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Interview on Healthcare, Law and Bioethics in the US

Screen Shot 2017-10-01 at 12.11.11 PMA shoutout to Anthony T. who dared to ask me questions for a mid-term interview he has in his coursework. His questions, along with my answers are below – which if you read in depth are just more questions…there are no easy answers in heatlhcare. (Caution: the opinions below are mine and mine alone – and I have a LOT of friends over at Facebook who completely disagree with me. We all have strong opinions about healthcare right now, which is a good thing for a democracy.)

Good luck with your assignment, Anthony!

Q1: Why did you choose to work in healthcare?

EA: I liked science and STEM in general, and also wanted to help people. For me, it was a choice between medicine and pharmacy, but I chose pharmacy because I didn’t want to be married to one career. After choosing pharmacy, I also have the opportunity to do a lot of additional things with my career and pivot – like law, business, entrepreneurship and writing.

Q2: What do you feel the biggest public health challenges in U.S. are now?

EA: 1. The opioid epidemic is killing our country….literally. Whether or not the genesis of the problem is in prescription drugs or illicit, I personally believe that addiction is an illness, and yet, we don’t have enough affordable options to treat it. A lot of this problem was caused by the economic issues we’re having in this country too. Health permeates everything – if society is sick, it affects commerce, work, employment, and so many other facets of life.

2. We are running out of effective antibiotics, as just one example. On the other hand, drugs that are newly approved for the most part are for orphan diseases and/or are high cost. How can we afford these as a society?

3. The graying of America – 10,000 baby boomers every day now are retiring. How can we help them live better, healthier lives while still covering everyone in this country for care? If they want to work and live independently, how can we help them live this way affordably and contribute to society?

4. How might we incentivize innovation in healthcare and life sciences while still making healthcare affordable?

5. And last but certainly not least, affordable healthcare is probably the biggest challenge now and in years to come. Our healthcare now consumes 17% of our total GDP in this country – and that is not sustainable. Other countries provide better and more affordable care – so we need the next generation of healthcare professionals to study other countries’ systems and bring the best hits back to our country, stat.

Q3: Regarding the Affordable Care Act, what are some of the gaps you feel should be filled to improve the U.S. healthcare?

EA: If you study other countries’ healthcare systems, you’ll discover that some of the best are driven more regionally and locally. I don’t think (and this is my personal opinion, and mine alone) that the federal government can do the best job of optimizing both the affordability and accessibility of healthcare in the US.  Our federal government was designed by our Constitution to be limited. The states (again, in my opinion) should drive healthcare and create more innovative solutions. If we wait for the federal government to solve this problem, we’re doomed.  No offense to the hard working federal government employees, but innovation comes from the states and regions, not the federal government. Bottom up (local) usually provides far more innovation than top-down government.

Some of the best healthcare systems on the planet almost set up funding via a competition – the regions with better outcomes with their people receive more funding. Innovative ideas are more likely to be spread this way. I hate using the Hunger Games analogy, but it’s a good one in the sense that there are regions that are known for certain commerce, or in this case – it would be regions known for better, more innovative healthcare ideas. Why not fund healthcare innovations this way so great ideas can spread? I think this may be one of the concepts around block grants for states with the feds, but this is just one example on a race to the top, rather than to the bottom of healthcare.

Q4: Do you think that the Affordable Care Act is an individual mandate, if so is this good or bad for the individual?

EA: I think while it’s a good thing for the individual to be covered, it also must be affordable. Mandating something that is unaffordable is unreasonable–it sets our citizens up for failure, (much like Thomas More wrote about in Utopia). I think ultimately, we need to have a fundamental debate in this country on whether or not healthcare is a right or a privilege. Countries like China have written into their constitution that their citizens have a right to basic healthcare.  Right now, we do not. So then, the next question after the fundamental right question we should be asking ourselves is – should healthcare be a for- or non-profit service? If it continues to be for-profit (for the most part, at least for working Americans who are mandated to have insurance coverage) how much profit is too much? For the pharmaceutical companies? For healthcare insurance plans? For healthcare providers? For everyone else in the industry?

On the other hand, how are we going to get big pharma, medical device and biotech companies to innovate if profits are smaller? Innovation in healthcare and life sciences is risky and expensive. You also left off an interesting party here too – what about companies who are paying for the vast majority of employees’ healthcare in this country? They are paying billions of dollars to insure their employees. Should employers have to pay for their employees’ healthcare? They don’t pay for our car insurance or home owner’s insurance for the most part – so why should they have to pay for healthcare?  Maybe we could get to the point where we have something like Medicare for all – the basics can be covered, then all of us can buy a supplement if we’d like. But that’s going to cost us a lot of money we don’t have. Healthcare is not free. Where are we going to get the money?

Q5: How can law and bioethics work together to improve the U.S. healthcare system?

EA: This may sound really odd coming from a pharmacist-attorney, but I think we need LESS law and red tape, particularly by federal government, in order to innovate healthcare in this country…not more. Ethics, similarly–ideas like autonomy, beneficence and justice (as just one example from the Common Rule 45 CFR 46 on the Protection of Human Subjects)–would suggest that individuals should have more freedom and choice when it comes to healthcare, which would in turn suggest less, not more mandates. On the other hand, laws like HIPAA and HITECH are there seemingly to protect us – should we have even more privacy laws to protect our data in other realms beyond healthcare?  Big data beyond healthcare and banking is still the wild wild west and largely self regulated. Healthcare is one of the most highly regulated industries in the US. Should it be? The more regulation, the more red tape, the higher the cost.

As I mentioned – not a lot of answers here. Just more questions…

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