A very telling measure of a nation’s priorities is how well it treats those who are perhaps the most vulnerable among its constituents — children, the elderly, the poor and the sick and injured. If we examine the United States’ health care arena, currently we are thriving neither in biomedical research innovation nor in access to basic health care services. If America truly wishes to achieve its purportedly “self-evident” commitments to “Life, Liberty and the pursuit of Happiness” — noting that the first mentioned among these ideals is Life — then further actualizing the availability of biomedical resources is critical and nonnegotiable. We cannot afford to settle for mediocrity (at best).
The premiere federal agency funding basic and translational biomedical research is the National Institutes of Health. Each fiscal year, under the purview of the United States federal discretionary budget, NIH funding is defined by Congress during appropriations processes. From approximately 1998–2003, Members of Congress on both sides of the aisle readily agreed to double the NIH budget — thereby expanding opportunities for Nobel laureates, young investigators and embryonic scientists to develop and share new knowledge. By contrast, today many of these individuals find a research environment with such burgeoning resources unimaginable. In fact, as a result of the Budget Control Act of 2011, a severe sequester went into effect in 2013, cutting the NIH budget by nearly $2 billion — a total cut of approximately 5 percent. Further, the government shutdown in 2013, resulting directly from an impotent, divided Congress, caused great losses — some of which were irreversible — of laboratory and clinical resources. During that year, in fact, Yale professor Dr. James E. Rothman ’71 shared the Nobel Prize in Physiology or Medicine for his work on cell membrane trafficking, showing how vesicles fuse with cell surfaces such that transports arrive at their appropriate destinations. Shockingly, he noted that he lost grant funding for this very work. The potentially lifesaving efforts of the most promising experts and budding scientists are being extinguished.
Fiscal year 2016 showed a very modest gain in NIH funding — a sum totaling approximately $32.3 billion. However, the funding levels have remained mostly stagnant for 13 years: The NIH appropriation in 2003 was approximately $27.17 billion. Biomedical innovation cannot withstand such severely malnourished conditions, stagnation and neglect. It is especially demoralizing to embrace these dollar figures in light of the nearly $6-trillion price tag of the wars in Iraq and Afghanistan — with additional trillions owed by the United States in projected interest payments, due by 2053. These data show clearly where federal priorities lie.
Furthermore, with the Affordable Care Act’s provisions in effect as of 2014, the landscape of medical care in the United States is in a dynamic state of reform. Fortunately, at present the law expands access to health insurance for nearly 20 million Americans, and there are data suggesting that the changes in federal reimbursement policies to medical institutions are helping to control health care spending and expenses. Still, however, even individuals with reasonable insurance coverage may not have sufficient access to high-quality medical care. And even if appropriate care is available, individuals often spend exorbitant sums on high deductibles and copays. Often, important questions remain about whether the value is commensurate with the price tag.
Health care spending in the United States constitutes approximately 18 percent of the GDP — a very high proportion compared with other social goods. (And this percentage is projected to rise.) One of the most telling reasons for this large sum likely is that corporate medicine seems unable, if not unwilling, to craft and manage reasonable pricing policies and transparency such that the “customers” know and consent to that for which they must pay. Instead, corporate medicine prefers to execute mergers and acquisitions to dominate markets, maximize profits and price gouge, forcing many into bankruptcy. In fact, the number-one cause of bankruptcy in the United States is medical bills. Alas, even if an individual’s “bleeding” were resolved at a given health care institution, the same institution may cause — even if inadvertently — a financial hemorrhage for the patient. Why does America tolerate such cruel and unusual punishment, condoning grave economic predation?
Throughout history, nations have failed in different ways, some more than others and with different degrees of reversibility. I hope and believe that America is capable of supreme innovation, if it makes and honors a commitment to promoting biomedical investigation, and if it actualizes fully caring for each of its citizens — not just its wealthiest.
Carolyn Brokowski is a graduate of Yale College. Contact her at firstname.lastname@example.org .