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By Don Howard
10/09/07
The Archimedes Movement and the Laboratory Industry
Don Howard, M.D., Ph.D., Chairman, CellNetix Pathology and Laboratories
“Give
me a lever long enough and a fulcrum on which to place it and I shall move
the world.”
—Archimedes (287-212 BC)
The forces for change impinging upon the laboratory industry are great. These
include a host of economic, demographic, and political influences as well as
scientific advances. Mergers, acquisitions, consolidations, competitive bidding,
and government regulations all are contributing to a re-sculpting of the laboratory
landscape. Which of these forces has the greatest possibility for impact on
the laboratory world, and what effect would that impact have? Likely, the force
most powerful is the one that will eventually change the face of medicine in
America: The looming health-care crisis.
In response to this pending crisis, a revolution is quietly brewing in the
far northwest of America, led by former Oregon Governor John Kitzhaber, M.D.
This is a revolution, not of arms and violence, but of vision and ideas. The
health-care crisis potentially is of dramatic proportions, and it requires
immediate significant bipartisan action on the Congress’s part.
Some history: The financing and delivery of healthcare in America is based
on programs that were created in response to the economic and demographic environment
that existed 50 to 60 years ago. The country has changed dramatically since
then, yet we are still attempting to use an antiquated health-care delivery
system, a system that was built around “categorical eligibility” (Medicare
and Medicaid), not “universality.” Today, more than 45 million
Americans lack health-care coverage. Economic and demographic realities are
now such that Medicare will not be economically sustainable in the future.
In 2004, Medicare accounted for 8 percent of all federal income from taxes.
This figure is estimated to rise to 19 percent in 2015 and to 32 percent by
2025. Medicare’s total liability (unfunded) is estimated at more than
$65 trillion. At this rate, America faces economic collapse in a fashion analogous
to the Soviet Union when it bankrupted itself by trying to outspend the United
States militarily.
This staggering weight of debt casts an ominous shadow over our children’s
future, and it suggests that healthcare is quickly becoming an issue of economic
security. Our financial stability as a nation is at risk, and we are transferring
power and influence to countries like China and others, which, at some point,
may refuse to underwrite U.S. deficit spending. Refusal on the part of these
countries to underwrite U.S. deficit spending could precipitate a currency
crisis, soaring interest rates, and a stock market collapse.
The Archimedes movement, by generating opportunities for public engagement,
is providing a mechanism for action by creating a fairer fair, more equitable,
and more sustainable medical system. The political process cannot, by itself,
solve this problem as it is inherently biased toward inaction.
Americans need medical coverage to which all citizens have access. We need
a system that produces health or wellness, not one that simply reacts to sickness:
a system that organizes the delivery of care efficiently and effectively and pays
for what works. We need a system that is fair to all and does not pit citizens
against one another; the old against the young, the rich and middle class against
the poor.
The Archimedes movement vision statement is as follows: “To maximize
health by creating a sustainable system that reallocates the public resources
spent on healthcare in a way that ensures universal access to a defined set
of effective health services.”
This vision is elegant in its simplicity. The adoption of a policy of universal
coverage for a defined basic group of effective health services subsidized
with public resources. All citizens paying taxes, regardless of their economic
circumstances, would contribute to the subsidy, and all Americans would be
covered for the same basic benefits. Citizens who want access to health services
not covered by the basic package would be free to purchase them at their own
expense. This creates two standards: One for that part of our health-care system
that is financed with public resources and a second standard for that portion
that is financed with private resources. This proposal is not a Canadian-style,
single-payor system.
Consider a similar situation: In the United States, because of the widespread
recognition of the importance of education, we have a policy that entitles
all children to a publicly financed education from the first grade through
high school. This is of value not just to individuals, but to society as a
whole. Our schools are publicly subsidized with general tax revenues, ensuring
availability to all. Everyone who pays taxes contributes to this subsidy—rich,
poor, people with children, people without. All children receive the same basic
benefit, everyone is included, and the public pays for the same benefit for
all. However, parents who wish to give their children additional educational
opportunities, in the form of private school, can do so, but the cost is not
subsidized by the general public.
General Principles Proposed by the Archimedes Movement
1. Universality/inclusiveness
2. Equitable/fair/just
3. Population benefit (greatest benefit for the largest number of people)
4. Value (lowest cost for highest possible quality)
5. Efficiency (use of fewest resources necessary for highest quality)
6. Effectiveness (outcomes measured by unbiased, objective evidence)
7. Economically sustainable
8. Explicit decision-making
9. Transparency
10. Community-based (unless outcomes better elsewhere)
This year (2006), within the proposed Oregon Health Act, 10 categories of
health conditions have been created with priorities ranked within each category
from most important to least important. This ranking will be based upon the
comparative health benefit of the treatment of each condition for optimizing
the health of the entire population. These prioritized conditions (medical
care for which society deems necessary for the general good of all) would be
funded to the extent financially possible. Consumers with elective, discretionary,
or lower-priority conditions would share in the cost. These proposed categories
are as follows:
1. Prevention
2. Pregnancy and childbirth
3. Acute life-threatening conditions
4. Acute non-life threatening conditions
5. Catastrophic conditions
6. Chronic life-threatening conditions
7. Chronic non-life-threatening conditions
8. End of life
9. Rehabilitation
10. Elective conditions
Major reform of our health-care system requires definitive action by the U.S.
Congress. But action by Congress will not occur without pressure, which is
already beginning to build. In order to drive this process, three steps are
necessary, as stated by the Archimedes movement:
1. A vision of a new health-care system must be clearly defined.
2. The contradictions and inequities of the current system must be exposed.
3. A “tension” must be created between the vision and the status
quo.
The success of this strategy depends on the capacity of people to come together
around a common vision and to build a clear, compelling, and broadly supported
vision of what a more equitable and sustainable health-care system should look
like. The Archimedes movement has articulated that vision, and the fusion of
individual people into one force has begun.
So…should this revolution, or one like it, succeed and actually change
American medical care, what would be the direct impact on the laboratory industry?
With a two-tiered system (basic coverage for all, optional coverage for those
who want it and are willing to pay for it), what economic forces will come
into play and how will these forces reshape the scope, delivery, and cost of
laboratory services? Speculate. A train is coming. Get on board, or get off
the tracks.
Use of materials and information provided by the Archimedes movement and Dr.
John Kitzhaber are gratefully acknowledged in the preparation of this article.
References:
Oregon Better Health Act (Oregon Senate Bill 27)
www.archimedesmovement.org
www.wecandobetter.org
The Archimedes Movement
-Vision and General Principles
-On the Road to Revolution: Fear and Loathing in the U.S. Health Care
System
-Rebuilding the Ladder of Opportunity
John Kitzhaber, M.D.
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