The current issue of The New Republic is devoted to health care. An essay by Jonathan Cohn presents a thoughtful and personal analysis of how universal coverage would not necessarily slow medical innovation.
Universal coverage doesn't have to kill innovation
By Jane Sarasohn-Kahn on 13 November 2007 in Uncategorized
Cohn talks about how his good friend and fellow writer, Michael Kinsley, was diagnosed with Parkinson’s Disease over ten years ago. In the past decade, Kinsley has searched for an effective treatment, and came upon Deep Brain Stimulation (DBS). DBS represents a medical innovation: a new-new treatment that was approved by the FDA only 10 years ago. Cohn is quick to point out that DBS costs a lot of money: $50,000 and $60,000 for the treatment.
According to the American Association of the Neurological Surgeons, deep brain stimulation is a surgical procedure involving implantation of electrodes into deep nuclei of the brain.
Cohn and Kinsley wondered whether a health system based on universal coverage would provide access to DBS to patients with Parkinson’s Disease. Cohn carefully examines the implications of universal coverage on innovation and access. He concludes that it’s not a straight-line logical argument to assume that universal health coverage = the death of medical innovation. This is an argument that many anti-universal coverage pundits often make.
Cohn notes that the DBS innovation came out of France, and not the US. Furthermore, Cohn writes, “Nearly every country in Europe covers DBS under its national health insurance system, even England with its famously low spending and scrutiny of new treatments. People over 70 can’t always get the treatment in those countries, but, in part, that’s because many physicians believe it’s not usually worth the risks at that age.”
Ironically, in the US, Medicare covers DBS but, according to Medtronic (the manufacturer of the electrodes used in DBS), many private insurers have denied coverage of DBS.
Health Populi’s Hot Points: One of Cohn’s key points is that broad funding of basic science research inspires a great deal of medical innovation. The National Institutes of Health is the largest funder of basic science in the world — not just in the US. Half of that money is allocated to university-based research, which is where so many innovations emerge. Cohn notes that, “There’s no reason why this has to change under universal health insurance,” since the NIH is funded separately from health care financing. We should be vigilant in the US to continue to fund this research stream to the greatest extent possible. It is one area of Federal spending that generates benefits far beyond the initial spend.