Personalizing medicine to combat the cost of health care

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But just as we have begun to make real progress, a new board of bureaucrats known as the Independent Payment Advisory Board (IPAB) could bring it to a screeching halt. Created under the Affordable Care Act, IPAB is mandated to make cuts to Medicare spending. In addition, these cuts are based on an annual spending rate, which is just the kind of short term fix that will undoubtedly result in further rounds of cuts in the years following.

Given the influx of baby boomers into the Medicare program, every member of Congress can agree that addressing rising health care costs is a priority for reducing the nation’s growing deficit. Republicans have already taken the first step by offering a strong stance in support of health care cost containment and strategic, long term health care reform as opposed to IPAB’s narrow mandate to focus on short-term cost reduction. Not only does a short term focus hold big risks for patient access to care, but also for the development of new, advanced diagnostic tests and treatment combinations, which may cost more on an individual basis in the short term, but help control costs over the longer term.

Take, for example, the important research being done by the Center for Urban Population Health in Wisconsin, which implemented a study on a commonly used blood clot prevention drug named Coumadin. Though effective, this medication has a high rate of side effects for patients which inevitably results in additional visits with their physician until the right dosage is found. To address this, researchers are studying the effects of different dosages of Coumadin based on individuals’ varied genetic makeup. Through this type of research, physicians will learn how to perform genetic testing and determine dosing recommendations, so a patient receives the right dosage the first time. However, under IPAB’s discretion, the resulting long term improvement of patients’ health would not justify the short term cost of research.

Equally troubling is the fact that patients, physicians or researchers in the field of personalized medicine will have no mechanism to raise these kinds of concerns. Once these IPAB recommendations are offered to Congress, they can only be overturned if lawmakers propose an alternative method for meeting the spending target or through a vote that has at least a three-fifths majority in the Senate.

Throughout the deficit debate, Americans are depending on elected officials to never lose sight of the end goal of preserving access to quality health care. Through advances in personalized medicine, we can not only preserve this vital program, but also shift the health care paradigm from one that is reactive and generalized to one that is proactive and personalized. By laying the groundwork for responsible reform and refusing to shirk responsibility for these important decisions, Congress has the chance to establish an innovative and sustainable future for Medicare. Allowing a board to make the tough decisions our elected officials should be making will ensure we never get there.

Nancy Johnson is a former Member of Congress from Connecticut. She currently serves as a Senior Public Policy Advisor for Baker Donelson.


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