Wednesday, March 24, 2010

The Unfinished Business of Healthcare Reform

It seems to me that Monday's celebrations over the passage of the healthcare reform act were a bit premature. As one of the 50 million uninsured, I couldn't help but notice a couple of things. Sure, I'll have to wait 4 years to get my coverage. The patients' exchanges have to be set up first.

But what if I'm in the group of 18 million uninsured whom Sunday's bill does nothing for? And what if I want an abortion? (Just kidding!)

Since when does taking care of 60% of a problem mean solving the whole problem? I'm sure President Obama didn't get into Columbia College and Harvard Law School getting 60's on his tests.

Here's the second thing that Sunday's bill didn't do: it did absolutely nothing to lower healthcare costs in the long run. Quite the opposite. It just committed the government to giving one or two trillion dollars to private health insurance companies with no guarantee whatsoever that the companies won't raise their premiums. Sunday's bill gave private insurance the same blank check that the government has already given Wall Street.

What's done is done, I suppose. As long as China keeps loaning us the money, I guess it doesn't matter which tiny group of rich people we make fabulously richer with taxpayers' money.

But how about a cost-neutral plan to take care of the forgotten eighteen million, a plan that would show the rest of the healthcare goniffs how to improve outcomes while lowering costs?

I'm talking, of course, about using the PHS. The PHS would be our public option, reconsitituted with the return of the VA's infrastructure and its $50 billion a year budget. It would continue to care for its current 3 million veterans, although this number drops by 1,000 every week with the death of WWII and Korean War veterans. But the new PHS would pick up the care of the abandoned 18 million uninsured, all for a cost of $50 billion a year.

If Medicare and the NIH (specifically, the NIDDK) bothered to do their jobs and eradicate 90% of kidney failure, now that it's been possible since 2002, there'd be an additional $50 billion a year available (see

The VA/reconstituted PHS could take care of 21 million without hiring a single extra staff member. Just get the current VA physicians, who see patients one half-day a week, to hold clinics four full days a week.

Then use the PHS to lead the way in lowering cost. Have the PHS report the outcome of each and every patient, each and every year. While Medicare is experimenting tentatively with clinical effectiveness research (CER), let the PHS take the problem seriously, using every one of its 21 million patients as a guide to what works and what doesn't, and how to do things more cheaply.

Then post the PHS's outcomes on the Internet for all to see. Patients in private health plans and Medicaid and Medicare, if they have any interest, can start asking their doctors why their toes are still being amputated, but diabetic patients in the PHS haven't had any amputations for the past 15 years. Patients with a bit more initiative might just drop their coverage, and let the PHS take care of them for free.

Of course, a free PHS that anybody could use would throw a monkey-wrench into the mandated health insurance system that just passed Sunday night. It would provide a free "out" to any American who didn't feel like paying thousands of dollars to a private insurer to get second rate care. It might even kill the exchanges, which I don't think would be such a bad thing, because the PHS is a much cheaper and more controllable alternative.

A robust and free PHS would certainly give all Americans more choice. It would ensure greater competition. It wouldn't cost an extra cent. It would provide an escape valve for any system that continued to price itself out of the reach of ordinary Americans, or went bankrupt, as the Massachusetts experiment is heading towards.

And, perhaps most importantly, a reconstituted PHS would save the VA's infrastructure from destruction, something nobody at the VA or the government is even talking about right now. For the first time in a long time, government would have demonstrated that it could grow taxpayers' investment over 80 years and return it to the taxpayers for their own use even better than before. For the first time in many years, the government would not have just flushed taxpayers' money down the drain.

Saturday, March 20, 2010

Tomorrow's Vote on Healthcare

Like most Americans, I've been calling and FAXing members of Congress for several years now about my plan for healthcare ( It's based on the unexpectedly awful experience I've had for the past 15 years with all the existing players in healthcare: the private insurance sector, the federal sector (VA, Medicare), the non-profits, academic medicine, the Institute of Medicine, the World Health Organization, et al. The whole gruesome story of all the authorities who've dropped the ball and refused to eradicate disease, presumably for their own financial gain, is laid out at

Lately, Congressional staffers have refused to speak to anybody outside their voting district. For the past few days, every number, including the FAX machines, at every office listed for every Congressman I've tried has been busy. Talk about feeling powerless!

Meanwhile, President Obama says that there is nothing new to discuss about healthcare, that all the ideas have already been discussed. I beg to differ. For 3 years, since the summer 0f 2007, I've tried to communicate my plan to his healthcare staffers. They turn out to be just as arrogant and inattentive as Hillary's. Funny thing! They're all the same people--Rahm Emmanuel and his brother Ezekiel are back again. Nancy-Ann De Parle was in-house counsel for Baxter, which profits from dialysis. No wonder she had no interest in me, since I can prevent 90% of dialysis.

As my father used to say, two things could happen tomorrow. (He liked dichotomous outcomes. In his own way, he may have been affected by Marx's dialectic. It certainly keeps things simple). One, the President's bill could pass. Two, it could fail.

While I personally hope that members of Congress will somehow find my FAXes and telephone communiques from the past few years before they vote tomorrow, I am not naive. I doubt if my input still exists, if it ever did. In any event, it's long since been consigned to the round file. Staffers must clean out their offices every night. Members of Congress will vote tomorrow purely with their gut. The time for facts and rational decision is long since gone. My own experience is that it never was.

No biggie. The net effect will be exactly the same. We're headed for bankruptcy.

Healthcare costs will continue to skyrocket. Medicare will go bankrupt by 2017, as predicted by its Trustees. Private insurance, even with government subsidies, will continue to price itself out of existence. Soon, only Fortune 500 CEO's and the few remaining labor union members left in the US will be able to afford private health insurance. The rest of us will have no healthcare insurance at all. We'll be one hospitalization away from personal bankruptcy.

Like any apparent catastrophe, this one has a silver lining. I happen to believe that the current healthcare system is so rigged against patients that even if it disappeared, patients would be better off. Here's why.

The current system, as everybody knows, makes money only when you're sick. When you're well, there's no money to be made. Science can finally keep you healthy, through this new field I love called "preventive molecular medicine." I first coined the phrase in 1996. Nobody else is using it yet, which just goes to show you what a real revolution medicine is in for. PM2, as I call it for short, is what medicine will become.

So it might not be such a bad thing for current healthcare to disappear. They certainly didn't want you to be healthy. Now that you're on your own, with a few dollars in your pocket, like a rolling stone, to paraphrase our generation's prophet, Bob Dylan, it turns out that's all you need to stay healthy. GenoMed, my Next Generation Disease Management company, can put off cardiovascular disease for perhaps a decade. Some things, like kidney failure, we can put off forever.

For the past decade, we've been working on cancer. Even with the vagaries of biotech funding, we've managed to find more cancer-causing genes than anybody else, about 2,500 per cancer for six common cancers: breast, colon, lung, ovary, pancreas, and prostate. Naturally, the National Cancer Institute and the American Cancer Society won't help us. This gives me hope: we must be on to something clinically useful!

I hope that (a) people hear about us through the Internet (in particular, I'd like to make the world dialysis-free by 2015); and (b) we bring in some cash soon to validate our cancer SNPs, so we can provide people with an early warning system for what cancer they're most likely to get.

For now, we can offer free Phase IV trials to anybody with Stage IV (metastatic) cancer, preferably in one of the six tumors mentioned above. But we would be willing to tackle any metastatic cancer, since there's a small number of genes (about 25) that show up strongly in all six cancers, and may contribute to other cancers as well.