Monday, July 30, 2012

A Health Care System to be Proud Of

I was not able to watch the 2012 Olympic opening ceremonies until last night. Though we are only half way through the spectacle on our DVR, I was remarkably surprised to find that featured among some of  the UK's proud traditions (the Queen, James Bond, Sir Paul McCartney, etc.) was a significant tribute to their national health service or NHS. According to the media guide, “The NHS is the institution which more than any other unites our nation."  Founded after World War II, the NHS offers universal health care to all of the UK's citizens.
This is not meant to be a post that necessarily supports a government run, single payer system or even the Affordable Care Act.  Rather, this is simply a musing on "what if" the US had a health care system that we could truly be so proud of that we too thought it worthy of such a national mention. Once can imagine that an opening ceremony in the US would likely feature similar historical events and sources of national pride such as our farmlands, Hollywood, "mountains and prairies," jazz music and maybe even Elvis; but probably not Medicare and Medicaid. Yet, our we really that far off?
We have some of the best trained doctors, skilled health care workers and the most technologically advanced hospitals in the entire world.  People travel from all over just to received their health care in the US. Yet, despite the many marvels of the US health care system; not all of our citizens have access to it, many that do can not afford it, and the escalating costs of care will likely cause our country to go bankrupt if something is not done done.
Part of the problem, in my opinion, is that we aren't seeing this as a national problem to be solved.  Our health care crisis has become so politicized, that nothing seems to be getting done (despite the ACA's passage). Not only have Republicans blocked Democratic health reform initiatives at every step of the way, but also remember that it was in-fighting among Democrats the lead to the failure of passing health care reform with a Democratic controlled House, Senate and Oval Office.  In addition, all stakeholders including doctors, hospitals, insurance companies, pharmaceutical manufactures, patient groups, etc. seem so entrenched in their positions; that no one is willing to budge and nothing appears to be getting any better.
But what if we saw our country's health care crisis as a national priority? What if politicians, stakeholders, and citizens all came together and decided that we as a country needed a solution now and, like "The Manhattan Project" got the greatest minds working together to create a uniquely American solution to health care? Surely that would be worthy of an opening ceremony mention.
I recognize that this vision is likely very unrealistic.  However, the way in which the NHS was featured during the Olympic opening ceremonies in London certainly gave me pause, even if just for a moment, to wonder "what if."

Thursday, July 19, 2012

What if IVIG really worked for Alzheimer's?

ABC News and other media outlets are reporting the results of a small, but very important study regarding a new treatment for Alzheimer's Disease.  Most Americans are familiar with Alzheimer's because it is so common (President Reagan had it), so devastating, and without a cure.  This new study gives hope to people who have or are at risk for the disease.

This week at the Alzheimer's Association International Conference 2012 in Vancouver, researchers presented the positive results of a study using intravenous immunoglobulin, or IVIG, to successfully keep Alzheimer's disease at bay.  Controversy exists because the study was very small (16 patients total), of which 11 patients took IVIG for three years and showed improvement thinking, memory, daily functions and mood.

Immunoglobulins are part of the human immune system.  They are made naturally and help ward of a variety of infections and disease. IVIG has been used to treat a variety of auto-immune disease. Though no one is 100% sure how IVIG works, it is though to have antibodies against amyloid.  Amyloid is a protein which accumulates in the brains of patients who who have Alzheimer's.

Though most experts caution current use in the general public and are clear that more research is needed, many believe this is a very good sign indeed.

However, let's assume that the research is proven correct, and that IVIG actually does work well for most patients to treat Alzheimer's disease.  One of the problems is that IVIG is not cheap.  Since it is a blood product it is expensive- you need to get it from human donors, you need a nurse to administer it, and it must be given in a doctor's office or hospital. It is given once every two weeks, with an estimated to cost a patient $2,000 to $5,000.

According to data from Alzheimer’s Association, there are 5.4 millions American’s with Alzheimer’s. If we take the low estimate of $2000 every other week, it would cost $280 billion each year to treat patients with Alzheimer's. In 2012, the direct costs of caring for those with Alzheimer’s to American society will total an estimated $200 billion, including $140 billion in costs to Medicare and Medicaid.  Essentially what this means is that it would cost nearly $100 billion dollars more each year to treat patients with IVIG and prevent Alzheimer's progression, than to simply treat this very expensive disease.

Though in some instances, like vaccines, an ounce of prevention is worth a pound of cure.  However, in many examples, medical treatment is very expensive and keeping people alive and well cost more in the long run. It is our skyrocketing health care costs that plague our health care system and if we don't fix the problem soon, it could bankrupt our country.  Resources are not limitless.  Since much of our health care is funded with taxpayer dollars, we as a society are going to have to make some very important decisions. If we decide that we think it is worth paying for everyone who has Alzheimer's to get IVIG for example, we are going to need to decide what we are not going to pay for to keep costs down.  These are difficult decisions.  The problem is that these types of conversations or not really happening today because the health care debate has become more about who will be the next President than actually solving our country's problems.