Healthcare reform begins with a $13 blood test

Sept. 1, 2009

As healthcare-reform legislation moves forward, the
President speaks about the urgency of the issue, taxpayers express their
concerns, and members of Congress face angry protestors at town hall
meetings. Pundits hit the airwaves — obsessing over who will be the
“winners” and “losers” of this process. This background noise, along
with chatter about “death panels” and what constitutes “un-American”
behavior is drowning out the real questions of healthcare reform.
How do we curb healthcare’s escalating costs? How can we best use the
resources of the healthcare system to keep Americans healthy?

The answers to these questions do not require complex
negotiations or massive infusions of funds. This nation’s clinical labs
represent a very small portion of the more than $2 trillion the United
States spends on healthcare each year, but clinical labs represent the
linchpin of a successful healthcare-reform strategy that could save both
lives and billions of dollars.

Healthcare reformers are striving for ways to bend
the cost growth curve. The starting point for this effort has to be
chronic disease. Treatment of chronic illnesses and their symptoms
account for 75 cents of every healthcare dollar spent. Much of that
spending, however, could be avoided with early diagnosis, prevention,
and management of diabetes, heart disease, asthma, and other serious

But early diagnosis and treatment is not happening —
at least, not at the level it should be. RAND Corp. researchers reported
recently in the New England Journal of Medicine that our nation
is seeing a severe underuse of well-established testing and screening
procedures. Even potential killers like colorectal, cervical, and breast
cancers are more prevalent than they should be because of a lack of
prompt testing.

Healthcare reformers need to focus on this problem, and
there are tremendous benefits in doing so. Take, for example, diabetes. A
simple hemoglobin A1C blood test costs just $13 to administer. But, if that
test detects diabetes early — enabling prompt treatment and preventing
complications — the financial gains are considerable. Treating
diabetes-related peripheral-artery disease costs $6,000 per patient each
year. Diabetes leads to heart attacks — a $28,000 bill to the healthcare
system for each incident. Amputation costs $27,000. Kidney dialysis runs
$50,000 annually. We are spending $174 billion to treat the consequences of
diabetes — instead of focusing on prevention with $13 tests.

How can we best use the resources of the healthcare system to keep Americans healthy?

The potential savings expand tremendously when you look
at both the reality and the promise of genetic testing. Just one simple gene
test, one that tells physicians the right dosage of blood-thinning
medication to use with individual patients, can reduce strokes by 17,000
each year and save in the neighborhood of $1 billion.

What needs to be done from a healthcare-reform
perspective to maximize the gains inherent in lab testing? Certainly,
increasing the ability of all Americans to afford health insurance is a
critical start. We know all too well that more than 45 million uninsured
people do not see physicians for regular checkups, do not have essential
health screenings, and end up getting expensive medical care in the
emergency room when their symptoms worsen. Much of the money Congress
authorizes in healthcare coverage subsidies for low-income Americans can be
recouped through fewer acute-care episodes.

Congressional deliberations on healthcare reform are,
by necessity, going to look at the way Medicare, Medicaid, and other
federal health programs spend their dollars — adjusting policy to invest
resources in keeping people well instead of simply treating them when
they are already sick. In order to pay for healthcare reform, however,
lawmakers are looking for ways to cut spending in federal health

There is no doubt that clinical labs are willing to
join other sectors in doing their share of belt-tightening to keep
healthcare reform from increasing federal deficits. It is essential,
though, for policy leaders to keep in mind the place lab testing
occupies in the healthcare continuum. Labs can serve as the critical
link to successful healthcare reform that achieves both improved health
outcomes and much-needed dollar savings.

The healthcare-reform debate also concerns questions
on the appropriate level of federal regulation in healthcare. Here, my
greatest interest is ensuring that we do not restrain the unlimited
promise of personalized medicine. We have just begun to scratch the
surface of the uses of genetic testing in tailoring treatments to the
exact genetic makeup of individual patients. Study after study has shown
that we have a problem with patients receiving overtreatment,
undertreatment, and, at times, the wrong treatment. This is not an
indictment of very capable physicians; it is the reality of a situation
in which doctors cannot know how one patient may react differently to a
medication than another person. Personalized medicine can significantly
increase the quality and cost-efficiency of healthcare by guaranteeing
the right treatment for the right patient at the right time, so we need
healthcare reform that protects and encourages innovation.

I have faith, though, that the American people and members of
Congress will find a way to focus on the critical issues of healthcare
reform: prevention, innovation, and the cost-efficiency that can come
from a healthier nation.

Alan Mertz, president of the American Clinical
Laboratory Association, represents association members’ interests before
Congress. In 2007, the organization launched “Results for Life” (
to promote the value of laboratory services.

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