By Suresh Kumar
Obsession with repealing the ACA without a coherent alternative or goal and the scourge of Ebola striking yet again in the Congo lead me to conclude that policy makers and industry leaders need to be more grounded on the purpose of their endeavors. They must articulate national and global aspirations and how industry can profitably and sustainably support the common good. Agreeing on the what is a prerequisite for not disagreeing on the how while determining the pathways to pursue. These steps also help address waste, fraud, and abuse to immediately contain costs.
U.S. PUBLIC POLICY 101: PLACING BETS TO IMPROVE OUTCOMES AND BEND THE TRAJECTORY OF COSTS
Understanding why, where, and how government spends monies helps frame what society seeks, how it pays for what it seeks, and its ability to hold government and industry accountable for what it seeks. Understanding these factors also helps show how public health fits within a broad framework of national policy (See table: 2020 Hindsight — U.S. Federal Budget 2020). Here are a few truisms:
Our policies abandon affordable alternatives of prevention and preemption. For example, funding diplomacy and international development will reduce or prevent conflicts, decrease the loss of American lives, and reduce tragic health-related costs of war. In some of my past columns I’ve explained the real and current danger of not prioritizing and promoting prevention in our healthcare policy. Caring for a growing population — and one with an increasing incidence of chronic disease — via a medication-in-perpetuity model is myopic; it will neither improve health nor bend the cost curve.
What should our healthcare policy accomplish? Should it:
Aligning programs and priorities is impossible without clarity of purpose.
PROTECTING THE VULNERABLE AND INSULATING ALL FROM INFECTION
Ebola first struck in 1976 in the Congo. Over the years, the disease has spread, with cases being detected in the U.S. and the U.K. Consequently, there has been increased public focus on the global risk of the disease and the flawed readiness and response protocols to combat infectious disease in general.
Today, we are far from preventing, detecting, containing, and eliminating the disease. Consensus between donor and recipient nations regarding the purpose of global public health policy remains as elusive as efforts to objectively measure progress. Defining the shape, cost, and funding of interventions, and which innovations will be pursued, is daunting but addressable.
Although it’s necessary to create conflict-resolution initiatives and build roads, power grids, cell towers, and hospitals in large urban centers, all of these tasks are outside the remit of global public health. These must be the responsibility of local governments and international and aid-giving institutions. What must global health policy accomplish for donor or recipient governments, the WHO, or other UN and UN-like agencies, and for civil society? Some suggestions include:
THE WAY FORWARD
Thanks for the many comments on my last column. Reader Tom Haling asked, “When free markets do not deliver the great solutions that they generally do, what is the role of public policy? Solving the problem? Changing the incentives to the free market? The system and companies are focused on ’tending to the sick’; pharma annual reports have a profitability focus. We need to improve our education system. We need to include wellness in the curriculum.”
I stated in my inaugural column, “I will share my perspective, raise questions, and paint a picture of the emerging future.” My goal is to provoke thinking and enroll more of us to help build better public health policy. We are well on our way on that journey.
SURESH KUMAR serves on the board of Jubilant Pharmaceuticals and Medocity. Formerly, he was U.S. Assistant Secretary of Commerce and Executive VP at Sanofi.