BY BEN Wheatley
We’ve heard before and it’s no longer shocking to say that in 2021, the US has spent 4.3 trillion USD about health care. To put this fancy number into perspective, we measure it as a share of our economy and report that healthcare accounts for 18.3% of our gross domestic product. we. CMS projects that healthcare will approach 20% GDP in the coming years—1/5 of everything we buy and sell in this country.
In a recent report, the Ministry of Health Council on Healthcare Spending and Value says that “it is not clear what percentage of GDP would represent the ideal level to spend on health care. However, the council believes current spending and growth rates are higher than necessary….” The council found that dollars spent on health care appeared “disproportionate to the health they generate” and noted that spending places “a significant burden on families, users, labour, employees and government.”
We spend about $12,900 per person per year on health care. For comparison, the average cost of health care per person in other rich countries is only about by half.
These figures seem to indicate that the US is spending too much on health care, however, we are still having trouble determining the “right” amount. However, if someone asked me, “In an ideal world, how much would we spend on health care?” I will suggest a very simple answer: zero. This is because, apparently, in an ideal world, no one would get sick.
You could argue that this is a bit of a fallacy. Obviously, we don’t live in an ideal world, we live in the real world, and here on planet earth, diseases and dreaded diseases are rampant. According to this worldview, disease can be seen as intrinsic—a fundamental feature of the imperfect world in which we live. But by nature I am an optimist. I believe it is possible to reduce the burden of disease and our clear goal is to reduce the burden of disease to zero.
In 2001, the Institute of Medicine announced Overcoming the Quality Gap: The New Health System for the 21st Century. Everyone has six goals in mind: care must be safe, timely, effective, effective, equitable, and patient-centered. But this is only the report’s second recommendation. The first recommendation says this: “All healthcare organizations, professional groups, private and public buyers should consider their explicit aim to continuously reduce the burden of disease, injury, and illness. and disability, while improving the health and functioning of the American people.”
Ours clear purpose should be continuous reduce the burden of disease. I am simply offering an addendum: our clear aim is to continue in this direction until the job is completed. That is, until the burden of disease has been lifted. Even if we believe fundamentally that this goal is unattainable, what harm is there in making it our goal? Make it direction that we want to go. Even in the real world, I believe our clear goal is to reduce the burden of disease to zero—allowing spending to go that way.
On March 26, 1953, American medical researcher Dr. Jonas Salk announced on a national radio program that he had successfully tested a vaccine against polio, the virus that causes polio. in two years Before the vaccine became widely available, the average number of polio cases in the US was more than 45,000. By 1962, that number had dropped to 910. As the incidence of polio fell, spending on polio-related care also decreased.
Polio was once one of the most feared diseases in America. This virus can spread from person to person and can enter the spinal cord of an infected person, causing paralysis. The virus paralyzes muscle groups in the chest, making it difficult to breathe. The medical device most commonly associated with polio was the iron lung, which in the 1930s cost about $1,500—average price of a house.
An interviewer once asked Salk who owns license of invention to the polio vaccine. Salk famously replied, “I would say everyone. Unpatented. Can you patent the sun?“
Polio has been remove in the United States, but it has yet to be wiped out globally. It still exists in some parts of the world. At the 2022 World Health Summit, the Bill & Melinda Gates Foundation announced it would commit to 1.2 billion USD to support efforts to end all forms of polio globally. billionaire “We have what it takes to finally wipe polio from the face of the earth.” However, he expects it to be rewarded. Gates told CNBC, “We felt there was on a 20-to-1 . profit.”
Science is beginning to bring about amazing cures for incurable diseases. wired magazine announced in late 2022 that “The era of one-off, multi-million dollar genetic cures has arrived.” The article describes a gene therapy called Hemgenix, which was approved by the FDA in November 2022 to treat patients with severe hemophilia. This therapy overwrites a DNA mutation that causes spontaneous bleeding episodes, some of which are life-threatening. “Unlike most medications that relieve symptoms, gene therapy addresses the underlying cause of the disease.” This therapy seems to offer a complete cure, at least in some cases. However, it remains unclear whether one injection has a lifelong effect. At $3.5 million for a single-use dose, Hemgenix is currently the most expensive drug in the world.
The company, CSL Behring, says the price is determined by looking at the “clinical, social, economic and innovative value demonstrated by this new gene therapy”. And they have the backing of the Institute for Economic and Clinical Evaluation,”national drug price watchdog.” ICER estimates that Hemgenix will be reasonably priced at 2.9 million USD. ICER collects testimony, reviews evidence, and seeks to ensure that Americans “stop paying too much for drugs that work too little.” However, they assert that “pharmaceutical companies that develop highly effective drugs will still generously rewarded.” Under this model, savings for the system are created, but kept in private hands.
Our current trajectory
Healthcare spending in the United States was already sky-high, even before these novel therapies were introduced. Nearly 1 in 10 adults is currently in debt substantial medical debt. More and more, employer are pointing out that health insurance is too expensive to offer their employees. And the nonpartisan Congressional Budget Office warns that a financial crisis looming if debt levels continue to rise as expected. The cost of health care is one main driver of the national debt.
It’s important to realize that not all health innovations are expensive. Take, for example, pasteurization of milk. Milk was once a common source of bacteria that cause tuberculosis, diphtheria, typhoid fever and other foodborne illnesses. The rate of outbreaks of milk-related diseases has been significantly reduced since pasteurization became popular.
Moreover, the profit motive sometimes slows down the innovation process. A Canadian startup has modified psychedelic DMT to treat depression, and a recent study shows very promising results. However, research”failed to stimulate investors.” “These results are extremely promising, but they have no effect on the stock price, zero,” said the founding partner of a venture capital firm.
Sam Altman, CEO of OpenAI (brings us ChatGPT) think hallucinogens will make revolution mental health care and addiction treatment. However, the business model is not yet available. Amy Emerson, CEO of another company in the same field, notes that profitability depends on things like making sure insurers cover drugs, developing billing codes for therapies, and training. Create clinicians to administer medications. “All of that is a burden,” she said. So monetization is hindering innovation in some cases.
A new direction
In 2016, the Obama Administration launched an effort to “end cancer as we know it.” The Moonshot CancerOriginally sponsored at 1 billion USD, which aims to halve cancer deaths within 25 years. But in the world of expensive biological research, such money might better be described as a cancer slingshot, the researchers said. “We’re not going to the moon for $1 billion.”
In 2022, President Biden relaunch Moonshot and his most recent budget include $2.8 billion for effort. However, cancer research is one of the items targeted to cut in the current debt ceiling battle. Regardless of your political views, it seems fair to say that healthcare is facing serious financial difficulties. Therefore, we need to be open to “Disruptive technology and business model that could threaten the status quo.”
Bringing the burden of disease to zero (admittedly) is an ambitious goal. But it can also serve as a barometer of how we are doing right now. For GPS to work, you must enter the correct destination. Our goal is to bring the burden of disease to zero, allowing spending to fall as well.
Ben Wheatley has 25 years of experience working in the field of health policy with organizations including AcademyHealth, the Institute of Medicine, and Kaiser Permanente.