Allow me to riff on a point that Jim Pinkerton made in a recent blog post on Medicare, that the parties are competing to accuse each other of being the ones to "betray" Medicare through cuts.
Jim has made the point elsewhere, as have I (here), that you can't cut your way out of the large fiscal cliff that we're facing as an aging population demands more health care, becomes more prone to devastating diseases like Alzheimer's, and becomes eligible for expensive nursing home care.
Is there any way out? The President's strategy is to adopt across the board Medicare cuts and then leverage them through expert advisory panels like the Independent Payment Advisory Board, which will strong arm Congress to make yet more politically unppalatable cuts (we'll see how well that works in the long run).
Indeed, Medicare's own actuary expects that these cuts are unsustainable. The conservative strategy, which I support, is to move to more market-based arrangements, where seniors (and all Americans) choose among competing private insurance plans, with some protections for ensuring that everyone can afford at least basic coverage.
But this, by itself, won't save us from the tsunami of rising health care costs we've mentioned before. So what would? Jim suggests a "cure strategy" to conquer expensive and debilitating diseaeses - along the lines of a vaccine for polio or smallpox - which would be both popular and effective in terms of lowering costs. Jim writes that:
If either party, Republican or Democratic, were leading with a "Cure Strategy," as opposed to a "Cut Strategy," it's hard to see how they would be suffering at the polls as a result.
That is, who in America would have voted against the Democrats in 2010 if Dems had announced a crash effort to eliminate, say, Alzheimer's? Similarly, who would be voting against Republicans today if the GOP had made the same cure-Alzheimer's argument in 2012?
If the answer, in both cases, is "no one," then you have to wonder why neither party chose to advance that cure-first argument.
Thankfully, the private sector is already ahead of the politicos. Innovative companies are already harnessing "big data" to drive large improvements in how we diagnose, treat, and (eventually) even prevent disease. Take GNS Healthcare, profiled in this month's Burill Report
By applying artificial intelligence and increasingly sophisticated software algorithms, modern health data analytics companies like GNS are using integrated data sources, such as electronic health records and genomics data, to move beyond historical, retrospective reporting toward real-time, predictive analysis. It's an approach that is driving healthcare into a future in which data analytics will be utilized at every point of care...
The company's main product, its Reverse Engineering and Forward Simulation platform, uses a supercomputer-backed framework to automate the extraction of causal network models directly from observational data. It then uses high-throughput simulations to generate new insights about disease starting, in effect, with no hypothesis, just data.
The GNS strategy - along with many other companies exploring the same space - will push health care towards both towards more automation (which means lower labor costs as artificial intelligence helps streamline treatment and diagnosis of complex diseases) and towards more personalized treatments for patients (and more personalized treatments=fewer wasted treatments and better health outcomes).
So why not build a cures strategy to help this vision become a reality faster? Advancing this argument requires both political parties to go against their instincts.
Democrats would have to admit that private companies are the only entities that are nimble enough to actually implement a "cures strategy", and they're going to make an awful lot of money doing it (even though it will save lots of money in the long run and spur economic growth).
Republicans are used to touting market cures, but are somewhat less adept in articulating the case for the places where government can get things right: investments in basic research (NIH), getting the patent and intellectual property regimes correct, and serving as a "neutral ground" where all of the critical parties could come together to hash out the key issues involved (How do we handle patient privacy concerns? What to do about the inevtiable lawsuits? Etc.)
Finally, the companies working in this sector who have the biggest potential to blow up the status quo, the biotech and pharmaceutical companies, the innovative start ups like GNS, and non-traditional health care operators (like retail clinics) are relative political lightweights.
Legacy health care players like nursing homes, hospitals, and (to a lesser extent) doctors carry more votes and are often more organized (think: SEIU 1199). This translates into much greater ability to set the terms of the debate when Washington sits down to write legislation.
In short, the political inertia is enormous to argue about what the legacy players care about, i.e., what they're paid for operating in today's system. This leaves both parties fighting over reimbursement strategies and formulas (private insurance v. public, increasing taxes v. entitlement reform), rather than thinking about what's around the corner and how to get there.
To be fair, plenty of very smart people in government and the private sector are thinking and talking about the evolution of personalized medicine. It just hasn't bubbled up into our politics yet as a topline issue.
But we can help make it a topline issue. Ultimately, I think Jim's cure strategy would work very well with the kinds of consumer-driven and patient-driven strategies that conservatives traditionally embrace. It should appeal to Mainstreet as well as Wall Street, because the gains, in human and economic terms are mind boggling. Save grandmother from Alzheimer's, and save yourself and your kids along the way.
So we need to do a lot more talking about not just what's wrong with the current system, but how to build a future that will make our current obsessions obsolete. (The same way that curing polio left iron lung wards in hospitals obsolete.)
Last but not least, we should remember that our competitors - Singapore, China, and the EU, are scrambling to try and develop the same cures we are. If we don't invent the "cures strategy" here, someone else undoubtedly will. And while that will be just as good for global health, I think that the U.S. is positioned to do it much faster and more efficiently, and (all other things being equal) I'd prefer the U.S. to spearhead the strategy and reap the economic benefits.
Advancing medical innovation is a cure both for the diseases that afflict us and the economic woes that beset us. As a matter of political optics and strategy, it is a low-hanging fruit that remains stubbornly unplucked.
Jim, back to you.