|
|
| Home | Current Issue | Archives | Topic Collections | Search | Blog | Subscribe | Contact Us | Help |
From the Editor |
America’s Love Affair With Medical Innovation
Rising health care costs are once again causing an up-roar, and pharmaceuticals are in the crosshairs. As private health plans demand double-digit increases in their insurance premiums, they are identifying the soaring cost of prescription drugs as the major culprit. But drug prices are only a part of a more complex equation, which also involves providers’ growing muscle to negotiate better deals with health plans—a derivative of the consumer rebellion against tightly managed care—and society’s enchantment with all forms of medical innovation. If past is prologue, the preference for ever more technology will trump rising costs at almost every turn, even in a slowing economy, because most Americans believe that the frontier of medical miracles is endless, and thus far they have been willing to pay for progress.
This enduring belief holds as true among politicians as it does among the public. It is most vividly documented by the remarkable bipartisan support of Congress, with the full concurrence of the Bush administration, to double the budget of the National Institutes of Health (NIH) over a five-year period (1999–2003). Whatever the NIH and its private-sector partners innovate, third-party insurers generally end up paying for—usually in the form of better, more expensive treatments; more of them; or both. So confident is Congress in the public’s strong backing of this massive new investment—following an estimated 400 percent real (inflation-adjusted) increase in spending on federal health-related research from 1970 through 1998—that it felt no need to engage the electorate in a national discussion of this initiative. While public research expenditures have been growing rapidly, private research outlays have grown even faster and have overtaken the government’s total commitment in this sphere. A recent international reading of the public pulse reported that Americans are much more interested in new medical discoveries than are most Europeans (see Minah Kim and colleagues, pp. 194–201). Interestingly, while Canadians share Americans’ strong interest in medical discoveries, their provincial health insurance plans invest only paltry sums in new technology.
Congress may soon face the innovation imperative from another more challenging angle: figuring out how to add prescription drug coverage to Medicare. Who should be covered? How expansive should the benefit be? And how should the bill be divided between retired beneficiaries and active workers? Congress has not voted on financing Medicare drug coverage for more than a decade. Thus, members of Congress and their staffs are faced with a critical need to gain greater knowledge of the Medicare/drug connection and the pharmaceutical industry in general. To help close the information gap, this issue is largely devoted to papers that shed new light on the quest for more effective diagnostic and therapeutic products.
We commissioned a number of the nation’s most respected policy analysts and researchers to write papers for this volume. Unsolicited papers that matched the theme were included, making for a large but timely issue. In our lead paper David Cutler and Mark McClellan discuss a critical question: Is technological change worth the investment? Victor Fuchs and Harold Sox, through a survey of internists, explore the relative value (to patients) of thirty medical innovations over the past three decades. J.D. Kleinke discusses the price of medical progress, while Alan Garber focuses on insurance coverage policy as the financial gateway for new medical technologies, with a perspective from Medicare’s coverage chiefs (Sean Tunis and Jeffrey Kang). Other innovation topics include the technology-induced shift to the outpatient setting (Patricia Danzon and Mark Pauly); the controversy over treatments for breast cancer (Michelle Mello and Troyen Brennan); and how patents and drug regulation work in tandem to limit drug market competition (Rebecca Eisenberg).
We gratefully acknowledge support for this issue provided by the Merck Foundation and the National Pharmaceutical Council. We also acknowledge the important contribution of Peter J. Neumann of the Harvard School of Public Health, who served as an editorial consultant to this issue. On another note, a paper in the May/June 2001 issue regarding the plight of hospital nurses in five countries hit a sensitive nerve. It generated as much newspaper and television coverage, along with responses from individual nurses in practice, as any essay we have ever published.
Founding Editor
| Home | | | Current Issue | | | Archives | | | Topic Collections | | | Search | | | Blog | | | Subscribe | | | Contact Us | | | Help |
|
© 2001-2001 Project
HOPE–The People-to-People Organization |
||||||||||||||||