Where's the revolution?

Jan 13, 2009, 1:52 AM, Posted by

In Sunday’s Washington Post, Health Reporter David Brown wrote a very interesting thought piece, We All Want Longer, Healthier Lives. But It's Going to Cost Us. He outlines the “steady, predictable, relentless growth” we’ve seen in health care costs since the end of World War II. He says the time of cheap innovations that can produce the longer, healthier lives we all desire—clean water, vaccines, antibiotics—is past. Citing work by David Cutler at Harvard, he writes, “In the 1970s, it took $46,870 to add a year to the life expectancy of 65-year-olds. By the 1990s, it cost $145,000.” The next gains, Brown suggests, will come at even greater price.

There are some things we could do to shift the curve down, to save some money. Bringing down administrative costs, for instance. Or prevention, thought he notes prevention hasn’t been demonstrated to be any cheaper in the long run. Ultimately, though, on our current path, “We are on a collision course between our wish to live longer, healthier lives and our capacity to pay for that wish.”


Brown suggests the current collision course sounds similar to that proposed by English Parson Thomas Malthus in the 18th century. Malthus published "An Essay on the Principle of Population as It Affects the Future Improvement of Society,” in which he projected a point in time where population growth would outstrip food production capacity. His analysis made a lot of people nervous.

But there were two things Malthus failed to imagine: “The first was that scientific agriculture would eventually double, triple and quintuple crop yields,” Brown writes. “The second was that when industrialization pulled huge numbers of people out of poverty, infant mortality fell, women became more educated, and the value of their labor rose. The net result was a huge decline in birth rates. This is known as the "demographic transition," and virtually every region of the planet has gone through it.”

We need a similar revolution in healthcare to avoid the collision between our desires for long and healthy lives and what those lives will cost, Brown says. Where it will come from, he doesn’t know.

So: Where will that revolution come from? Advances in genomics? Proteomics and diagnostics? New business models ala Clayton Christensen’s recent book, The Innovator’s Prescription? Any and all thoughts welcome.

This commentary originally appeared on the RWJF Pioneering Ideas blog.