A couple of weeks ago, renowned physician Dr. Samuel Nussbaum—who served as chief medical officer for Anthem through 16 years of dramatic change in the healthcare industry—took the stage at the Sept. 7-9, 2016 ASAP BioPharma Conference in Boston with a big grin, twinkling eyes, and an embrace of new ASAP Chairman Brooke Paige. Paige introduced Dr. Nussbaum and noted that speaking in Boston was a homecoming for “America’s Physician,” who trained in internal medicine at Massachusetts General and then in endocrinology at Harvard. Indeed, Nussbaum, who is now strategic consultant for EGB Advisors, paid homage to the Boston and Cambridge, Mass., area’s medical science history and still-expanding potential for academic partnerships.
“One only has to go a few blocks west of here to see where Merck began to work with Harvard; Novartis has a research center near MIT in Cambridge,” Nussbaum noted. Then he turned serious. “It’s great to be here,” he began, “but it’s also an extraordinary time in healthcare, an industry, a space, under siege. It’s no longer fully understandable to say we discover, we cure, we make health better for the world. One has to take on a different social contract … and drive collaboration.”
Nussbaum echoed Dickens’ famous description of the Elizabethan era in England.
“We live at a time which is unprecedented. It’s the best of times, because we are in an age of unprecedented advances in medical technology and human science, yet it’s the worst of times, because we have a healthcare system in the US and around the world that doesn’t provide access for everyone. The state of public health is not a focus; the quality of medical care doesn’t keep pace with the science. Looking back to halcyon days, we had a great healthcare system [in the US] and research leading to some of the most extraordinary advances in healthcare. Yet we have storm clouds on the horizon.”
Nussbaum discussed a variety of driving forces vs. restraining forces
- Breakthrough science vs. affordability for government and private payers
- Personalized medicine vs. reputation issues
- Technology, big data, bioinformatics vs. value-based payment models, bundled payment
- Patient-centered outcomes and clinical design vs. impact of consolidation
He juxtaposed several triumphs of modern medicine with what has become a key factor in recent news coverage of the pharma industry and in the run-up to 2016 US presidential election.
“Cardiac death rates dramatically reduced. Antiviral drugs transform HIV into a chronic illness vs. a killer. And screening and better drugs improve cancer survival. But there is anger, there is outrage,” over high-profile drug price increases in the US and lack of access in other places in the world. “Why are people so angry? Because they can’t afford, and as nations, we can’t afford, the cost of healthcare,” he said. “Over the last decade, the average US family wage hasn’t changed much—from $49,309 to $53,800. Why the movement to Sanders or Trump? Capitalizing on outrage.”
He further explained the context of this outrage—and why expanded coverage (in Massachusetts and across the US under Obama’s Affordable Care Act) hasn’t been the cure-all for healthcare in the US.
“Massachusetts was the first state to have universal coverage. It was done under ‘Romney Care,’ similar to ‘Obamacare,” he said. The problem? “In Massachusetts, healthcare costs went up $5.1 billion and everyone applauded that type of access. But look what happened to other essential services: public health spending down 40 percent; mental health spending down 33 percent, etc.” In other words, Nussbaum explained, “We stole from what are called the social determinants of health. We know that education and housing leads to better health and better health outcomes,” while costing less. In other words, prevention costs much less than the healthcare cure.
“More importantly,” Nussbaum continued, “we are not using our $3.2 billion wisely—30-40 percent of healthcare spending is wasted on unnecessary services, administrative costs, prices, fraud. This is what we have to contend with. That’s why it is about collaboration, why it is the focus of the Obama administration, and of private business, to introduce reforms.”
Don’t miss “Dr. Sam Nussbaum: Healing the US Healthcare System One Politician at a Time,” my colleague Genevieve Fraser’s previous blog coverage of Dr. Nussbaum’s keynote address.