Americans should be deeply concerned about our “sick care” health care system. We wait for people to get seriously ill, then we apply emergency care. But we don’t provide the highest quality care in the early stages of illness for the average American. Instead, the system is designed to withhold the best drugs, medical devices, and operations until their health deteriorates, and then belatedly, emergency care is offered.
It is a senseless approach to clinical care that puts patients at risk. There is a much better alternative.
A truly patient-centered healthcare system would assess patients’ risk for heart attacks, diabetes and other serious conditions, and then devote resources to preventively reducing that risk while improving their quality of life. The current system, more actuarial than Hippocratic, limits access to health care in the name of short-term savings and ironically increases long-term spending.
Nowhere is this clearer than our approach to prescription drugs.
Politicians can get guaranteed applause by promising to reduce the cost of drugs. And this political drumbeat is reflected more and more in political efforts, whether it is the executive branch trying to tie the prices of medicines in our country to those in other countries that use government price controls, legislation. Congress that would give the federal government greater powers to control drug prices in the Medicare program, or greater reliance on institutions such as the Institute for Clinical and Economic Review (ICER) which assigns a financial value to a person’s life in determining whether to grant patients access to innovative treatments.
All of these efforts are focused on reducing dollars spent on prescription drugs, with hardly any attention given to the sole purpose of our health care system, which is to mitigate risk – keeping people out of hospitals, preventing them. to become disabled and avoid fools. early deaths.
What makes this crude approach to drug pricing so untenable is that we are living in a medical revolution. We read the book of life, the genomic codes, and translate them into life-saving therapies. Yet we have those who bemoan innovations and concoct ploys to deny average Americans access to groundbreaking medical interventions. They are so focused on managing financial risk that they devalue the cure for hepatitis C, our success in turning HIV / AIDS from a death sentence into a chronic disease, the decrease in annual cancer and cardiovascular deaths. , and increased life expectancy.
We must pursue a patient risk framework that will accelerate the delivery of breakthrough treatments to those who need them most. Healthcare providers should use data analysis and clinical assessments to assess the risk to the health of each patient and devote the medical resources necessary to reduce that risk.
Just consider how this would change our approach to a disease like diabetes, which is particularly prevalent in minority communities. More than 16% of blacks and almost 15% of Hispanics live with the disease, compared to less than 12% of whites. In total, it cost our country more than $ 237 billion in direct medical costs in 2017. Of that amount, about $ 15 billion was spent on insulin, which helps patients control disease and lead a life. relatively normal.
A true health care system would screen regularly for about one in three Americans who have prediabetes – and make it easier for patients to access medication.
Instead, our current health care system forces patients with diabetes to pay a hefty share of insulin costs out of pocket. Many cannot afford it. Over 13% of diabetic patients skipped medications or failed to fill their prescriptions due to cost issues.
As a result, they often suffer from the worst complications. Lower limb amputations – which about 70,000 Americans with uncontrolled diabetes need each year – cost about $ 70,000 each.
In other words, we spend about $ 5 billion chopping off people’s feet and toes. It doesn’t start counting expenses associated with other complications, from kidney disease to blindness.
The old adage, “an ounce of prevention is better than a cure”, is really true. According to the CDC, “Effective blood sugar management can reduce the risk of eye, kidney and nerve disease. [resulting from uncontrolled diabetes] by 40 percent.
If we don’t do more to predict patient health risks and improve outcomes, then the trillions we invest in transportation, housing, energy, education, environment and food have limited value. In an age when historic advances are being made in the treatment of diseases, from cancer to Alzheimer’s disease, it makes little sense to focus solely on reducing drug costs rather than on a holistic view of health spending.
Simply put, the political imperative to reduce drug costs goes beyond the broader goal of improving and extending life. Isn’t it time to get it right?