Where to Restart With Health Care
By now it has become clear that the Trump administration, much like its predecessor, imagined that its health care mission was to devise another universal insurance plan to optimally distribute limited health care resources (like Obamacare only better). But had the Administration’s proposal actually passed, it would have likely guaranteed the GOP ownership of both old and new failures because the current occupants of both the White House and Congress still fail to understand the difference between a health care crisis and a crisis in health care financing — a distinction that demands better medicine before better law.
The United States, like all developed nations, is currently suffering history’s first lifestyle-driven pandemic. Roughly 48 percent of all American adults already suffer from one or more lifestyle–driven chronic diseases (i.e., cardiovascular disease, stroke, hypertension, diabetes 2, COPD, and as many as 80 percent of all cancers). And by age 55, 78 percent of all Americans will have incurred at least one such disease. 47 percent will have two.
Equally disheartening is that the cost to treat those diseases is as fast growing and unprecedented as their incidence; and, barring a national strategy to change the common lifestyles that cause the onset of such diseases, the cost of treating life-style driven disease in a health care system structured for the symptom-driven treatment of acute illness will inevitably outrun the nation’s ability to pay the bill.
In FY2015, 86 percent ($2.75 trillion dollars) of our $3.2 trillion national health care expense was spent to treat lifestyle-driven chronic diseases. That’s equal to the entire tax revenues of the federal government just two years earlier, and almost four times the total FY2015 spending on national defense. A single heart attack now costs from $760,000 to more than $1 million in the lifetime of the patient.
Worse still, what’s not accounted for in that $2.75 trillion is the loss in GDP due to the indirect costs of chronic disease-related expenditures.
To the best of this writer’s knowledge no comprehensive study of those indirect costs has recently been undertaken, but in years past the Milken Institute has estimated that the indirect costs of lifestyle-driven chronic diseases — i.e. presenteeism and absenteeism of ill employees and the home health care services and products they require — were likely to be two to three times greater than the cost of treatment; and on that basis, one might very conservatively estimate that the actual total costs — direct and indirect — of lifestyle-driven chronic disease in FY2015 was at least $5 trillion dollars or 28% of this nation’s $17.8 trillion GDP.
The health care mission of the Trump Administration and the 115th Congress should be nothing less than the design and rollout of a nationwide plan to reduce the exploding demand for those resources by preventing, stabilizing, and/or reversing the pandemic onset of lifestyle-driven diseases.
It is also true that no nation has yet succeeded in doing that. In fact, as the seminal Rand Study of November 2013 concluded, the 50 largest U.S. employee wellness programs had a statistically insignificant outcome.
In the wellness industry itself, the usual excuse for the continuing insignificance of all varieties of wellness programs is that they fail to properly communicate and engage with the diverse US employee population they intend to enroll; and the great majority of those who are enrolled do not stay the course; hence those programs are seen as “culturally incompetent”.
But, as is more fully explained below, the cultural incompetence of those programs is actually worse than the industry imagines because from the outset those programs utterly fail to identify and enroll the persons whose participation is most critical to their success.
The more fundamental cause of failure, however, if that could be possible, is not their cultural but clinical incompetence.
Leading health care policymakers are always assuring us that the research necessary to avoid, stabilize, or reverse the onset of lifestyle-driven chronic diseases is substantially complete.
And in fact, the convergence of the once independent sciences of genetics, nutrition, mathematics, statistics, artificial intelligence, and pharmacology has evolved into the new life- science of “Nutrigenetics”; and that new life-science has not only made it possible to precisely diagnose an individual’s risk for specific lifestyle-driven diseases, but to craft molecularly precise diagnostic strategies and treatment protocols — “lifestyle plans” — that can not only be tailored to an individual’s genetic heritage and lifestyle, but also to the genetic profile and lifestyle of each of the family members that share that individual’s usual diet. Indeed that family’s micro culture, — principally their habits of diet and exercise —should itself be the principal target of any wellness program that purports to reduce risk in any specific individual.
But even when the next generation of programs better understands both its primary targets, and the wealth of relevant research already in place, the fundamental clinical challenge, the ability to apply that new science, is yet to be met.
For though the volumes of research produced by the emergence of that new science are certainly available to treating physicians in the form of raw data, they are not also available as useful information.
What’s needed is a clinical information technology that can reformulate that raw data as diagnostic strategies and clinical protocols —tools that will enable the practice of a new precision medicine by even solo practitioners —a practice of medicine that could within a matter of months begin to significantly reduce the entire nation’s risk for the onset of culturally driven diseases simply by renormalizing individual metabolisms; an unstable metabolism is the leading indicator of risk for lifestyle driven chronic diseases
Such an information technology is, in fact, being attempted by a number of startup companies whose vision of the possible hasn’t yet been frozen in the concrete of larger corporate cultures. Unfortunately, however, those startups have struggled to find individual investors who understood the vision well enough to fund it.
So, until both the White House and Congress both understand that the development of a clinical information technology —not a more efficient insurance plan — is this nation’s greatest and most important mission, it may be years before the practice of precision medicine will have its opportunity to make us truly well.
The writer is a former lawyer, legislator, judge, and C level financial and health care executive. He is currently General Counsel to an Ohio Bioinformatics company.