Learn More About Health and Medical Research

What is the Problem?

What are the Solutions?

The Frontiers of Medical Research
     Who Funds Medical Research
     Promising New Research: Stem Cell Research

Public Opinion and Medical Research


What is the Problem?

Health Care
Based on their experience, more Americans understand that our national health care system desperately needs an overhaul. In public opinion polls, health care now ranks as one of the top three public concerns, eclipsing terrorism. By an 84-12 margin in one recent poll, Americans think there should be more money spent on health care instead of federal tax cuts. Our nation has the most advanced medical technology in the world as well as the highest rate of any industrialized nation of citizens with no insurance. Currently, this includes nearly one in six Americans, with more added every year.

Health care should be a social commitment in our society. The commercial interests of health care providers and employers over the last 25 years have outweighed the social and economic interest of better insuring and caring for all citizens. This is the reason the United States is the last industrialized nation not to have universal health coverage. Forty-one million Americans are currently without health insurance. Most of them work.

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The United States has the most costly and least efficient system in the world. The World Health Organization ranked the United States 37th of 191 countries for “overall health system performance;” 72nd for “level of health,” and first for “health expenditures per capita.” Distorted costs, quality and access have plagued the health care system for the last 25 years. The real crisis has not been the absence of a policy to fix these problems (many exist on paper) but lack of political will. The leading players have yet to reach a consensus that their common problems are greater than their differences—the prerequisite for any overhaul.

A report, “Hidden Costs, Value Lost: Uninsurance in America,” released on June 17, 2003 by the Institute of Medicine of the National Academies, estimated that the United States loses between $65 billion to $130 billion annually due to the poor health and premature death of the 41 million uninsured Americans. The annual losses likely exceed the costs to provide the uninsured with insurance by $34 billion to $69 billion. To estimate the value that would be gained if health insurance were extended to all, the authors of the report calculated the “health capital” of the uninsured—the value of an individual's health over future years of life—including the subjective value of being alive and healthy, earning potential, and children's physical and mental development. The estimated value of improved health that an uninsured individual would gain ranges between $1,645 and $3,380 annually.

Those with insurance face a private bureaucracy which has imposed double digit premium increases in the last several years on the public, forcing many small businesses to end or restrict coverage. Those in HMOs or even the higher cost PPOs are well aware of the delay in payments and the turning down of crucial medical procedures. There has been far too little accountability in the system. Individuals inside the for-profit hospital or medical system know all too well the “downsizing” of nurses and other critical medical personnel.

Though a number of states have attempted to redress this imbalance by passing Patients' Bill of Rights, some members of Congress have blocked any comprehensive federal legislation. Most insurers and HMOs will oppose any reforms that threaten their control of the health care system and record profits. Private insurers have become a problem but could be part of a solution if there was a national policy to insure everyone in large enough risk pools. Insurers must accept increased regulation and administrative cost controls for the public good.

This model was just accomplished in Maine under the Dirigo Health Plan, which will work with private insurers to guarantee health coverage to all residents of Maine. Maine is not a rich state, but the Governor and state legislature made a commitment to make this happen. Premiums will depend on income and employment status. There will be a watchdog group, the Maine Quality Forum, to oversee the program. This combination of public and private money and oversight could become a national model. California has become the second state to require employers to insure their employees.

Our present system of public and private health care is our historical accident. Employers first started offering health care as a bonus to certain employees and as the result of collective bargaining by unions. Favorable tax treatment allowed it to spread. Because the costs were reasonable and employees came to expect it as a term of employment, more and more Americans were insured. Medicare was added to cover seniors and Medicaid was offered to low income Americans without employer-based health care.

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During the 1990s, there was progress, adding millions of children to basic insurance through the CHIP program. Now it seems that we are going backwards. Businesses are reluctant to hire full-time employees because of exploding health care costs. This hurts continuity and productivity. Even healthy individuals find the cost of buying individual family insurance to be prohibitive.

Many businesses that oppose government regulation as a matter of course now would welcome some increased role by the government. A poll of California business executives revealed the following: 79 percent of executives reported that “HMOs and insurance companies” were “very responsible” for “the problems in the current health care system”–the most to blame for those problems. Fifty eight percent indicated that they “support universal coverage.” Executives registered overwhelming support (70 percent) for “increased government funding to expand community health clinics.” Most were initially hesitant about the idea of “a system where health insurance is not linked with employment, and instead all businesses pay to a health care fund a fixed percentage based on the company's size” (35 percent in support versus 55 percent opposed). However, more than two-thirds supported the idea (70 percent in support versus only 22 percent opposed) when it was qualified with the question: “Would you support this if it guaranteed that all your workers and their dependents were covered, and it would cost your business less than it pays now in health care costs?”

Savvy business executives understand that the current system is inefficient, clogs our emergency rooms, and wastes valuable resources and time for both medical personnel and human resource departments. There is little support for maintaining the current system except inertia and special interests like the private insurers and HMOs. Fear of what a better system might look like has also stymied reform. Our nation must move forward and solve this problem.

There is enough money collected in national premiums to cover everyone in America with basic health insurance. The United States has the most costly and least efficient system in the world. The political question is how the money in the U.S. health care system will be allocated and what the role of the private market is in what is a clear public good—better health care for the greatest number of our fellow citizens. A universal system will save money in the long run.

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What are the Solutions?
What should our health care system look like in the future? Certainly if we designed it from the point of view of medical professionals and the public, it would have the following elements–universal coverage, comprehensive benefits portability (coverage with an individual not a job), cost effectiveness, accessibility, quality assurance and accountability to patients and the broader public.

Universal coverage means coverage for every patient in the United States. Obviously, there must be a discussion about residency or citizenship in this regard.

Portability means adequate coverage for everyone that would follow an individual and not a specific job.

Cost effectiveness means there is a national health care operating budget with room for negotiated fees and economies of scale. There would be a clear effort to eliminate waste and fraud. Administrative costs would be capped at 10 percent for any entity that provides for or arranges care. The new system will be publicly financed and privately delivered.

Accessibility means leveling the playing field, regardless of income or disability. Deductibles or co-payments should not be insurmountable barriers to treatment.

Quality assurance and accountability refers to public oversight of costs and quality of care. This can be done locally with boards comprised of doctors, nurses, hospitals, health care providers and citizens, and following national standards.

This is a solution that would not only change the balance of power of medical care delivery but also would benefit the public. It would also help many in the business community who would like to get out of the health care business but would continue to shoulder some of the financial burden in exchange for ridding themselves of the administrative costs and added burden of managing health care programs.

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What we are advocating is not what has been labeled “socialized medicine.” We want to take the best aspects of American medicine and improve on them with private delivery and much lower administrative costs. The original HMO concept administered by physicians on a non-profit basis would be a good place to start. By focusing on preventive health care, the original HMO model tried to ensure that small health problems did not become bigger ones. By stressing prevention, there was also a vital focus on nutrition and exercise to promote individual wellness.

Instead, our current system moved away from the original conception to what critics have labeled “mismanaged” care. Now small problems often become bigger because for-profit bureaucracies refuse to order a second test or an MRI for symptoms that could potentially be treated cheaply, compared to the eventual costs. Instead of preventive medicine, what we now have is a system that has an incentive to profit by second-guessing doctors over what is a medically necessary treatment. It is a system that is designed to often ignore what is medically right.

Some tout free market solutions for health care, but any large-scale inefficiencies have long since been realized. Companies now make money not by better administration but by squeezing doctors and raising premiums.

As an example, overhead for the Medicare system is two percent of the system's costs while private plans spend from about 15 to 20 percent to do the same thing. Private plans use that money for large staffs, salaries and profits. In Medicare, it is spent on the patient.

Unless one owns stock in or works for a for-profit HMO or insurer, which system is better for the public? Certainly it is in the public interest to regulate the amount of money that private insurers can take out of the system in profits and inflated overhead. If triple the overhead of Medicare was not sufficient for private companies, then perhaps, the system should be entirely administered by non-profits.

Comprehensive patients' rights legislation would help ensure that HMO bureaucrats do not override doctor's decisions. This combination of reforms would save money and provide Americans with a system that better meets our medical needs. It is our individual responsibility to maintain our health through diet and exercise wherever possible, but as a nation, we need to take steps that benefit our society as a whole. This means major reform of our current system to better serve civil society.

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The Frontiers of Medical Research
Hardly an American family has not been touched by the ravages of cancer, heart disease, diabetes, Alzheimer's, spinal cord injuries, Parkinson's or Lou Gehrig's disease. These diseases can be costly in terms of human suffering, lost productivity and adding to the already sky rocketing costs of medical insurance.

But investment in medical research is good for patients who are suffering AND adds value to the US economy. Consider the following:

• Increases in life expectancy in just the decades of the 1970s and 1980s is worth $57 trillion to Americans–a figure six times larger than the entire output of tangible goods and services in 1998. (Source: Exceptional Returns: The Lasker Foundation www.laskerfoundation.org).

• Gains associated with prevention and treatment of cardiovascular disease alone in the 1970s and 1980s totaled $31 trillion. (Source: Exceptional Returns: The Economic Value of America 's Investment in Medical Research)

• Medical research that reduced deaths from cancer by just one percent would be worth $10 trillion to Americans. (Source: Exceptional Returns: The Economic Value of America 's Investment in Medical Research)

• The total economic value to Americans from reductions in mortality from cardiovascular disease averaged $1.5 trillion annually in the period from 1970-1990. (Source: Exceptional Returns: The Economic Value of America 's Investment in Medical Research)

• The treatment of diabetes consumes 25 percent of Medicare's annual budget.

• Heart disease and stroke will cost the US almost $330 billion in 2003.

• Alzheimer's disease costs American businesses more than $61 billion annually.

• Significant progress in research to cure juvenile diabetes has resulted in more than 250 diabetic patients receiving islet cell transplantations, with 80 percent of the patients becoming free from taking insulin shots after a one year period. While the problems of immune suppression after transplantation must still be researched, the fact that 80 percent of the patients were successfully treated remains an important step along the path to a cure for this devastating disease. (Source: Juvenile Diabetes Research Foundation International www.jdf.org).

• The cancer death rate has dropped more dramatically for children than for any other group. Up to 70 percent of all children with cancer can now be cured. (Source: Research! America www.researchamerica.org).

• The ability to diagnose breast cancer earlier has saved the lives of women.

• A new treatment (hydroxyuera) for sickle cell anemia has increased the quality of lives of those affected by this disease. (Source: Research! America )

• Cases of cavities in the permanent teeth of school-aged children have been declining in the United States for approximately 20 years.

• In the last two years alone, pharmaceutical companies have added over 100 new drugs in the national medicine chest, including important new treatments for heart disease, organ transplants and Parkinson's disease.

• Having a stroke won't always mean suffering from a disability afterward. The discovery of a “clot busting” drug called tissue plasminogen activator (t-PA) can give stroke victims 30 percent greater chance to recover with little or no disability if taken within three hours of the initial stroke.

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Who Funds Medical Research
There are many sources of funds for medical research. The mainstay of federal funding for medical research is the National Institutes of Health. It distributes taxpayer money, the amount determined by Congress, to universities, medical schools, hospitals, and laboratories in virtually all states across the United States. In addition, the Centers for Disease Control and Prevention, the National Sciences Foundation, the Veterans Administration and the Agency for Healthcare Research and Quality also fund medical research.

Funding also comes from private companies and voluntary health organizations and foundations such as The Juvenile Diabetes Research Foundation International, the American Heart Association, Christopher Reeve Paralysis Foundation, Alzheimer's Foundation and others.

The dollar amount for research expended by government agencies depends on public advocacy, since Congress votes upon it. Without significant federal funding for medical research, opportunities will be lost to alleviate the human suffering and economic burden of disease.

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Promising New Research: Stem Cell Research

Stem cells are cells with the capacity to reproduce themselves, and to produce distinct differentiated tissue. There are many potential sources for stem cells. Embryonic stem cells are derived from the inner cell mass of a blastocyst (a very early embryo). Adult stem cells are derived from mature tissue like skin cells.

Stem cell research holds enormous promise for curing diseases. These cells could be the “missing link” needed to cure some of the world's most deadly diseases like heart disease, certain forms of cancers, Alzheimer's disease, ALS, spinal cord paralysis, Parkinson's disease, and diabetes.

The hope with stem cell research is that researchers will be able to direct embryonic stem cells to develop into tissues, organs, and nerves that could serve as the missing link needed to cure disease. For example, researchers hope that one day stem cells could be coaxed into becoming beta cells located in the pancreas to cure juvenile diabetes.

Stem cells come from excess fertilized eggs that were created by couples trying to become pregnant through in vitro fertilization. When couples attempt to become pregnant, many more fertilized eggs are created in order to improve the chances of achieving one pregnancy. The excess eggs are stored in freezers at in vitro fertility clinics. There are approximately 100,000 of these excess eggs that will be thrown away if they are not used for stem cell research or offered to other infertile couples. Nearly half of the couples that undergo in vitro fertilization say they would like to see some good in research come from their excess eggs.

On August 9, 2001, President Bush announced his stem cell policy whereby the National Institutes of Health would be able to fund embryonic stem cell research from a limited number of cell lines that were in existence prior to his announcement. At the time, the Bush Administration announced that there were 60 stem cell lines in existence that could be used for medical research.

In the spring of 2003, it has become clear that 60 stem cell lines DO NOT exist. Only 11 stem cell lines exist.

The Coalition for the Advancement of Medical Research (CAMR), a coalition of patient groups, science organizations, and medical research organizations, have questioned the President's commitment to stem cell research because of the existence of significantly fewer stem cell lines. Michael Manganiello, President of CAMR, stated in a press release that “We still do not have the 60 cell lines promised, only 11 are available for researchers, and we believe that only one stem cell line owner is actually sharing its line with research labs. The Administration has not created a sufficiently positive environment for embryonic stem cell research to flourish, nor have they been as aggressive in implementing their policy as they should have been.”

Manganiello continued, “In the end, this all comes back to the 100 million Americans suffering from life-threatening diseases and conditions who could be helped from advances in embryonic stem cell research. The stakes are high, and the potential benefits could mean the difference between life and death for the families we represent,” added Manganiello.

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Public Opinion and Medical Research

Public Opinion Strongly Favors Embryonic Stem Cell Research

• The majority of Americans (regardless of religious affiliation) support embryonic stem cell research.

• Independent opinion surveys show that public support is overwhelming–70 percent or more.

• These same polls demonstrate that there is strong backing among evangelical Christians, Catholics and abortion opponents for the use of fertilized eggs that would otherwise be discarded after use in in vitro fertilization.

Public Opinion Strongly Favors Government Priority for Medical Research

Polls taken by Research! America show strong support for funding for medical research. Findings include:

• Ninety seven percent of Americans believe that it is very important or somewhat important for the United States to maintain its role as a world leader in scientific research.

• Seventy four percent of Americans believe that it is very important or somewhat important for Congress to support tax and regulatory policies that encourage private industries to conduct more medical research.

• Eighty six percent of Americans would be more likely to support a candidate for public office if they support research to find cures for and prevent disease.

To become an activist in medical research, go to www.stemcellfunding.org. This site offers frequent action alerts on how to influence policy on stem cell research.

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