Tuesday, November 13, 2007

Would Universal Health Care Stifle Medical Innovation?

An excellent article appears at The New Republic. Jonathan Cohn discusses 'The best case against Universal Health Care' in his article "Creative Destruction."

This is an absolute must read...

Besides, true innovation ultimately benefits everybody by pushing the boundaries of the medically possible. Can we really count on a universal coverage system to weigh all of that? In other words, can we really be sure that universal health care won't come at the expense of innovative medicine?

This [scrutinizing treatments for cost-effectiveness] , in turn, would lead to both less innovation and less access to the innovation that already exists. And the public would end up losing out, because, as Tyler Cowen wrote last year in The New York Times, "the American health care system, high expenditures and all, is driving innovation for the entire world."

Consider this innovative treatment for Parkinsen's disease --
The story of Deep Brain Stimulation actually holds some important lessons about how innovation frequently takes place--and why it's not all that dependent on a non-universal, private health care system like the one we have in the United States. For one thing, it turns out that DBS isn't exactly an American innovation. If anybody deserves credit for developing it, it's the French--and one French doctor in particular.

That doctor's name is Alim-Louis Benabid...A recently retired neurosurgeon who did his work at the University of Grenoble, near the French Alps...

Did the for-profit system drive this innovation? --

In this sense, DBS offers an important window into the way medical innovation actually happens. The great breakthroughs in the history of medicine, from the development of the polio vaccine to the identification of cancer-killing agents, did not take place because a for-profit company saw an opportunity and invested heavily in research. They happened because of scientists toiling in academic settings.

According to Robert Gross, an Emory University neurosurgeon and expert in the field, Benabid had actually approached the companies that already made electrodes for use in treating chronic pain, suggesting they develop a device specifically for Parkinson's. But they declined initially, so Benabid had to use the existing devices and adapt them on his own. "The companies did not lead those advances," Gross says. "They followed them."

So who does lead medical innovation? --

"The nice thing about people like me in universities is that the great majority are not motivated by profit," says Cynthia Kenyon, a renowned cancer researcher at the University of California at San Francisco. "If we were, we wouldn't be here." And, while the United States may be the world leader in this sort of research, that's probably not--as critics of universal coverage frequently claim--because of our private insurance system. If anything, it's because of the federal government.

The single biggest source of medical research funding, not just in the United States but in the entire world, is the National Institutes of Health (NIH): Last year, it spent more than $28 billion on research, accounting for about one-third of the total dollars spent on medical research and development in this country (and half the money spent at universities). The majority of that money pays for the kind of basic research that might someday unlock cures for killer diseases like Alzheimer's, aids, and cancer. No other country has an institution that matches the NIH in scale. And that is probably the primary explanation for why so many of the intellectual breakthroughs in medical science happen here.

But what has happened to NIH funding in recent years? --

It so happens that, starting in 2003, President Bush and his congressional allies let NIH funding stagnate, even though the cost of medical research (like the cost of medicine overall) was increasing faster than inflation. The reason? They needed room in the budget for other priorities, like tax cuts for the wealthy. In this sense, the greatest threat to future medical breakthroughs may not be universal health care but the people who are trying so hard to fight it.

And once again, President Bush is threatening the veto the Labor-HHS-Education bill (H.R.3043) which would provide much needed funding for medical research.

Congress has incorporated nearly $4 million in funding in the bill for the development of a multiple sclerosis and neurodegenerative disease research center at West Virginia University in Morgantown, W.Va. This first comprehensive center for MS research and care in West Virginia holds great promise for people living with MS not only in the state but nationwide.

In addition to this specific funding for MS, the Labor-HHS bill includes a 3.1% increase for the NIH, a 6% increase for the Centers for Disease Control and Prevention (CDC), and $2 million for state respite care grants authorized by the Lifespan Respite Care Act (which MS activists helped pass last year).


  1. It seems as though universal health care may slightly cause a delay in nedical advancements. However, like everything else in the country it will pick back up when the dust settles. I don't know if we have time to let the dust settle.

  2. What doesn't President Bush veto? Has SCHIP been passed yet? Universal health care is the hot topic right now for good reason. We needed to do something about it 20 years ago.

    Nice blog, I enjoy how you use facts instead of opininons, as the facts speak for themselves.

  3. Thank you for the comments. I'm glad that you enjoy the blog. I try to keep facts in the discussion.

    Regarding Bush's vetoes. I was disturbed to learn that Congress was only 2 votes short of overturning his veto of the Labor-HHS-Education bill. I imagine that the White House is laughing at the Dems who seem to be incapable of getting things done recently in a bi-partisan manner, as long as Bush is standing in the way.

    I certainly regret my vote some 7 years ago.