How Medical Breakthroughs Could Save a Sick Health Care System

​It’s easy to lament the current state of the U.S. health care system. Monthly medical insurance premiums, along with various services and drugs, cost way too much – with no end in sight. People ration pills or treatment, or file for personal bankruptcy because they can’t afford to pay their hospital bills. Navigating care practically requires a personal assistant. Doctors are almost always paid based on volume and not value. Misdiagnosis is a serious problem. Pharmaceutical kickbacks run rampant. I could go on, but I digress.

While there’s much to gripe about, and with good reason, all this white noise can eclipse some pretty exciting developments.

Case in point: the emergence of precision medicine, which as its name suggests, tailors treatment to each patient’s unique genetic or molecular profile and condition. What’s so promising about this customized approach is the opportunity to prevent disease, improve clinical outcomes and reduce costs for patients, insurance carriers, employers, doctors, etc. To allay privacy concerns, health plan operators must comply with the Genetic Information Nondiscrimination Act. 

Perhaps nowhere is the potential for progress more breathtaking than in the area of prescription drugs to ensure that patients receive the correct medication at the right dose and duration.
As I wrote in a recent trade magazine cover story, a pharmacogenomics test “can evaluate how hundreds of drugs interact with an individual’s genetic makeup and suggest an ideal clinical pathway for each patient.” Their power is undeniable as a means of achieving better control of rising costs associated with a myriad of chronic illnesses.

One knowledgeable industry source I interviewed used a baseball analogy to guess that medical science is in the top of the third of nine innings on implementing precision medicine, which means there’s still a lot more that needs to be done. Seventeen years after cracking the code on how to sequence the human genome, we’re clearly at the cusp of a new era that by today’s standards sounds a lot like science fiction.

Another noteworthy development that’s gaining traction is telemedicine, also known as telehealth. The virtual delivery of care through video conferencing, telephone calls, email or text messages has the potential to save a substantial amount of both time and money. Diagnosing the common cold, flu, skin rashes, or similar conditions in this way bypasses notoriously crowded waiting rooms, reduces unnecessary visits to urgent care or emergency rooms, lowers tardiness and absenteeism, and improves productivity and patient satisfaction. A telemedicine call typically is $40 compared with $125 for a traditional office visit. The approach also is being applied to mental health visits.

It’s remarkable to watch marketplace innovation, but the latest and greatest medical treatments will be out of reach for most Americans unless there’s enough meaningful competition or reasonable price controls. Shopping for health care isn’t like buying a car or groceries because services are priced in an opaque or arbitrary fashion. Consequently, it may be only a matter of time before Uncle Sam steps in to end the madness.

Conservative columnist Charles Krauthammer last year predicted that there will be a single-payer health care system in the U.S. in less than seven years. While blasting
ObamaCare as a failure “at every level,” he said it changed expectations to a point where most people believe the federal government should guarantee health care for everyone.
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The clock is ticking, and unless the marketplace adjusts, we’ll all be paying this price in terms of higher taxes and a serious commitment to expand the reach of government. Whether it will be worth the investment, a disastrous turn of events or somewhere in the middle, no one really knows. But everyone can agree that the current system is perverse and unsustainable. Unless we take substantive action to reform it for the long haul, we’ll never cure what ails us and health spending as a share of Gross Domestic Product will far exceed the nearly 18% rate that economists have calculated.