America has expensive health care but it also has the best health care. As the Federal government has discovered in trying to implement the Affordable Care Act, giving something away for free will not maintain that level of quality.

Instead, the future could be one where there are two classes of care - those with private insurance and those without. Higher treatment costs are already linked to better survival rates, according to a study by Yale School of Medicine researchers in the Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center at Yale School of Medicine and Yale Cancer Center.  
The authorss analyzed Medicare billing records of 9,708 women across the United States between the ages of 67 and 94, who were diagnosed with Stage II or Stage III breast cancer. The research team assessed trends in treatment costs and survival rates in two different eras: 1994 -1996 and 2004-2006. They found that over the course of a decade, Medicare costs for caring for women with Stage III breast cancer increased from $18,100 to about $32,600, while the five-year survival rate improved from 38.5% to 51.9%.

Although the costs of caring for women with stage II breast cancer also increased substantially by over 40% (from $12,300 to $17,400), the improvement in five-year survival was more modest (67.8 to 72.5%). 

"Our findings indicate that in some instances, newer and costlier approaches may be leading to improved outcomes in breast cancer patients," said senior author Cary P. Gross, M.D., professor of internal medicine at Yale and director of COPPER. "Now we need to tackle the harder questions about what we can afford to pay, and find out which treatments are effective for each patient.

"The cost increase was largely attributable to a substantial increase in the cost of chemotherapy and radiation therapy. Regardless of the mechanism, the pattern is clear: Higher costs of breast cancer care have been accompanied by improvements in survival." 

First author Aaron Feinstein, M.D., a resident in head and neck surgery at UCLA, said, "We view our findings as a glass half-full: survival is improving, although costs are rising substantially. We need research that can help us not only to develop new treatments, but to learn how to contain costs while we are advancing patient care." 

Published in  Health Affairs. Other authors on the study included COPPER Center researchers Jessica B. Long, Pamela R. Soulos, Xiaomei, Jeph Herrin, Kevin D. Frick, Anees B. Chagpar M.D., Harlan M. Krumholz M.D., James B. Yu M.D., and Joseph S. Ross M.D.  The study was funded in part by the Yale Office of Student Research.