One of the more interesting questions that needs to be explored is what impact government policies have on long term investments in health care. It may be true, for example, that Cuba can perform a particular test more cheaply than in a Western country, but that test or treatment was developed outside of Cuba, then incremental cost of performing that procedure understates its true cost. Wikipedia describes the extent of medical research in the US:
As in physics and chemistry, Americans have dominated the Nobel Prize for physiology or medicine since World War II. The private sector has been the focal point for biomedical research in the United States, and has played a key role in this achievement. As of 2000, for-profit industry funded 57%, non-profit private organizations such as the Howard Hughes Medical Institute funded 7%, and the tax-funded National Institutes of Health funded 36% of medical research in the U.S. However, by 2003, the NIH funded only 28% of medical research funding; funding by private industry increased 102% from 1994 to 2003.
The National Institutes of Health consists of 24 separate institutes, the NIH occupies 75 buildings on more than 1.2 km² in Bethesda, Maryland. The goal of NIH research is knowledge that helps prevent, detect, diagnose, and treat disease and disability — everything from the rarest genetic disorder to the common cold. At any given time, grants from the NIH support the research of about 35,000 principal investigators, working in every US state and several foreign countries. Among these grantees have been 91 Nobel Prize-winners. Five Nobelists have made their prize-winning discoveries in NIH laboratories.
NIH research has helped make possible numerous medical achievements. For example, mortality from heart disease, the number-one killer in the United States, dropped 41 percent between 1971 and 1991. The death rate for strokes decreased by 59 percent during the same period. Between 1991 and 1995, the cancer death rate fell by nearly 3 percent, the first sustained decline since national record-keeping began in the 1930s. And today more than 70 percent of children who get cancer are cured.
With the help of the NIH, molecular genetics and genomics research have revolutionized biomedical science. In the 1980s and 1990s, researchers performed the first trial of gene therapy in humans and are now able to locate, identify, and describe the function of many genes in the human genome. Scientists predict that this new knowledge will lead to genetic tests for susceptibility to diseases such as colon, breast, and other cancers and to the eventual development of preventive drug treatments for persons in families known to be at risk.
Research conducted by universities, hospitals, and corporations also contributes to improvement in diagnosis and treatment of disease. NIH funded the basic research on Acquired Immune Deficiency Syndrome (AIDS), for example, but many of the drugs used to treat the disease have emerged from the laboratories of the American pharmaceutical industry; those drugs are being tested in research centers across the country.
Dr. Sikora is undoubtedly right in implying that ideology is the bane of any public policy analysis. But even Dr. Sikora, who is no true believer in the US health care system, understands that choice and competition are key elements in any viable solution. Every health care system has gaps. Some countries with hybrid systems allow consumers to get private cover to supplement their state cover; and it is also possible to craft a policy in which the state can fill gaps in which the private market fails. The real test for any proposal is will it work; and will it work sustainably?