In America’s endless health-care debate, Medicaid serves as a Rorschach Test for the Left and Right. Critics of government intervention in medical care such as Avik Roy, president of Foundation for Research on Equal Opportunity, contend that America’s “low cost” insurer fails patients at astronomical costs. Allowing Medicaid to continue to expand as-is just doubles-down the federal government’s role in a colossal blunder.
To supporters of the Affordable Care Act, Medicaid serves as an effective insurer for poor and near-poor Americans, shielding them from the medical misfortunes of life. Supposedly, they’ve got the data on their side. Headlines proclaim that, “Medicaid is an effective, efficient program.” But at an annual price tag of nearly $600 billion and burdened with a scourge of improper payments, little evidence suggests that the program improves actual access to care or health outcomes.
What does it mean for Medicaid — or any other insurance regimen — to “work”? One easy metric is insured status, but this seems like a cop-out. In other developed countries, individuals insured on paper routinely fail to get the care they need and succumb to preventable, treatable illnesses. A better measure of success is whether uninsured individuals have an easier time getting much-needed treatments and see improved health outcomes as the result of being on Medicaid. On these questions, supporters and opponents of the current Medicaid structure frequently trot out studies affirming their pet theories about the program. This tendency is all-too-common in public policy, with dueling studies the norm on minimum wage, trade policies, and welfare spending.
For this reason, meta-analyses analyzing dozens of studies at a time are useful for solving some of the pressing public policy questions vexing lawmakers. In June, Health Affairs published such a study analyzing 77 studies on Medicaid’s effectiveness. The incorporated studies asked more than 400 questions on the impact of state-level Medicaid expansions on various outcome measures, ranging from access to treatments to insurance status to hospital financial performance.
More than ever, success in the modern world depends on adaptation to new technologies. Nowhere is this more evident than in the field of health care. If the United States fails to advance its digital health care industry well beyond its current state, it will not remain the world’s leader in health care.
Recently, the Federal Communications Commission (FCC) voted on a bipartisan basis to increase funding for the Universal Service Fund’s Rural Health Care Program by $171 million annually. The goal of the funding increase is to help rural health care providers develop a “telemedicine” infrastructure that targets rural citizens who lack easy access to medical services. As my colleague Matthew Glans notes, “Telemedicine is the use of information technology to remotely diagnose, treat, or monitor patients.
Although it may seem FCC is ahead of the curve, the United States is actually behind in worldwide telemedicine access. Recent comments from Jonathan Larsen, CIO of Ping An Group (PAG), demonstrate the massive initiatives to expand telemedicine in China. Larsen told Health Transformer China has developed a health care “ecosystem” that has grown into the world’s largest telemedicine platform — now with 192 million active users.
“We have about 5 million visitors engaging on health topics every day and about 500,000 users actually seeking medical consultations on a daily basis with the panel of about 9,000 doctors that we have,” Larsen said of PAG’s “Good Doctor” project. Although PAG works to support China’s state-run health system, it’s not hard to extrapolate what telemedicine might look like in a free-market environment. Under such a system, individual states, insurers, and physician-patient teams would hire developers to customize telemedicine products based on their unique needs.
In 2005, the FDA approved a new treatment for pain, administered through a patch on the patient’s skin. The drug’s approval coincided with a movement in the medical profession towards treating pain as the “fifth vital sign,” leading doctors to take more aggressive steps to deal with pain. By 2012, doctors were prescribing the drug, called fentanyl, over 255 million times a year throughout the U.S. For millions of Americans, these legal prescriptions intended to help their chronic pain had already pulled them into opioid dependency. The role of doctors in creating the current national crisis cannot be ignored.
Fentanyl is now one of the most infamous drugs of America’s opioid epidemic, which claimed more than 30,000 lives by accidental overdose in 2016 alone. While about half of those deaths were from heroin and other illegally obtained opiates, most opiate-users started taking opiates prescribed by their doctors. Troublingly, many of these doctors — one in 12, according to Boston Medical Center researchers — received money from opioid manufacturing companies.
Opiate prescriptions have fallen steadily since their peak in 2012, but nothing has fundamentally changed about the incentives doctors are offered for prescribing opiates. The Chicago Tribune reported that just last year, 28,000 Illinois doctors accepted more than $74 million from pharmaceutical companies. In another report from CNN, more than 200,000 doctors throughout the U.S. admitted to taking payments from opioid manufacturers for prescribing their drugs, and made more money the more they prescribed.
But convincing doctors to prescribe more opiates takes a lot less than nefarious kickback schemes. The Journal of the American Medical Association recently demonstrated that doctors who received a free meal from an opioid company were more likely to prescribe opioids than doctors who didn’t get free meals. Moreover, doctors’ persistent use of opioids for long-term treatment, despite the FDA’s well-publicized warnings against using opioids this way, shows a disturbing trend in the way doctors write prescriptions.
As Americans confront a growing array of hard problems here at home, there is a natural tendency to turn inward for solutions. This makes for the potential to miss insights we might gain from abroad.
Our health-care system seems particularly conducive to such inward-looking thinking. Rising costs, reform, barriers to access, and the growing rural-urban divide are just a few of the challenges that bedevil our field.
In this environment, it might make sense to say “let’s fix our own problems first.” But his would be a mistake. Foreign engagement is one of the most effective tools we have to produce better doctors and to deliver better care at home.
This is why many leading medical schools and teaching hospitals are committed to strengthening their programs abroad. My own institution, the University of Michigan, now has formal agreements with partners in 12 countries, including India, Taiwan, and Brazil, Ghana, Uganda and Ethiopia.
Few occasions are more joyous than the birth of a child. But for scores of families, the arrival of a newborn can also augur heartbreak.
Each day, nearly 100 babies are born in the United States with congenital heart defects. Many will not make it to their first birthday. Fortunately, several breakthrough technologies have emerged in recent years that are poised to save many of these babies. It’s time we put them to more widespread use.
Congenital heart conditions are the most common birth defects in this country, afflicting about 40,000 babies — nearly 1 percent of births — each year. These defects can range from manageable to fatal: a valve that doesn’t fully close; abnormal connections of veins and arteries; even a hole inside the heart. Any one of these problems can make it more difficult for the heart to pump blood and feed oxygen to the rest of the body.
Some heart defects can be treated with medicine; others require surgery. But in too many cases, the array of current health-care technologies available for treating infant heart defects is insufficient.
Conflation is a commonly used rhetorical ploy: combining two things that don’t belong together or using one word to imply another when they don’t exactly mean the same thing. When the Affordable Care Act was pushed through Congress, advocates conflated health care with health insurance. The act was intended to reform health insurance, not health care. And despite common associations, they aren’t the same thing.
A recently filed lawsuit claims the ACA became unconstitutional when Congress set the individual mandate tax to zero as part of the 2017 tax bill. An opposing newspaper headline, “Lawsuit could jeopardize health care for 52 million,” demonstrated both conflation and exaggeration. Assuming the lawsuit is upheld by the Supreme Court and the ACA is struck down, many insurance regulations would disappear, not insurance itself nor the doctors who actually provide the care.
Let’s separate, rather than conflate, health insurance from health care.
Start by debunking the false presumption that the uninsured do not get health care. The Emergency Medical Transport and Labor Act (EMTALA), passed in 1986, assures that seriously ill Americans get care regardless of insurance status. People have not been “dying in the streets” for more than thirty years. Just look at volume of uninsured patients who get care at no cost to them, which admittedly costs the federal government billions of dollars.
The opioid abuse crisis has been building for 30 years. It started with physicians over-prescribing painkillers and has now morphed into a heroin and fentanyl epidemic. In 2017, an estimated 62,000 people died from opioid related overdoses, up 48 percent from 42,000 deaths in 2016. Drug overdoses now represent the leading cause of death for Americans under the age of 50 and life expectancy has fallen.
This public health epidemic isn't just deadly, it is also costly. Between 2001 and 2017, Americans spent $217 billion on healthcare related costs connected to the opioid abuse epidemic. Widespread opioid addiction has also hampered economic productivity and necessitated additional spending on social services, education, and criminal justice, at a cumulative cost of $1 trillion.
Physicians and addiction specialists agree that “medication-assisted treatment” could curb this epidemic. MAT combines prescription drugs that prevent opioid cravings with counseling and other clinical support. Increased access to MAT would greatly reduce the number of lives lost and dollars spent. Fifty percent of opioid addicted individuals who undergo MAT remain free of illicit drug use after 18 months. By contrast, 90 percent of individuals who try to discontinue opioids without MAT relapse within a year.
The recent decision not to defend critical components of the Affordable Care Act (ACA) in legal challenges brought by the state of Texas is the latest sign that Trump and his administration are willing to abandon millions of Americans living with chronic or pre-existing conditions. These Americans suffer from diagnoses including HIV, hepatitis, and other STDs, and they rely on the ACA for access to critical, affordable health care coverage.
In a suit filed in federal court earlier this year, Texas claimed that when Congress eliminated the penalty associated with the individual mandate, it made the mandate itself unconstitutional. In its brief filed with the court on June 7, the Department of Justice (DOJ) agreed with this view that the individual mandate is indeed unconstitutional. And if eliminated, it argued, two provisions of the law that offer protections for people with pre-existing conditions — specifically, the guaranteed issue and community ratings provisions — must also go.
Having failed repeatedly to repeal the ACA last year, this decision is the latest tactic in the Trump administration’s new health care playbook: stripping the law of so many essential components that it collapses under its own dysfunction.
The potential effects of the administration’s new position cannot be overstated. If implemented, the actions proposed by the DOJ’s court filings would gut health care reform and wreak havoc on insurance markets. In so doing, the administration would rip health care from millions of Americans, including those who voted for the president. Instead of fighting for the well-being of his own constituents, President Trump is fighting to strip them of their protections from health insurer discrimination and possible denial of coverage based on pre-existing conditions.
One hundred fifteen people needlessly die every day across our states from opioid overdose. That’s almost 42,000 deaths from opioids each year. One person’s death to the scourge of opioids is one too many, but this public health issue has not been given the attention — and federal action — it deserves. In 2017, opioid overdoses killed more people than breast cancer, while there were only 30,000 deaths from prostate cancer.
While no one denies the criminal component of illegal opioid use, legislators must address the opioid epidemic in the same way as we treat other public health issues: by treating the disease. Like cancer, opioid addiction is a disease. It affects Americans of every age, race, ethnicity, political party, and socioeconomic status. For three years, I’ve read about increased awareness of the looming national epidemic, but state legislators have been debating and developing solutions — state by state — for almost a decade. I urge Congress to look to the states for innovative solutions.
The public health and criminal justice infrastructure in the states represent the front line in the fight against opioid abuse. Until recently, little had been done to halt the spread of opioid addiction, even in some of the hardest hit areas. Places like New Hampshire, West Virginia, Texas, and Maryland all struggle with an increasingly addicted population and the resulting civil and criminal issues. State spending on corrections alone has grown faster than nearly every other budget item, topping $50 billion. But a focus on crime and prison time without equal attention to addressing the underlying causes of addiction is a futile endeavor.
I know first-hand how hard it can be to watch someone suffer in the grips of addiction. For the past five years, I have helped lead Wisconsin’s legislative efforts to combat the opioid epidemic through the Heroin, Opiate, Prevention and Education (HOPE) Agenda. HOPE resulted in 30 new Wisconsin laws addressing drug treatment and law enforcement as well as the implementation of the Prescription Drug Monitoring Program (PMPD) — a nationwide database for doctors to monitor their patients’ opioid prescriptions, preventing abuse or “doctor shopping.” Wrap-around programs like those implemented in Wisconsin are making a difference: Since 2015 opioid prescriptions are down nearly 20 percent in Wisconsin. But, Wisconsin isn’t the only state legislature taking action; other legislatures are implementing innovative approaches and are creating a vast library of proven options for Congress to consider.
Members of Congress are signaling rare bipartisanship in their support for crucial updates to health savings accounts (HSAs) — a key casualty of last year’s ill-fated Affordable Care Act (ACA) “repeal and replace” efforts. This is would be a small, albeit important, victory for collaboration across the aisle. More crucially, it would be a major victory for the American people who are struggling with ever-increasing health-care costs and complexity.
Yet Congress shouldn’t stop with easy updates. Rather, transparency should become the greater bipartisan cause.
HSAs are tax-advantaged financial accounts paired with High-Deductible Health Plans (HDHPs) in what are called Consumer-Directed Health Plans (CDHPs). Currently held by more than 21 million Americans, HSAs were created as part of the Medicare Modernization Act of 2003 to combat rising costs with “consumerism.” As the thinking went, a high deductible would force people to pay “first dollar” for many medical expenses instead of the low or no copays of traditional medical plans. The new plan design and tax-advantaged account would give consumers “skin in the game,” which in turn would make them be more conscious of costs in their behavior.
While there has been some progress on consumerism, important updates are needed. In separate hearings on back-to-back days for the House Ways and Means Committee and the Joint Economic Committee, numerous business and professional groups, industry insiders, and think tanks spoke in support of the Bipartisan HSA Improvement Act, H.R. 5138.
As a practicing physician with over 30 years of experience, I am honored to be an advocate for the ethical care of all patients regardless of their stage of life. Since assisted suicide became legal in California and Oregon, I have experienced first-hand the abuses this practice incentivizes.
The American College of Physicians (ACP) has recently reiterated its opposition to assisted suicide, and the American Medical Association’s (AMA) Council for Judicial and Ethical Affairs (CEJA) appropriately recommended that the AMA do the same. I couldn’t agree more, and I applaud both organizations for pointing out the ethical problems with assisted suicide.
Unfortunately, however, the AMA House of Delegates just rejected this recommendation, passing up a golden opportunity to reaffirm opposition. The matter will now be taken up once again by CEJA.
I cared for two patients in my hospital in Northern Nevada who were seeking transfers to their home states of California and Oregon for life saving treatments. With these particular treatment options, both patients had an excellent chance of cure. Without the treatments, both would likely die from their diseases.
Medical advances have contributed to a near doubling of life expectancy over the past century and will produce more than 1 billion individuals over age 60 worldwide. However, this monumental achievement has also fueled dramatic increases in the incidence of diseases such as cancer.
As a father to three teenagers, a son whose father lost his battle with cancer, and a physician-scientist specializing in cancer research, the facts about cancer deeply trouble me. Cancer will claim 100 million lives worldwide over the next 10 years. One in two men and one in three women will face cancer in their lifetime. Seventy percent of cancers occur in low- and middle- income countries, and an overwhelming majority of these populations do not have access to advanced cancer care. The economic impact of cancer will exceed $3 trillion annually while the social and emotional toll on patients and their families are incalculable.
But up to 50 percent of cancers are completely preventable. And, while cancer skyrockets after age 60, the opportunity to prevent cancer must begin during childhood.
Medical research tells us that many cancer “seeds” are planted during childhood. For example, 88 percent of adult smokers start smoking before age 18 and become lifelong nicotine addicts, potentially leading to lung cancer. During childhood, skin-peeling sunburns or tanning bed use can double the risk of melanoma decades later. The tanning culture, in particular, has produced a 700 percent increase in melanoma in women. Childhood obesity can increase the risk of uterine cancer and other cancers. The opportunity to protect ourselves from HPV-associated cancers, such as cervical and throat cancer, necessitates vaccination during young adolescence.
If everyone were young and healthy, it would be easy to create an accessible and low-cost health-care system. But in the real world, many individuals are facing very serious health problems that require a great deal of medical attention. Unfortunately, in Washington there are certain government policies that are making it very difficult for some patients to access the care they need — and special interests in the medical industry have helped to support those policies.
A policy debate is currently raging over how to care for individuals suffering from end-stage renal disease (ESRD). This is a life-threatening disease that requires frequent dialysis treatments. Needless to say, these services come at a very high cost. Many insurance companies would prefer to move ESRD patients off of their plans and onto public programs like Medicaid and Medicare, where taxpayers will be responsible for the bulk of the costs. However, because private insurance companies generally provide better service and higher-quality care, many ESRD patients would prefer to avoid government programs.
A number of charitable organizations have stepped up to keep private insurance options on the table when they would otherwise fall through the cracks. This is particularly important because ESRD disproportionately affects low-income individuals, who often struggle to balance employment responsibilities with their treatment regimens. Charitable support is essential for many of these patients to pay their insurance payments to private insurers and keep the coverage they need.
Unfortunately, some private insurance companies have teamed up with opportunistic union groups (which hope to use this controversy to unionize workers at dialysis clinics) to try to prohibit charitable organizations from helping to cover premium costs for ESRD patients. Losing this source of financial support would force these individuals to leave their current insurance plans and move to government plans, such as Medicare or Medicaid. In addition to reducing coverage options and quality of care for these individuals, the result would be a higher burden on government health care programs. This is particularly troubling for taxpayers because Medicare and Medicaid are already facing enormous economic difficulties.
The news that America is facing a national health crisis in the form of opioid addiction is well known. Last October President Trump declared a national public health emergency, which was extended for a second time in April. What is starting to emerge now is the exact extent of the damage on the lives of those who struggle with substance abuse along with their families and communities. It will take the collective efforts of legislators, doctors, social workers, specialists, and citizens to combat this epidemic.
May has been National Foster Care Month. As the opioid crisis strains the nation’s child welfare system, below are several ways that Americans can step up to protect and support vulnerable children and families hurt by addiction.
The human and economic costs of this epidemic are staggering. The National Institute on Drug Abuse estimates that every day more than 115 Americans die from prescription opioids, heroin, and fentanyl. A report from The Council of Economic Advisors estimates that in 2015 alone, the economic cost of the opioid crisis was $504 billion; $431.7 billion in mortality costs and $72.3 billion in lost productivity, health care, and criminal justice costs. Research estimates that in 2015, almost 1 million prime-age individuals were not in the labor force because of opioids.
Addiction is also increasing the number of children in foster care, as caregivers are unable to provide the necessary care and stability they need. According to the Administration for Children and Families, out of all the reasons states can report for a child’s removal from his or her home and placement into out-of-home care, drug abuse by a caretaker had the largest percentage point increase from FY2015 to FY2016. In FY2016, over 90,000 children were removed from their homes because a caretaker had a drug abuse issue. As Sally Satel writes, “The jarring visual of the crisis is … an overdosed mom slumped in the front seat of her car in a Walmart parking lot, toddler in the back.”
Hardly anyone would disagree with the general goal behind President Trump’s pledge earlier this month to “bring soaring drug prices back down to earth.” In fact, President Obama expressed the same objective, as have Members of Congress, state legislators, think tanks, economists, Medicare and insurance company officials, businesses, and patients. To paraphrase the old Cole Porter line, “birds do it, bees do it, even educated fleas do it” — everyone is opposed to high drug prices charged by pharmaceutical companies, one of the nation’s least loved industries.
Unfortunately, President Trump’s plan to increase industry competition and strengthen the negotiating power of Medicare Part D, the private prescription-drug plan, but not the much more powerful federal Centers for Medicare and Medicaid Services is — like many others’ proposals — too weak, stopping short of taking on the real culprits behind high drug costs. Rep. Elijah Cummings (D-MD) said: “I think very expensive champagne will be popping in drug company boardrooms across the country” in response to Trump’s proposal.
The failure of the federal government to rein in drug prices has led a number of states to take action. Unfortunately, despite thoughtful measures such as California’s new drug-price transparency law, some state initiatives also take misbegotten approaches that yield little in savings and leave Big Pharma popping more champagne.
Last year, Maryland passed a first-of-its-kind law aimed at stopping “price gouging” by drug makers. The law excluded expensive brand drugs made by big pharmaceutical companies, targeting primarily generics, which actually saved the U.S. health-care system $1.67 trillion between 2007 and 2016, according to Food and Drug Administration (FDA) Commissioner Scott Gottlieb. A federal appeals court struck down Maryland’s law last month for violating the Constitution’s commerce clause.
After decades of investing in achieving the lofty goals of so-called precision medicine, the field of medicine has realized that we may have been targeting a necessary, but not sufficient definition of success. “Precision health” is a far more precise term to describe our evolving efforts to use big data to tailor individual treatments for each patient.
This change is more than semantics. It reflects one of the key insights that have emerged during the last few years of intensive research and planning: Health care is no longer completely defined by the always essential relationship between medical professionals and their patients. Increasingly, patient health is being safeguarded and improved by a broad range of experts who are collaborating on the ever-growing array of questions that involve not just medicine but the social, psychological, and physical health of patients.
This is the idea behind the new Precision Health Initiative at the University of Michigan. It involves 19 schools and colleges across the college, including several historically under-connected to medicine, such as law, social work, and literature. It is being led by leaders from three distinct schools, Public Health, the College of Engineering and, of course, Medicine. This broad collaborative is similar to efforts underway at Stanford University, Indiana University, the University of Washington and the National Institutes of Health’s one million-person precision medicine initiative.
We need the best minds from a variety of disciplines because the challenges of modern health care far exceed the skill sets of doctors. At its core, precision health involves drawing on the health records of tens of thousands, and one day, millions, of patients to find the best course of treatment for each patient.
Last Friday, President Trump delivered a major speech from the White House Rose Garden on prescription drug prices. He announced several policies aimed at reducing the overall cost of pharmaceuticals and limiting patients’ out-of-pocket expenses.
His reform agenda, entitled “American Patients First,” is largely excellent. It mostly harnesses the power of free-market competition, rather than government price controls, to drive down costs for patients while continuing to incentivize drug manufacturers to invest in innovative, lifesaving research.
Contrary to popular belief, drug spending has been relatively flat. It rose just 0.6 percent in 2017 — significantly lower than the overall rate of inflation. Per-patient prescription spending actually decreased 2.2 percent. That may come as a surprise to some patients, who have seen their out-of-pocket costs at the pharmacy counter skyrocket. Powerful middlemen known as pharmacy benefit managers (PBMs) are to blame for those rising costs.
PBMs negotiate drug prices on behalf of insurance plans. These middlemen also determine which drugs insurers will cover and the levels of co-payment and co-insurance. PBMs use their enormous negotiating leverage to extract big concessions from manufacturers. Pharmaceutical companies give 37 percent of drugs’ list prices back to PBMs, insurers, and other middlemen via rebates and discounts. These rebates are often paid to PBMs weeks after a transaction occurs at a pharmacy — and add up to more than $100 billion annually. Patients rarely get a share of that 12-figure sum. PBMs and insurers keep nearly 90 percent of the rebates they receive from drug companies.
This year drug overdose deaths may exceed 70,000 Americans. We do not really know, however. We have no estimate of the number of non-fatal overdoses and no estimate of how fast addiction is spreading.
Over 64,000 Americans died of drug overdoses in 2016 and that number has been growing at 20 percent a year. So it is likely that more than 170 Americans are dying each day from illegal drug use. Why, then, is the response to these deaths so much less urgent than the reaction to a health crisis such as the E. Coli outbreak in lettuce that has, so far, killed one person?
The most deadly part of the overdose carnage, the opioid epidemic, has yet to be treated as a true epidemic by the institution intended to combat such dangers — the Centers for Disease Control and Prevention (CDC). Most critically, though the death rate has reached historic levels, CDC has not committed resources to track the threat in a timely manner. It offers no real-time information on the spread of opioid use and addiction across America and CDC’s reports of overdose deaths lag by almost a year.
Contrast this response to the reporting on the Ebola virus in 2014, which caused one death in the U.S. in four reported cases. CDC received over $500 million for domestic preparedness and response and a total of $1.77 billion for domestic and global Ebola efforts for 2015–2019. Or compare the tracking and CDC funding for the Zika virus. Zika-related birth defects, certainly a serious risk, in reality involved fewer than 7,000 women between 2015 and 2018. Yet in 2016 alone, CDC received $1.1 billion in Zika response funding.
Since taking the Oath of Office just 16 months ago, President Trump’s tenure as Chief Executive has been marked by notable successes — such as tax reform — and partisan controversies, such as alleged Russian collusion. What’s remarkable about the president’s brief tenure isn’t so much that there have been successes or controversies. This, of course, is true of any new administration. What’s remarkable is the unprecedented partisanship and division. There is no middle ground on issues where Left and Right might agree to disagree. Politics today is a blood sport: It’s not enough to win the argument; you must destroy your political enemy.
Taxes, the environment, foreign policy, judges, immigration, entitlement reform, health care — there are fewer and fewer issues where both Republicans and Democrats can come together to work out policy solutions. Virtually the only thing everyone agrees upon is that drug prices are too high. Indeed, high drug prices just might be Washington’s last “policy unicorn.” It’s the mystical policy area where Senator Chuck Schumer (D-NY) and President Trump might agree.
Earlier this year in his State of the Union speech, President Trump reaffirmed that one of his highest priorities is to reduce the price of prescription drugs. “In many other countries, these drugs cost far less than what we pay in the United States,” Trump said. “That is why I have directed my Administration to make fixing the injustice of high drug prices one of our top priorities. Prices will come down.”
Even though both political parties agree that Americans are paying too much for their medications, very little has been done over the past 15 years to solve the problem. President George W. Bush had a Republican Congress, yet his administration did little to bring market reform to the crisis of rising prices. Though President Barack Obama enjoyed a Democratic supermajority for the first two years of his first term, he squandered this opportunity to address rising drug costs. Instead, Democrats leveraged their majority to jam through Obamacare. Big-League failure by both political parties.
First Charlie Gard and now Alfie Evans. These are babies who, though verbally silent, still gave clarion warnings to proponents of single-payer health care: The government — not my parents — is in charge of my life.
Charlie Gard was born in August 2015 with a rare genetic disorder that carried a poor long-term prognosis. In July 2017, little Charlie was just 23 months of age and on a ventilator. Over the objections of his parents, British doctors decided to withdraw life-sustaining care. According to British Courts, the National Health Service (NHS), the country’s single-payer system, is the ultimate medical decision maker — not the family. Ventilator support was withdrawn and Charlie died.
Starting in March 2018, another 23-month old British baby hit the headlines. Alfie Evans was a comatose child whose NHS doctors said his condition was hopeless. They wanted to terminate life support, but the parents wanted to transfer their child to Rome’s Bambino Gesu Pediatric Hospital for further care. The British High Court ruled against the parents’ wishes, leaving Alfie’s fate to the NHS. As Justice-Baroness Hale wrote in Aintree v James: “we [referring to patients] cannot always have what we want.” On April 28, 2018, with ventilatory support withdrawn, Alfie died.
Baroness Hale had previously written the following for the British High Court, the U.K.’s equivalent of the U.S. Supreme Court:
Decision-makers must look at [the patient’s] welfare … the nature of the medical treatment in question, … they [decision makers] must try and put themselves in the place of the individual patient.