An opinion piece in the Wall Street Journal last Friday caught my attention because of the way it illustrated the many common misunderstandings about health care reform. The article, "Health Reform and Cancer" (http://http://online.wsj.com/article/SB10001424052970204886304574306693989102298.html) is written by Myrna Ulfik, who is battling non-Hodgkin's lymphoma as well as uterine cancer. Despite having gone to Germany to obtain a cancer vaccine that is not yet approved for use in the United States, the author argues that our current health care system works, it just needs some tinkering.
I have been a health and medical writer for the last twenty years and have closely followed all the activity surrounding the recent reform movement. To begin, I am puzzled by her basic argument that the American health system works. If the American health care system works as well as she seems to feel it does, then why did she determine her best option was to seek treatment elsewhere? In the article, she explains how she determined her own course of action, traveling overseas to obtain the cancer vaccine she felt she needed. To me, her experience indicates that our system fails people with time, intelligence, and financial resources. It goes without saying that our system fails the 47 million people who have no health insurance. For them, traveling to Germany for a special vaccine is unthinkable. And for a person in this country without insurance, the care received may come too late in the illness to preserve quality of life.
According to Ulfik's WSJ piece, the British health care system denies state-of-the-art drugs to cancer patients. Whether or not this is true is debatable, but just because the U.K. does it one way doesn't mean that their system is a blueprint for America. The proposed plans being considered by Congress generally provide for "effective" medicine to be used. If a medication or treatment works successfully with a majority of patients, it will be recommended.
In the Wall Street Journal article, it is implied that expensive tests and therapies (like the latest chemotherapy or cancer vaccine) will be rationed. But that is not the aim of the current proposals; the aim is to reduce all of the waste in the system, specifically the unnecessary tests and procedures that are often performed. Atul Gawande astutely points out the misaligned incentives that led to this problem in his article, "The Cost Conundrum" (The New Yorker, June 1, 2009, http://http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande). Gawande provides several examples, including cardiac catheterizations for uncomplicated chest pain and gallbladder surgery for first-time gallstone pain. These remedies are the types of waste targeted by the proposed legislation, not innovative therapies for cancer.
Ulfik also worries that reform will slow medical progress. The U.S. government has rarely been able to finance what would be considered innovative research. Nonprofit organizations raise money for their research divisions, and these organizations are the ones who provide funding for scientists who present interesting, out-of-the-box thinking. For example, with a puzzling illness like lupus, scientists apply to organizations like the Lupus Research Institute (http://http://www.lupusresearchinstitute.org/) where a board of scientists and physicians award grants to promising proposals. With this initial money, scientists can often take a project to an acceptable state of accomplishment to justify why the government should provide further funding. That's the way the system works now, and it is not expected to change. Health care reform is what is being discussed; not health research.
The misunderstandings put forth in the Wall Street Journal piece are a good reminder of the aspects of health care reform that are most often ignored in our current conversations. Tomorrow I will elaborate on some of the issues that are not being discussed frequently enough.
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