What The New Republic Got Wrong On Health Care

See More Central Planning: The Failed Panacea for Health Care Reform by Ronald Bailey of Reason. Excerpts:

"Callahan and Nuland boldly (and pessimistically) declare that at the heart of our dysfunctional system is the fact that are “no imminent, much less foreseeable cures for the most common and most lethal diseases.” Yet good news abounds: In May, the Centers for Disease Control and Prevention announced that average U.S. life expectancy has risen to an all time high of 78.2 years. In fact, age-adjusted death rates in the United States show that the risk of mortality at any given age have been declining substantially. In 1950, the death rate was 1,446 per 100,000, falling to 1,039 per 100,000 in 1980 and further to 741 per 100,000 in 2009. Age-adjusted rates show that, despite the fact that the U.S. population has been aging over the past half-century, the risk of mortality has actually fallen by half.

The three biggest killers are diseases of the heart, cancer, and strokes, which account for nearly 60 percent of deaths in 2009. In 1950, 1980, and 2009, the death rates for heart disease were 587, 412, and 180 per 100,000 respectively. The cancer death rates in those same years were 194, 208, and 174 per 100,000. The rate death from strokes were 181, 96, and 39 per 100,000. (A good bit of the cancer death rate increase from 1950 to 1980 was the result of increased tobacco smoking. In 1965, 42 percent of U.S. adults smoked. Just around 20 percent do now.)

Americans still do die of infectious diseases, but nothing like they did in the past when the death rate for tuberculosis in 1900 was 194 per 100,000, which fell to 46 per 100,000 in 1940. The current TB death rate is 0.2 per 100,000, and the rate of tuberculosis infection fell to an all-time low in the U.S. of 3.6 per 100,000 last year. Even the U.S. death rate from HIV infections has fallen from 10.2 per 100,000 in 1990 to 3.7 in 2007.

Modern medicine cannot take all the credit for these declines in age-adjusted mortality. A recent study suggests that declines in risk factors such as smoking reduced heart disease rates more than medical interventions. Nevertheless, medical innovations have helped.

Cancer has been a much tougher nut to crack. The latest data shows that “overall cancer incidence rates decreased by approximately 1 percent per year” and that cancer mortality rates have been falling even faster at around 1.5 percent per year. It is good news that modern medicine has increased the five-year survival rates of cancer patients from 50 percent in the 1970s to 66 percent today."

"Are Callahan and Nuland right to suggest that we are coming to the end of our therapeutic rope? I think not. The two men are correct that stem cell therapies and new treatments based on genomic science have been oversold. Nevertheless, the next biomedical revolution is just getting started.

Just this week, hints of how the future will unfold were reported by leading journals including a much more effective new treatments for advanced melanoma, and a new preventative drug for breast cancer. Last year saw the development of a vaccine to treat prostate cancer. A new study recently found that retroviral therapies dramatically reduce the transmission of HIV and work continues on developing a vaccine against HIV. As antibiotic resistant strains of microbes develop, researchers are looking for new ways to target them and new ways to disarm them. Further down the road, RNAi (ribonucleic acid interference) might be used to treat heart failure, and stem cells to repair broken spinal cords. Successful treatments for obesity would shift the prospects for increased health in old age.

But Callahan and Nuland may grant that such treatments could be developed, and still remain convinced that something will break in our bodies in any case, resulting in (expensive) disease, disability, and inevitably death. The reply to their objection is clear: The only way to stay healthy is to prevent aging. Luckily, out on the horizon are possible therapies to do even that, including sirtuins and compounds that extend the ends of chromosomes, called telomeres."

"As evidence that medical progress is not affordable, Callahan and Nuland cite the now-standard litany of how health care costs are spiraling out of control, absorbing an ever larger fraction of our economy. They are right that such spending increases are not sustainable.

They have correctly identified the symptom—unsustainably rising costs—but missed the cause of the disease. Vast subsidies, increasingly administered by a system of centralized top-down management are the leading cause of American medicine's process of “destroying itself.” Nobody in the system—not physicians, politicians, insurers, nor patients—has historically had any incentive to try to rein in spending on health care.

Callahan and Nuland perfer to see "a centrally directed and budgeted system, oversight in the use of new and old technologies, and price controls.” They are like fiscal homeopaths in reverse. Instead of treating the patient with attenuated versions of the substance linked with an illness, they want to increase the dosage massively. If their prescription doesn’t kill off American medicine, it will certainly end up killing a lot of patients."

"One of the chief causes of our current health care malaise is the increasing centralization of the health care budget. In 1965, the health budget of the federal Department of Health Education and Welfare totaled $1.9 billion (about $14 billion in today’s dollars). Then Congress approved legislation establishing Medicare and Medicaid whose costs have increased exponentially since then. Medicaid enrollment increased from 18 million Americans to 68 million now and costs state and federal governments nearly $400 billion last year. Similarly Medicare enrolled 19 million Americans at a cost of $10 billion. Today nearly 48 million Americans are receiving Medicare coverage at a cost of more than $500 billion. If government agencies were able to rein in health care costs, they have had nearly 50 years to prove it."