Most Americans have lost track, if they ever knew, of the real history of medical care in the last two centuries. Indeed, therapies and drugs now available would seem utterly miraculous to any person of the early 20th century. But this pace of progress is not a given. Will the new health care initiative being pushed by the Obama administration spell The End of Medical Miracles?
Americans have, at best, a love-hate relationship with the life-sciences industry—the term for the sector of the economy that produces pharmaceuticals, biologics (like vaccines), and medical devices. These days, the mere mention of a pharmaceutical manufacturer seems to elicit gut-level hostility. Journalists, operating from a bias against industry that goes as far back as the work of Upton Sinclair in the early years of the 20th century, treat companies from AstraZeneca to Wyeth as rapacious factories billowing forth nothing but profit. At the same time, Americans are adamant about the need for access to the newest cures and therapies and expect new cures and therapies to emerge for their every ailment—all of which result from work done primarily by these very same companies whose profits make possible the research that allows for such breakthroughs.
So begins an article by Tevi Troy, deputy secretary of the United States Department of Health and Human Services from 2007 to 2009. The last two paragraphs of the article:
We forget the power of the single-celled organism. For most of man’s existence on earth, the power of a single-celled animal to snuff out life was an accepted—and tragic—way of the world. Human beings could be wiped out in vast communicable plagues or simple through ingesting food or water. In the last century, the advent of the antibiotic has changed all that. For millennia, the only cure for an infection in humans was hope. Today, antibiotic use is so common that public health officials struggle to get people not to overuse antibiotics and thereby diminish their effectiveness.
Just as there is potential danger from the way in which Americans take the power of the antibiotic for granted, so, too, one of the greatest threats to our health and continued welfare is that Americans in the present day, and particularly their leaders, are taking for granted the power, potency, and progress flowing from life-saving medical innovations. And in so doing, they may unknowingly prevent the kind of advance that could contribute as vitally to the welfare of the 21st century as the discovery of the antibiotic altered the course of human history for the better in the century just concluded.
Tevi Troy’s complete article is must reading for anyone who would understand how we got where we are with pharmaceutical costs and the price of medical innovation.
At its most basic level, health care is not a civil right, any more than food, clothing, shelter, or for that matter, automobiles, cell phones, internet access, or lattes. Food and shelter are THE most basic human physical needs. We have a safety net for the poor, but we do not try to provide caviar and mansions, or even a balanced diet and permanent digs. What those on public assistance get is pretty basic (or it should be), and is normally a no frills operation (though disturbing numbers of them wear better clothes than I do). Similarly, it may be reasonable to have a safety net of very basic health care for the poor (though a very large percentage of the “uninsured” are not “poor,” and have simply chosen to spend their money other ways). That safety net should not include high cost drugs and medical procedures that were not even available to the richest people in the world 50 years ago. At the same time, the poor of today, being given a very basic standard of health care, would be getting the equivalent of medical miracles to the richest person on earth in the year 1930.
The simplest way to characterize this: medical miracles are not a civil right. Many of the most expensive health care developments of the last half-century qualify as “medical miracles.” Just as it’s unreasonable to provide a public guarantee that everyone will drive the same car, eat the same food, wear similar clothing, have similar vacations, and all the rest, it’s completely unreasonable to try to approach “egalitarian” health care. Quite simply, it has never worked anywhere. What makes us think it can work here?
For those who ARE interested in even more medical miracles, fair warning is given. The reason that about 90% of the medical miracles of the last half-century have been developed in the USA is because we have had largely private health care (admittedly with lots of government interference, most of which has not helped). If the USA goes the way of most European nations, or Canada, or Australia, we can kiss that entrepreneurial energy goodbye, as the article referenced above makes very clear.
The very sad thing: even if the modern “miracle” standard becomes the common standard for everyone, if progress in medicine is largely stifled, or simply greatly slowed, it is likely that a great many more people will die in the future of things that COULD have been prevented, if we’d continued at today’s pace of research and innovation.
And they won’t even know that the cause of their suffering or death could have been preventable.
September 15th, 2009 9:25 pm
I agree that progress and research is driven by funding, and that the superiority in quality of American health care is largely due to the fact that it has been in the private sector until now. However, why is health care, in and of itself, not a public service that the government should provide? What differentiates health care from our systems of transportation, mail, schools, and having clean air?
September 15th, 2009 10:47 pm
Well, one by one:
The post office is a failure. It’s losing money by the zillions every year. And it has a protected monopoly status, i.e., UPS and Fedex can deliver overnight and packages, but they cannot simply deliver basic mail. They are not allowed to compete with the government postal system. It shows.
Our schools, by and large, with a few exceptions, are failing. They are, literally, worse every year in most places. At the same time, up until recent economic travails forced some budget cuts, the schools were costing MORE each year, almost everywhere, for a constantly worsening product.
The government does not “provide clean air.” God did that… except for the occasional sand storm, volcano, tornado, hurricane, not to mention allergens and lightning caused forest fires… but I digress. The government does regulate emissions for some industries and technologies. This comes under the heading of ameliorating “externalized costs,” i.e., costs born by other people (those breathing dirty air, for example) due to the economic activities of others (industries, drivers, etc.). But this is an action to stop certain people from doing things that will harm others. It is not the “provision” of anything except protection of the public from activities that harm the public, in some sense not fundamentally different than laws regarding theft, vandalism, fraud, etc.
Transportation is a really interesting situation. We have four basic transportation systems in the USA. Roads, trains, planes and boats (rivers). I’ve written elsewhere about the forms of “socialism” that seem relatively non-controversial, including roads.
It’s worth noting that trains are losing money left and right, even WITH government subsidies, because they are inefficient methods of transportation in the modern world, mostly, with occasional exceptions. Planes and boats are privately owned and operated.
So the only transportation system that actually works OK (sort of) and involves the government is roads. But this is under the heading of a public commodity/accomodation, not a privately consumed product or service (like medical care, groceries and auto repair). That is, if I drive into town tonight to shop, or if I don’t, it really doesn’t matter much to anyone else, does not cost much of anything for anyone else (I have to buy the gas), etc. If I drive ten times as much as anyone else, it hardly matters, though truckers who drive all day long for most of the year pay higher road use taxes/fees, because their vehicles are harder on the roads, and they use them so much. But mostly, it simply doesn’t matter to anyone else, economically, whether or not I get in the car and drive around the USA all year long.
Medical care, on the other hand, immediately incurs costs for every decision to consume medical services that is made. If government simply “provides it”, there is no reason for ANY consume to moderate their consumption of it, and inevitably costs go up, shortages happen, etc…. Imagine if the government provided free Alaskan King Crab in the stores. Would their be ANY left, most of the time? Would most people who might formerly have bought it with their own money even be able to FIND it anywhere? When something is “free” to the consumer, the consumer consumes without regard for cost, limited only by availability. That leads to shortages, long waits, and de facto denials of service, as the socialized medicine experience in Canada and Great Britain attests.
So the main point: your examples of things the government does are mostly things the government does badly, or they are things that simply are not analogous to the provision of medical care.