You Wouldn't Buy a Car Without a Warranty; How About a Hip?

Let's say I'm a car manufacturer, and a prospective customer is asking about what sort of warranty I'll be offering on my new XY7200. Here's my reply:

"The longevity of a vehicle depends on a great many factors beyond my control, including the driver's skill, the types of driving done, and the owner's adherence to break-in time restrictions and the regular maintenance schedule. Because of the multifactorial nature of the survival of a vehicle, no, we really can't offer any kind of warranty."

So... would you buy that spiffy new XY7200?

I didn't think so.

I wouldn't either.

Such a scenario could never play out in the big-ticket world of automobiles, or in the small-ticket world of appliances like toaster, TVs, and kitchen mixers.

But in orthopedic implants? Oh, yeah.

Today's New York Times has an excellent article by Barry Meier on how the "health system bears [the] cost of implants with no warranties."

The million or so artificial hips and knees implanted each year in the United States ... are normally not guaranteed. Instead, the costs of replacing implants that fail early because of design or mechanical problems -- devices that sell for as much as $15,000 each -- are largely paid by Medicare, insurance companies and patients.

Implants can fail for many reasons, but if only a small percentage of them fail prematurely because they are substandard, the costs to taxpayers, policyholders and patients can run into tens of millions of dollars each year, health care experts estimate.

Orthopedic producers may sometimes even profit from the failures because they sell the replacements at full price.

Anyone else see a problem with this picture? [Read the full article for, among other things, the comment by Zimmer Holdings on why they don't guarantee their products, which I only barely parodied above.]

There are serious financial concerns here -- at a time when everyone is arguing about how best to rein in healthcare costs, this seems like a good place to start -- but there are also serious ethical concerns.

The system, as currently constructed, actually provides incentives for building something badly. Why should I care if my products are substandard if I don't have to bear the cost? If, indeed, there is a financial incentive to do so? (Yes, I know, we'd like manufacturers to build good products because it's the right thing to do....)

To add insult to injury, accord to Meier's piece, at least one manufacturer does offer warranties on certain of its knee, hip, and shoulder implants (including a "free of charge replacement" if one fails) ... just in Great Britain, and not in the United States.