning away from the less lucrative family practice model.
Besides inflation and the simple fact that America has an aging population, the single biggest factor driving the cost of health care is technology, according to Dr. Mongan, who uses the word technology to include prescription drugs and new medical hardware and procedures.
"CAT scans and MRIs never existed 20 years ago, but they're now commonly used and quite expensive," said the hospital president.
And the implantable defibrillator inside Vice President Dick Cheney's chest is now a popular item, its usage having quadrupled in the last few years. Dr. Mongan also pointed to the increased use of intensive care units while questioning whether the cost of such technology really equals the benefit to the patient.
"The odds of an 88-year-old grandmother being admitted to an ICU are greater here than in Canada, France or Germany," he said.
Dr. Mongan's assessment was clearly disconcerting. Shouldn't technology drive down costs while also improving quality as it has in most every other public and private arena, one man asked?
The response to the question illustrated the complexity of health care which seems to resist simple logic.
"CAT scans are cheaper now than before, but there's a utilization impact. Now we have 10 CAT scans instread of one," said Dr. Mongan. Plus, he added, medical technology "is not a curative," but rather a tool that sustains a condition or a patient.
"There are no crisp results," he said. "Just additional costs."
John Ferguson, the new chairman of the Martha's Vineyard Hospital and the president of Hackensack University Medical Center, said the growth in technology is largely market-driven.
"There's an increased demand for services," he said. "People with money are willing to pay for it."
Mr. Ferguson flashed the statistics from Hackensack. Billings for Lasik eye surgery went from $215,000 in 1997 to $1.3 million in 2001. Cosmetic surgery is another area of rapid growth.
"We don't call ourselves nonprofit. We're tax-exempt," he said. "We're projecting a $38 million profit this year. We sell quality."
One theme running through the evening was that America is a wealthy country, reluctant to give up access to wonder drugs and cutting-edge surgeries. But the inevitable consequence of unstoppable health care costs is that more of the burden is passed to the consumer.
Companies will shoulder less of the premiums and employees will be left with higher deductibles. More people will be uninsured, and hospitals won't be able to absorb the cost of providing free care.
"National health insurance will need to be discussed again," said Mr. Ferguson. "It could decide the next presidential race. It's that big an issue."
But Dr. Mongan was skeptical. Presidents Nixon, Carter and Clinton all tried to pass national health insurance plans, and they all failed. The reasons for failure, he said, are twofold.
The public lacks a clear understanding of the consequences, Dr. Mongan said. They don't see babies being born in the streets, but they don't understand that people with diabetes, hypertension and early stages of cancer are not receiving care.
"My own view is that if a nation can stand 44 million uninsured, why not 48 million? I don't see a clear tipping point with this issue," he said.
The other barrier, he said, is the prevailing anti-tax sentiment in the United States. "They want to cover the uninsured, but they don't want to pay for it," Dr. Mongan said.
He pointed to the recent Bush tax cut as a prime example. "The $1.6 trillion tax cut could have gone down another path," he said. "It could have been a $1 trillion cut with $600 billion set aside to cover the uninsured for a decade. But nobody in either party argued to go down that path."
No one disputed that grim analysis. But the panel moderator, Dr. Andrew Warshaw, chief of surgery at Mass General, tried to lighten the mood at the conclusion of the evening. "It's daunting to all of us, but we're trying very hard to take care of people," he said. "Don't go away thinking we've just given up."