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AcademyHealth 2018 National Health Policy Conference

Policy Talk Tries Shifting Conversation About Who Pays for What in Healthcare

Allison Inserro
We have been living in a groundhog world for the past several decades when it comes to healthcare spending, said Robert Dubois of the National Pharmaceutical Council (NPC) during AcademyHealth’s National Health Policy Conference, in Washington, DC. The session called When Are We Going to Get Serious About Health Care Spending in the United States? came a few days after the NPC launched an effort to have a dialogue around this issue by issuing a call for research around the topic and partnering with Health Affairs on a campaign called Going Below the Surface.
 
We have been living in a groundhog world for the past several decades when it comes to healthcare spending, said Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council (NPC), during AcademyHealth’s National Health Policy Conference, in Washington, DC.

Dubois asked his audience, in a session called When Are We Going to Get Serious About Health Care Spending in the United States, to vote on who should oversee making the tough decisions about where healthcare funds are spent—the government, doctors, insurance companies, patients? The session came a few days after the NPC launched an effort to have a dialogue around this issue by issuing a call for research around the topic and partnering with Health Affairs on a campaign called Going Below the Surface.

“We keep having the same discussions about too much waste in the system, too much low-value spending,” Dubois said.

“We can’t keep kicking the can down the road,” he said, citing new advancements that prolong life or are curative, such as chimeric antigen receptor (CAR) T-cell therapy therapy for B-cell precursor acute lymphoblastic leukemia (ALL) in pediatric patients, or hepatitis C drugs. The treatments prolong life or are curative, but at huge expense.

While everyone in the country wants these innovations to continue, but we are running out of ways to pay for it, Dubois explained.

These dialogues are not going to be easy, he said, citing a few of what he called “third-rail” issues that need to be addressed, such as:
  • How much, and how should, health spending be allocated?
  • Should we shift money from end-of-life care or treatment for rare diseases?

One of the panelists, Amitabh Chandra, PhD, the Malcolm Wiener Professor of Public Policy and director of Health Policy Research at the Harvard Kennedy School of Government, called himself “the skunk at the garden party” for diving right into those third-rail issues.

“What is the price of our values?” is his retort when he is asked, as an economist, what is the right amount to spend on healthcare—because how much society spends on anything is a question of values, whether it is heathcare or education.

“We spend 18% of [gross domestic product on healthcare], but the problem is we don’t insure everyone,” he noted.

And then there are the tradeoffs. Who decides what to cover and whom to cover?

As an example, he cited Tarceva for advanced pancreatic cancer, which costs $600,000 per year of life gained, versus Hercepetin for advanced breast cancer, which costs $100,000 per each year of life gained.



 
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