Michele Bachmann, Right About Health Care
Ricochet friend Jim Pinkerton has been saying for years, especially on his excellent (though slightly wonky) blog Serious Medicine Strategy, that we need to be thinking a lot bigger about health care than we are.
Right now, the sad, small-timers in the Obama administration are concentrating on allocating -- read: rationing -- resources.
Pinkerton has been arguing that we need to be focusing on curing diseases, not treating them. And he's apparently convinced Michele Bachmann, the hugely misunderestimated congresswoman and potential presidential candidate. From the Daily Caller:
There are essentially three ways to lower the cost of health care — two of which get all the attention. The first option, supported by many liberals, is bureaucratic rationing of care. The second option, supported by many conservatives, involves cuts in overall spending, plus the use of market forces, to control costs. The first two options are perpetually in conflict, and so far, at least, the two options seem to be fighting to a stalemate. But there is a third option for conservatives, which builds on the free-market/limited government model — and which offers the hope for a political breakthrough.
And that third option — currently being championed by Rep. Michele Bachmann — is to actually cure diseases.
Bachmann’s argument, which she first sounded on “Fox News Sunday” on May 1, is that [Paul] Ryan-type fiscal rigor needs to be linked to pro-medical science vigor. As she told Fox’s Chris Wallace, “We should focus on…cures — cures for things like Alzheimer’s, cures for things like diabetes. It’s very expensive to just cover the care for sickness. I’d prefer to see money that we have at the federal level go for cures.”
It is an interesting, albeit seemingly obvious, point — a cure is cheaper than care. But actually, it’s not so obvious. The idea of curing diseases as a health care strategy — as opposed to financing the care for those diseases — seems to have faded from the political discourse in recent years. Whether it’s Ryancare or Obamacare, both parties have chosen to focus on the mechanisms of health care finance, as opposed to health itself. The immediate question comes back: Are cures even possible?
And Bachmann has an answer to that, too, pointing back to past successes for a can-do America; as she told Wallace: “Probably one of the best examples is polio. If you look in the 1950s, polio was a huge issue. And government was forecasting at that point that we might be looking at $100 billion in costs. Today, polio costs us really virtually nothing. Why? A private charity, March of Dimes, put money in to finding a cure. We all have the little vaccines that Jonas Salk came up with. Thank God. I would like to see that with Alzheimer’s and diabetes and others.”
I love it when a conservative politician speaks eloquently and passionately and especially optimistically about health care. We shouldn't fall into the Obama Gloom trap. We're Americans. We solve problems. There's nothing intrinsic about health care to suggest that it's any different from any other technical or industrial problem. I like the way Bachmann is reframing the debate, and I hope she does more of it.
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Mar '11
Re: Michele Bachmann, Right About Health Care
At the risk of torpedoing my own argument, I think it also only fair here to point out an uncomfortable fact: the development of every medication and every vaccine on the market today was based at least in some part on government-sponsered research.
For years, academic researchers have provided the foundations in basic research which are then built upon by the pharmaceutical industry to create useful products. This relationship is not dissimilar to the internet: government-funded projects invented the original platform, but private enterprise has created the entities which are of value to society.
Even if we do need some government funding of basic research for pharmaceutical companies to survive, I still think the translation of this research into products should be the exclusive realm of the private sector. The plan endorsed by Bachmann and Pinkerton sounds to me like government meddling, even if it is for a good cause.
Science is not immune to the law of unintended consequences.
Jul '10
Re: Michele Bachmann, Right About Health Care
Rob Long
Isn't that the problem? I'm not clear what you're arguing...What she's saying is that only the private sector can think big.
Big Pharma complains about this all the time. They've even admitted they're no longer trying to cure AIDS.
Bachmann, at least, is identifying the problem: Big Government stifles innovation.
I agree that Big Government stifles innovation. AIDS, in the U.S., does not pose as big economic payoff as does other diseases. The problem with cancer is that many drug companies are emphasizing biomarkers (does patient have X cancer) for early detection rather than focusing on anti-cancer agents because therapeutics for many cancers caught early are efficacious. Breast cancer is imminently curable; ditto prostate. Ovarian and pancreatic cancer will take you right out. What gets the most funding? One word: boobs.
The argument as I saw it written is we can 1. ration care 2. cut spending or 3. find a cure for diseases. We have to cut spending in order to be solvent nation. #3 doesn't happen without debt reduction. As others have pointed out, the desire to centrally plan is strong...
Jul '10
Re: Michele Bachmann, Right About Health Care
Mendel: At the risk of torpedoing my own argument, I think it also only fair here to point out an uncomfortable fact: the development of every medication and every vaccine on the market today was based at least in some part on government-sponsered(sic) research...
Science is not immune to the law of unintended consequences. · Jun 6 at 2:21pm
With all due respect: Horsefeathers.The best selling pharmaceutical agent in history was discovered by Bruce Roth in a laboratory owned by Parke-Davis Warner Lambert. That research was pioneered by Akira Endo, who worked at Sankyo, another drug company in Japan. P. Roy Vagelos of some company called Merck, replicated his results. Roth built upon their research and made atorvastatin. Roth won the 2003 American Chemical Society Award for Creative Invention.
NIH or NSF were never mentioned.
Your statement disqualifies you from further discussion as you've imbibed the leftist premise for the argument. I can't tell you how many times I've heard that in academia and how many times I've batted that one right out of the park.
May '10
Re: Michele Bachmann, Right About Health Care
Michael Tee
With all due respect: Horsefeathers.The best selling pharmaceutical agent in history was discovered by Bruce Roth in a laboratory owned by Parke-Davis Warner Lambert. That research was pioneered by Akira Endo, who worked at Sankyo, another drug company in Japan. P. Roy Vagelos of some company called Merck, replicated his results. Roth built upon their research and made atorvastatin. Roth won the 2003 American Chemical Society Award for Creative Invention.
Horsefeathers, Michael- one statin's history doesn't encompass the range of pharmaceuticals. Go down the list of prescribed drugs, tell me how many were completely independently developed with no government or academic involvement. The fact is, development of medical therapies is symbiotic in a way that almost nothing else is.
On Alzheimer's, Elan is scrambling now to catch up after backing the wrong horse. You can't draw a clear line between academia and pharma on that disease right now, and a major drawback is the inability to get all the parties together sharing knowledge and reagents in the way that is essential because each component is trying to fence off its IP rights to the maximum extent. The problem is simply too big.
May '10
Re: Michele Bachmann, Right About Health Care
Furthermore, just as with orphan drugs, there are essential things that don't get done because no one party has enough of a financial stake to drive it. Alzheimer's is of interest only to the extent that you can sell a drug for long term maintenance therapy at patented new molecular entity (NME) prices. Find the preventive, and no one cares, because the payoff is in reduced nursing home care. Doesn't help Amgen a bit.
I've worked with medical venture capitalists- they frankly and bluntly like two kinds of investments: 1) cures for life-threatening diseases (e.g., cancer), and 2) long term maintenance drugs for serious, incurable, chronic disease (asthma, arthritis, osteoporosis, Type 1 diabetes).
There actually is such a thing as market failure- and that is not bad to admit. It usually isn't the examples that lefties try to pretend (e.g., mortgages), but it does apply to drugs and other medicine treatments. If the public policy consequences of market failure are costly enough, it is not only acceptable, it is the moral thing to do for government to get involved.
Our job is to make sure they do it the right way.
Re: Michele Bachmann, Right About Health Care
This is interesting stuff. A very smart debate. Thanks to all for helping think this through.
I sent the first part of this conversation to Jim Pinkerton and asked him to respond. Which he does below, in several parts, and with a chart!
Here's Jim:
I think that Michele Bachmann has it exactly right: we have to cut and control spending, of course, but we need to do it in a way that is ethically and thus politically sustainable. That's where the idea--not a new idea, of course, but an idea that's been neglected in the last two decades--of cures comes into play.
As the late Julian Simon reminded us, the "ultimate resource" we have, here on earth, is people. And that would mean healthy people. Because not only our healthy people happier, they are also more productive. From a purely utilitarian perspective, it makes sense to "amortize" (perhaps a bad word in context, but it's the best I know) all our human capital over a long and productive life. Indeed, over the last two centuries, increases in life expectancy have closely correlated with increases in real per capital input.
Re: Michele Bachmann, Right About Health Care
And of course, when an epidemic strikes, its prudent, as with any other disaster, to deploy resources toward resolving the crisis. That's how the US has won its wars. And it's also how the US has won its medical struggles.
It's what the US did to reduce malaria and yellow fever--such a reduction made the Panama Canal possible, and the US South a better and more productive place to live. Similarly, the successful efforts against most contagious diseases were a combination the science and technique of public health and then the bench science of making medicines. And on this, the 30th anniversary of the realization that AIDS was a killer, we learned that once again concerted action can solve a problem, and save lives. Once again, aside from significant humanitarian concerns, the economic benefits from longer lives for HIV+s have been estimated to be in the hundreds of billions, even trillions, by academics Philipson and Sun.
Mar '11
Re: Michele Bachmann, Right About Health Care
Michael Tee
The best selling pharmaceutical agent in history was discovered by Bruce Roth in a laboratory owned by Parke-Davis Warner Lambert. ...
NIH or NSF were never mentioned.
Michael, your example of Lipitor demonstrates my point. The enzyme that statins inhibit (HMG-CoA reductase) had been discovered years earlier in state-funded labs. That same enzyme would never have been found without elucidation of cholesterol synthesis in the body, which was also driven in large part by public-supported research. Akira Endo and his colleagues would not have known how to test their compounds without this body of government-financed knowledge.
Don't get me wrong: I have worked in academia, seen how inefficient and misunderincentivized it is, and support reducing public funding for research. But we shouldn't fool ourselves into thinking that private sector contributions to medicine over the last few decades were made without any government support. Hidden subsidies are everywhere in America, and pharmaceutical companies are no exception (even if we do punish them later with onerous regulations).
Edited on June 7, 2011 at 10:32amAug '10
Re: Michele Bachmann, Right About Health Care
Rob Long: Here's Jim:
...
As the late Julian Simon reminded us, the "ultimate resource" we have, here on earth, is people. And that would mean healthy people.
This might apply to diabetes, but unless we're also talking about extending the retirement age to 80 I don't see how this is a fiscal (as compared to humanitarian) argument for a very expensive push on Alzheimers.
Jul '10
Re: Michele Bachmann, Right About Health Care
Mendel
Michael, your example of Lipitor demonstrates my point. The enzyme that statins inhibit (HMG-CoA reductase) had been discovered years earlier in state-funded labs.
Edited on Jun 07 at 01:32 am
It is clear that neither you nor Duane know anything about drug discovery or read what I wrote.
The fact that research took place before the invention does not obviate the uniqueness of the invention. Again, the guy who discovered the first statin was Akira Endo at Sankyo labs in Japan. The discovery of HMG-CoA reductase came later.
At Merck.
Read your Vannevar Bush.
If you think that every scientific invention somehow is connected to some research that was funded by government by seven degrees of separation, you'd be right. But most of the life changing actual inventions were made by people in companies.
Your argument boils down to that the U.S. Constitution was based upon the thinking of Plato, Aristotle, Locke et al. and therefore it is not important at all that Madison wrote it.
Care to debate the discovery of the first transistor?
Nice try. But you both lose.
Edited on June 9, 2011 at 2:00am