Signposts That the Health Care Debate Is Shifting

The drumbeat of bad news for Big Pharma continues. First, a federal appeals court rejected the Abigail Alliance's efforts to force the Food and Drug Administration to approve new drugs for dying patients before they've been proven safe and effective. And the front page of today's New York Times has a story showing that the long-predicted shift to generic drugs -- an inevitable by-product of the pharmaceutical industry's failure to generate new drugs that represent a significant medical advance when their blockbuster drugs lose patent protection -- is finally taking hold in the marketplace.

To me, these stories suggest that the era where drugs, drug safety, and drug pricing dominated public concerns about the direction of our health care system is drawing to a close. Last week's battle over state health insurance programs for children (S-CHIP) was the forerunner over the coming debate over health insurance reform, and the health insurance reform debate will inevitably turn to the broader issue of societal affordability. Drug spending, which represents just one-tenth of overall health care costs, is just one part of that larger problem.

When it comes to that issue, New Mexico Gov. Bill Richardson's comments in Iowa yesterday are worth highlighting. Alone among all the candidates, he is claiming that health insurance can be expanded to cover all Americans without raising taxes on the general public. Of course, that's a bit disengenuous. He would get there by requiring employers who don't provide coverage to contribute to a fund for insuring the uninsured. But his broader message is a welcome antidote to the liberal platitudes offered by the other candidates. "By streamlining the system, increasing efficiency, and asking everyone to pay their fair share, we can make accessible, affordable health care a reality for everyone," he said.

But his "increasing efficiency" is so far an empty vessel. Will he go the final mile and begin talking about reorganizing how health care is delivered in this country, which inevitably takes on the individual practioner/specialist model that undergirds many physicians' incomes? Will he outline some proposals for saving money while transforming the quality of care in the nation's hospitals, which are the largest component of health care costs? And will he talk about ways to eliminate useless procedures, tests and drugs that needlessly inflate costs without commensurate benefit?

Indeed, when will he or any of the candidates begin putting health into the health care debate? Along those lines, today's Journal of the American Medical Association has a short news article on an innovative North Carolina test program that showed that public health lifestyle intervention programs (blood sugar screening; nutrition and diabetes management courses; organizing walking classes) can significantly reduce the incidence of diabetes. If implemented on a nationwide basis, that could have a significant impact on obesity, the rising tide of diabetes and, ultimately, lower overall health care costs.

Here's an interesting question someone might want to ask the candidates at the next presidential debate (either party):

If you had an extra $5 billion to spend on health, would you put it into more research for a cure for diabetes or into public health programs to reduce the incidence of the disease?