Tuesday, November 13, 2007

Clinical Innovation, universal coverage - Can Innovation and Universal Coverage Co-Exist?

Innovation is the U.S. health system’s prime asset, and government-controlled universal coverage may threaten it.

That being the case, I was surprised to find unexpected support for my thesis from a Nov. 12 article in the The New Republic, a liberal publication that’s usually a staunch proponent of government controlled universal coverage.

The writer, Jonathon Cohn, in a Nov. 12 piece, “Creative Destruction: The Best Case against Universal Health Care,” cites the case of Michael Kingsley, former New Republic editor. Kingsley has Parkinson’s disease. It improved in 2006 after he received a new innovative treatment, Deep Brain Stimulation, at the Cleveland Clinic.

In his 4000 word essay, Cohn uses the word “innovation” 33 times. Here are a few things Cohn has to say.

“The United States is famously the world leader in medical innovation-- in part, it would seem, because we spend like a drunken sailor when it comes to medical care.”

“Maybe the trade-offs between covering everybody and fostering innovative health care is inevitable--and perhaps innovation has to come second.”

“Innovation ultimately benefits everybody by pushing the boundaries of the medically possible. Can we really count on a universal coverage system to weigh all of that? In other words, can we really be sure that universal health care won't come at the expense of innovative medicine?”

· “In a universal coverage system, the government would seek to limit spending by forcing down payments to doctors and pharmaceutical companies, while scrutinizing treatments for cost-effectiveness. This, in turn, would lead to both less innovation and less access to the innovation that already exists. And the public would end up losing out, because, as Tyler Cowen wrote last year in The New York Times, ‘the American health care system, high expenditures and all, is driving innovation for the entire world.’ "

· “Most economists would concede that it's possible a universal system could stifle innovation by pushing too hard on prices or applying the wrong kind of scrutiny to medical treatments.”

· “The forces that produce innovation in medicine turn out to be a great deal more complicated than critics of universal coverage seem to grasp. Ultimately, whether innovation would continue to thrive under universal health care depends entirely on what kind of system we create and how well we run it. In fact, it's quite possible that universal coverage could lead to better innovation.”

· “Computed Tomography (CT)--which a survey of internal medicine doctors recently ranked the top medical innovation in recent history--owes its existence to basic scientific discoveries about physics. But it's the steady involvement of companies like General Electric, which have poured untold sums into research and development of CT scanners that produced the technology we have today--and will produce even better technology tomorrow.”

Ultimately, of course, The New Republic being a liberal publication, Cohn comes down on the side of centralized systems controlling innovation.

· “The government, by contrast, has plenty of incentive to prioritize these sorts of investments. And, in more centralized systems, it can do just that. Several European countries are way ahead of us when it comes to establishing electronic medical records. It's the single easiest way to prevent medication errors--a true innovation. Thousands of Americans die because of such errors every year, yet the private sector has neither the will nor, really, the way to fix this problem.”

· “Another virtue of more centralized health care is its ability to generate savings by reducing administrative waste. A universal coverage system that significantly streamlined billing (either by creating one common form or simply replacing basic insurance with one, Medicare-like program) and cut down on the need for so many insurance middle-men would leave more resources for actual medical care--and real medical innovation.”

· “You don't have to choose between universal access and innovation. It's possible to have both-- as long as you do it right. “

That’s possible, but improbable. Centralized health care technological assessment and innovative development has never worked across the health care spectrum.

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