The room was full of medical researchers at a top research institution. A bioethicist strolled in — and told them the government should stop sending billions of dollars in research grants if it wants to fix health care.
That money produces too few results and drives up the cost of health care, said the bioethicist, Daniel Callahan (pictured).
Needless to say, not everyone in the room shared his view.
Callahan, director of of the Yale University/Hastings Center Joint Program in Ethics & Health Policy, was one of four speakers at a forum Tuesday afternoon billed “Health Care Reform: The State of the Debate.” It took place in Winslow Auditorium at the Yale School of Epidemiology and Public Health on College Street. The event was not itself a debate, but an opportunity for four experts to weigh in on the subject.
Callahan was provocative.
“I must say I had a very perverse reaction to [U.S. Sen.] Arlen Specter, who was very instrumental in getting $10 billion added to the NIH [National Institutes of Health] budget in the stimulus package, and particularly making the case for cancer research,” Callahan said. “My God, pouring another $10 billion into NIH is a surefire way to keep raising the cost of health care.” (Click here for the story on that episode.)
Click here for a recent story on the minimal drop in cancer deaths compared to the drop in deaths from other major diseases.
Callahan said many proponents of health care reform promote dealing “with access, quality and cost all in one package. De facto, that turns out to be very hard to do.”
He gave the example of Massachusetts’ health reform experiment. It has provided almost universal access. But costs keep rising, presenting a threat to its long-term viability.
“I’m interested in the long-term problem of cost control and I think one has to speak the truth, even if speaking the truth means you will harm the drive for universal access,” Callahan said. “So I put cost first, realizing it may actually do some harm but nonetheless in the long run maybe that’s the only way to go.”
A woman in the audience rose to the challenge.
“To say that in an academic medical center is very brave,” she said. “I don’t know if this is a direct parallel, but it’s almost like saying, ‘Let’s not support astrophysics because going to the moon is a waste of money.’ There’s so many reasons why research in the medical field is absolutely invaluable, and it doesn’t necessarily lead directly to treatment outcomes. But how are you going to know which treatments work and which don’t, if you don’t have research?”
“My simple point is, like it or not, I think this is factually the case — that health care costs and research costs ran parallel for 25 years,” Callahan responded. “The research is doing great things, but it’s impossible to pay for it. It’s a dilemma, that’s all I’m pointing out.”
Another panelist, Yale emeritus professor Ted Marmor (pictured), chimed in.
“I think there’s a sharp distinction to be drawn between what the merits are of university-based research in biomedical sciences, and the question of whether or not that’s compatible with controlling inflation in a system where you don’t have good inflation controls,” said Marmor, who has been an influential voice on national health care policy for decades.
Then audience member Lauren Serven spoke up. “I would think that a better place to start for savings is to cut out insurance middlemen, and that points to single payer coverage,” she said. “I would just urge everybody who feels something in this direction to speak up, because obviously our legislators need to know that.”