Amidst All The Political Tumult Over "Health Insurance Policy"--Let's Keep Our Eye on the True Bottom Line: Better Health Outcom
Posted Aug 28 2009 8:06pm
Yes, it's the doldrum-y middle of August, but this is a great season for political junkies. But for those with real illnesses, or who worry about real illness and incapacitation, there's little news to be interested in--other than the usual grim news about the new deaths from swine flu and the hoped-for progress toward a swine flu vaccine, or the threat of new strains of HIV. That's where the real action is.--or, as we shall see, is not.
But from a strictly Serious Medicine Strategy point of view, none of this matters too much. To borrow some computer programming lingo, the current political battle is a battle over "inputs" and "throughputs." That is, how much money do we spend in the name of health care (inputs), and how is it spent (throughputs)? So the whole debate over "the public option" is a long debate over throughputs. By contrast, Serious Medicine is about outputs--outcomes. Do people get better? Can they live better and longer?
Serious Medicine is about waging war on Serious Illness. As in, nuking diseases, the way that we nuked tuberculosis, or polio, or smallpox--or, for the most part, AIDS. Medical triumph over those illnesses made life immeasurably better, and longer, for billions of people. (And so it's a shame that we have backslid so much on TB in recent years, and it's an open question what will happen with AIDS, here and worldwide.) Such medical victories require Serious Resources: money, talent, regulatory streamlining, leadership, and a general sense of mobilization. That's how you win a war.
But a look at the budget of the National Institutes of Health tells a tale of Serious Medicine demobilization. During the latter years of the Clinton administration, and through most of the Bush 43 administration, the NIH budget more than doubled. But funding growth notably slowed starting in 2006, and the the Obama administration's 2010 budget continues that plateau-ing trend. President Obama managed to raise overall federal spending by about 25 percent in just his first year, but NIH spending is due to rise less than 2 percent. To put these numbers another way, in the six years from 1998 to 2003, NIH funding went up 99 percent. But in the seven years of 2004 to 2010, spending will have risen just 12 percent.
What's going on here? Some, such as Betsy McCaughey argue that the Obama administration is showing its egalitarian impulses here. That is, if the diagnosis of top Obamans, such as Peter Orszag and David Blumenthal, is that health care is too expensive overall, well, one way to reduce the growth of spending is reduce the rate of medical advancement. Hence, keep the NIH under control. Is that an unfair explanation of Obama budget priorities? Who has a better one?
Now of course, some will argue that NIH spending is just another kind of government spending, and that as such, it is mostly wasted. This is a purist argument that most Americans reject--there is a good enough connection between "input" and "output." And so the burden is on the purists to identify another, better, way to move resources into the Serious Medicine sector. But let's never be complacent: If there's a better way to run and fund the NIH, or something different altogether, let's have a debate. If there's a need to look at the FDA and the overall regulatory climate, let's do that, too.
And there's an opportunity here, too, for politicians. Why do all our leaders want to argue about throughputs? Why can't they argue about outputs?
Making our lives longer and better. That's a real bottom line, and we should lose sight of it, even in August.