Jun 14 2009

Medical Miracles are not a civil right

Category: government,healthcareharmonicminer @ 9:23 am

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.