July 21, 2002

Healthcare costs soar now we don't die the old fashioned way

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The hero, played by Michael York, wanting to survive longer than the average Stepford wife or husband who zombied around blissfully unblemished, tried to escape beyond the city’s wall to a mythical place called Sanctuary, where, it was rumoured “old people” thrived.

Older people were perceived as a threat to the youthful colony and ‘Runners’, as euthanasia dodgers were termed, were hunted down by the youth police.

I must have been about 12 when I first saw this movie. Thirty seemed so far away that it didn’t strike me as particularly weird. I thought I’d have done, seen and achieved everything by thirty — a view substantiated for me by George Best’s retirement from football at 26. Obviously, I think a bit differently these days and my daily popping of vitamin tablets indicates a yearning to stay on top of the game for as long as possible.

Vitamin tablets are a thirtysomething manifestation of a dependence on pharmaceutical drugs that is likely, if global trends are correct, to increase as we all get older, culminating in a blast of chemicals when we move into our dotage. Of all the drugs we will consume, 80 per cent will be in the last six months of our lives.

Not surprisingly therefore, healthcare costs rise dramatically as societies get old. Keeping a lid on healthcare costs will be one of the major headaches facing the western world’s governments over the coming decades. In the absence of Logan’s Run-style premature obsolescence, we have a problem, because at the moment nobody has the faintest idea of how to square an ageing population with affordable healthcare. In fact, the issues are so complex that no single catchall ‘reform’ will do the trick.

In Ireland, we sometimes see the debate on healthcare in isolation from these global trends. When the government appears to renege on healthcare pledges due to financial constraints or it sanctions VHI increases due to rising costs, the immediate media reaction is to point the finger at the incumbent in the black Merc. But three inescapable factors are driving up the cost of health care everywhere.

First and most importantly, the population is growing older every year. Secondly, the population is becoming more dependent on drugs as the types of conditions killing us change. In the past, people died from one-off infectious diseases. People in the Third World continue to suffer from these sorts of illnesses.

In Ireland today, as we age our bodies gradually seize up with arthritic conditions, heart disease and the like. These gradual conditions are treated by courses of drug treatment. The ongoing degenerative process costs much more money than one off, quick-killing infections.

A third factor is the change in the nature of drug consumption. People are becoming savvy about what drugs are on the market and are beginning to express preferences about which drug they’d prefer to use. This trend is particularly marked in the US and is likely to become increasingly the norm here. As a result, no government is responsible for health dilemmas.

Against this background, the debate on healthcare will, sooner rather than later, become a debate on drugs, probably polarising into a two-sided moral polemic about the role of pharmaceutical companies in society.

It is fashionable to characterise large drug companies as evil empires which make enormous profits from the suffering of others. The recent cases in South Africa and Brazil, where drug companies sought to prevent generic drugs being made available, at much lower costs to treat Aids sufferers, appear to substantiate the good-versus-evil caricature. It has also focused the debate on the morality of patents.

The drug companies argued that global patent law, enshrined in the WTO agreements, protected their innovations for a certain period, giving them exclusive exploitation rights. Without this protection there would be no innovation. Given the cost of developing a drug, from the first twinkle in a scientist’s eye to the chemist’s shelf, this is a fair point.

Yet the South African and Brazilian governments argued that the cost associated with branded drugs was killing people in poor countries. If these countries were able to import copycat generic or yellow-pack drugs from India, which has an extensive drug industry, millions of lives could be saved. This is equally persuasive and is easy on the morals.

But reducing the discussion to good-versus-evil doesn’t get us very far and by doing so, we are in danger of throwing the baby out with the bath water. It is clear that when it comes to innovation, the large drug companies are the only game in town and their intellectual capital has to be protected somehow.

Innovation is the key to the argument. Ever since the first caveman learned how to make fire, we have been in the knowledge economy where innovation, its protection and exploitation is the difference between winners and losers. That said, we have to devise a patent system subtle enough to protect innovation but flexible enough to prevent a monopoly that keeps out other innovators and copiers and precludes affordable world-wide dissemination of the drug. This is not easy or straightforward.

For example, the US pharmaceutical industry is spending three times as much on drug research this year as it did in 1991, yet it plans to release half as many new drugs as in 1996. What does this tell us? That drugs are becoming more expensive to make? Maybe. That it is taking longer from laboratory to pharmacy? Possibly. A cynic might argue that drug companies hold back the release of drugs to keep prices high. It is probably a reflection of all of the above.

The point is that we need the drug companies if we want to live longer. The only way we will live longer is if we have better and smarter drugs to keep our bodies ticking over. It is likely that we will spend considerably more on healthcare in the future.

Incidentally, the US spends about $13,000 per head annually on healthcare while we spend about $2,000 per head. Somewhere in the middle is the likely ballpark for health spending in our lifetimes. This implies that health care spending will increase in Ireland by at least 300 per cent over the coming decades, which would push the overall cost to the economy up towards 13 per cent of GDP.

It won’t matter a jot who is in power over the coming years, this process is inevitable — unless we embrace euthanasia. That’s where the morals get tricky — and the scenario of Logan’s Run, or a version of it including the words “older” and “voluntary”, becomes reality.