Politics. Does health care as an issue have the political power it once did? It is a question that will be answered this summer as the debt ceiling – the last remaining vehicle for compromise on Capitol Hill – gets a turn in the barrel.
In 2013, the U.S. Government shut down over funding for the partisan Affordable Care Act, including the expansion of Medicaid. Today, as federal health care expenditures have ballooned to half of the budget, will the health care defenders still be at their posts?
The demographic shifts of the last decade seem to suggest the vigor of earlier debates may not be there. In 2012, the 1947 cohort aged into Medicare. In about five years, the last of the post-war generation will be eligible.
Behind them is a nasty demographic trough, replaced in a decade or so by a generation that got the short, sharp end of the health care stick. This younger cohort has gotten used to high deductibles and equally stratospheric premiums. After the catastrophic policies of COVID and the aftermath we are just now encountering, it is easy to see why a call for political help might go unanswered.
Perhaps not this summer, but soon.
Policy. Cancer, has been the obsessive focus of federal health care policy since Richard Nixon – a man desperate to change the subject in 1971 – asked for and got the National Cancer Act.
Since then the National Cancer Institute has grown to be the largest at NIH with a budget of over $6B. At his State of the Union address, President Biden asked for reauthorization of the National Cancer Act and more resources under the 21st Century Cures Act. His goal is to reduce cancer deaths by 50%.
But, wait, be still my heart! PoliticoPro carried an article last week, quoting Dr. Ezekiel Emanuel at the University of Pennsylvania and Dr. Gilbert Welch and Brigham & Women’s Hospital in Boston, that suggests the cancer money spigot needed to be throttled back a bit, maybe a lot.
As Dr. Welch points out, behavioral changes have been the most decisive in reducing deaths from cancer. Deaths from lung, bronchial and esophageal cancers have declined significantly since the 1990s. That victory primarily goes to local, state and federal policies that discouraged tobacco use. For all the focus and billions of research dollars, death from breast cancer has barely budged.
Research’s poor record, frequently disguised by bad drug approvals that offer little in the way of succor, is not going to change course. There is simply too much at stake for anyone to admit they are (mostly) wrong.
No, a change in policy will come when people with low risk of cancer, due to their age, assume power. That could happen as early as next year.
Power. If there is any good that has come out of the sheer public health insanity of the last three years and the commensurate rise in distrust of federal health bureaucracies, it has to be the increased emphasis on evidence-based medicine.
The opaqueness of American health care has made it difficult to ask simple questions like, “does this work?” With the path to objective analysis blocked, greater emphasis has been placed on the good word of physicians and federal regulatory authorities.
Alas, they have lost the thread. With evidence for two of the most divisive public health policies ever conceived falling aside – mask wearing and the superiority of vaccine-induced immunity –in favor of, you know, that pesky thing we call evidence, it appears patients have a right to ask more question.
Bill Maher may have his detractors but his challenge to the public health status quo has been unflinching and right. When it comes to cultural change, in this case a reversal of the medicalization of American life, nothing works quite like comedy. See also, George Carlin.
Have a great rest of your long weekend.
Emily Evans
Managing Director – Health Policy
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