One of America’s most prominent physicians takes exception to one of the nation’s top health care officials in what is, well, one of the most hotly debated policy issues in medicine: Would universal health care, sponsored and regulated by the government, be a barrier to medical innovation?
It’s a thorny question that’s sure to elicit some passionate responses. Case in point: The disagreement between Dr. Eric Topol, founder and director of the Scripps Research Translational Institute, and Seema Verma, who heads up the sprawling Centers for Medicare & Medicaid Services (CMS).
Verma’s role at CMS involves overseeing massive public health programs such as Medicare, Medicaid, and the Affordable Care Act. She’s a persistent critic of government-sponsored medicine, which she says stifles innovation and attenuates patient choice; she’s also taken to social media to slam Obamacare on multiple occasions (even as she’s technically tasked with administering the health law).
So Verma’s recent statements decrying the burgeoning “Medicare for All” movement shouldn’t come as much of a surprise. “One of the things that troubles me in terms of how we go forward with technology and innovation and harness that to solve some of our most difficult problems is there has been a lot of discussion about government-run health care around ‘Medicare for All.’ I think those proposals are the greatest threat to innovation in health care. The reality is government has often been a barrier to innovation,” she said at a recent conference in Boston, according to MobiHealthNews.
“I think we all have to recognize the important role that the U.S. plays in bringing innovation to the entire world, and recognize it is the private system that we have in place that is spurring innovation, and be very careful about those initiatives that would put more government in control and would thwart innovation going forward,” she continued.
Topol rejects the general sentiment. “Noteworthy that @SeemaCMS can say that providing #healthcare for all US citizens is “the greatest threat to innovation in healthcare’… I couldn’t disagree more, whatever it is called—Medicare or Mediscare—must be considered a civil right,” he wrote in a tweet on Tuesday.
The replies to Topol’s tweet underscores what a controversial subject this is in the health world. What’s the right way to balance what many see as a moral necessity versus the specter of negative externalities that do more harm than good? Does guaranteed health care access truly preclude innovation?
Some prominent minds who are significantly above my pay grade have weighed in on the subject. And several argue that this doesn’t have to be a case of either/or. In fact, the entire debate may be improperly framed.
“We have confused the issue of how we pay for care—market-based, Medicare for all, or something else—with how we spur innovation,” Harvard’s Dr. Ashish Jha told the New York Times’ Aaron Carroll and Austin Frakt back in 2017. “In doing so, we have made it harder to engage in the far more important debate: how we develop new tests and treatments for our neediest patients in ways that improve lives and don’t bankrupt our nation.”
That entire Times article is worth a read. Jha, health economist Craig Garthwrite, and others point out that America is exceptional in amount of medical innovation it produces (the U.S., for example, has the world’s largest number of clinical trials, and and strong patent protections alongside the profit motive are correlated with increased innovation).
But the same experts point out that the carte blanche, pure market approach can lead some drug makers to charge significantly more than the value of their products. The pharmaceutical (and, for that matter, hospital and doctors’) industry’s refrain that price caps and government mandates are a slippery slope to rationing and diminished care quality have been met with some mixed evidence. Veteran health reporter Jonathan Cohn penned an in-depth story for The New Republic more than a decade ago outlining several criticisms of that argument (including the undeniable reality that American health outcomes are considerably worse than many developed nation peers’ despite our innovation advantage).
What do you think about this—especially if you work in the health care space? Please feel free to shoot me a line—I’d love to hear your thoughts.