A few weeks ago, I went to the Aspen Institute which just held an astonishingly good symposium on health. Special thanks to Michelle McMurry. It was particularly amazing and interesting to hear the talks of Peter Agre and Michael Bishop whose stories about winning the Nobel prizes were fascinating because both started in many ways as outsiders to the world of biology and without the relentless pre-professionalism of today’s kids and perhaps because of this initial distance changed science and medicine as we know it.
The obvious focus at the conference was on the train wreck that is US health care today. It became clear at the conference that if things continue as they are right now, we will manage to be spending $4.4 trillion dollars by 2015 or almost the entire Federal budget and still be delivering less than high quality health care and probably not solving the new epidemics of obesity and diabetes in this country. Clearly, this can’t go on. We are currently spending over 16% of our GDP on healthcare whereas France is around 8% and our overall health is worse. To go to the projected 30% would be a disaster and it was telling that not one but two heads of the congressional budget office (one past and one present) were attending the conference. One of the moments I found most unintentionally ironic was Bill Frist saying that of course we needed universal insurance as an obviously frustrated Elizabeth Teisberg pointed out with her usual lapidary clarity that insuring all would actually be cheaper because we would have preventative medicine rather than disaster handling, clinic care rather than ER care, and much less money spent by insurers trying to duck covering people since all would be guaranteed coverage. Where were the Republicans on this during the last eight years? But there was a thoughtful discussion about how this, all by itself, isn’t a solution, and we need to alter the system to actually reward people for good overall care and wellness of patients and good outcomes rather than paying doctors for procedures. It short we need the system to help keep people well rather than only treat them (at best) when they are sick.
There was an interesting talk given at the conference where it was claimed that of the four things you want from insurance:
- Access for all
- Affordable by all
- Quality care
- Constant innovation
you can only get two. The European system was held up as one that delivers on access and price, but not quality. Frankly, while I’m aware of some of the long and even unacceptable waits in the UK and the limited access of cancer patients there to new drugs, it isn’t clear to me that Europe isn’t in general getting three out of four while we get only one (innovation).
The most striking and shocking graphs at the conference were about type II diabetes and its rise in this country from a rare occurrence to a national epidemic in just 16 years due to an epidemic of obesity. Watching the time lapse graphs of this spreading across the US is like watching some terrifying science fiction movie about aliens taking over the country except that this is real and has happened. The terrible cost of this disease will dwarf that of cigarette smoking which, even now, kills 440,000 US citizens a year or ten times as many as breast cancer for example and compared to all coronary disease killing about 2,400,000 a year including those due to cigarettes. As it is, we cannot afford Medicare and as I said above, within eight years the cost of the current health system is projected to approach the total cost of the entire Federal government and we haven’t saved any money for this. Furthermore, incredibly, despite these crushing expenditures we are getting worse outcomes and longevity than countries spending half of what we do such as France and Japan.
So the focus was largely on why do we have this catastrophe and how do we do better? I’ll talk more about this later. While sitting at this conference it was depressing to watch the Republicans fighting and Bush vetoing the proposed extensions to SCHIP where the states are trying to extend to just guarantee medical coverage to poor kids who otherwise aren’t getting it where again the alternatives are ER room, much more severe problems, years of illness (these are kids!), or families going deeply into debt to keep their kids healthy.
It was fascinating to learn about how much genetics is now able to play a role in diagnosing illnesses and in even predicting high risk, but my overall take was that while it is amazing what we do now know, it is still a very very long step from here to actual drugs which take advantage of what we know to cure the diseases in question. What genetics clearly can do for us, even today, is start to inform us about when we need to live our lives with particular care because of an unusually high risk of diabetes or breast cancer or ventricular fibrillation.
Overall, I was struck by two very basic points:
- We need to work much harder to help people stay healthy. The epidemic we face is largely avoidable. If we could reach out to the huge number of people currently at risk of type II diabetes or in the early stages and just get them to eat better and slightly less and exercise 30 minutes a day, we’d literally save this country hundreds of billions of dollars or thousands of dollars for every man, woman, and child in this country not even counting the terrible costs in lost productivity and illness and poor quality of life for those who suffer.
- If we can just agree that the job of medical care is to keep people well or get them better and reward people for doing this well rather than paying insurers and middlemen and doctors for procedures, we would save even more not even counting again the terrible costs in lost productivity and the damage to our overall competitiveness.
I was asked in some comments since I restarted blogging to discuss what I learned while running Google Health at Google. It is a delicate subject because I’ve publicly blogged about a fair amount of what I learned and some of the rest I think is now Google’s business. So, I’ve added a sidebar listing the talks I did give publicly on health while I was still at Google. This is a starting point for learning what I learned while working on health during the last two years.
Lastly, while I was at the conference, Microsoft launched HealthVault. I want to commend Microsoft for launching HealthVault in Beta. The web desperately needs an ATM networks for health records so that we can find and connect to the expertise we need online with our health data as context be it interpreting our labs or warning us about medicine issues or helping us recover from an illness. I read a snarky blog complaining that they were copying Google Health. I don’t see it that way. They launched. They are doing a good thing. Consumers need to be able to take charge or their health data and control it. Not the federal government. Not the hospitals. Not the insurers. Us. Even if Google does launch something similar, competition is a good thing for all of us. That being said I certainly hope that Microsoft follows the principle that our health data is our data for us to control and allows those of us who put data into the health vault to easily take it out of the health vault or copy from it electronically if we so choose and provides an open doorway to those who have programs to help us make sense of our health data. But I bet they will and if so, congratulations to them.