Biden's Proposal for New Government Agency On Disease Specific Research is a Bad Idea and Here's Why

 President Biden’s 2021 discretionary budget request includes 6.5 billion for the creation of a separate government healthcare research agency, outside the purview of Health and Human Services. The agency, entitled Advanced Research Projects Agency-Health (ARPA-H) is modeled after the defense agency DARPA. This analysis reviews why this proposal is a bad idea for healthcare, public spending and for governmental oversight. Here are the criteria the Biden Administration outlined for ARPA-H:

1. Research funding would not be subject to the normal Health and Human Services Agency grant vetting process

 2. The focus would be on research that would not necessarily have a foreseeable payoff

 3.  Initial research would focus on three diseases Alzheimer’s, Diabetes, and Cancer

The creation of ARPA-H balloons federal spending for an unnecessary healthcare agency with no clear mandate and porous accountability, while competing for resources from existing healthcare research initiatives, which have been vetted. Healthcare research in the U.S. is still largely funded by Health and Human Services (HHS) through grant awards mostly to universities and nonprofit research groups. The annual medical research allocation for all government agencies was 39.5 billion in 2017. (Research America An Alliance For Discoveries in Health, 2018) In 1991, the U.S. funded 83% of all biomedical research in the nation and by 2017 U.S. investment in scientific research had fallen to less than half. (Mervis, 2017)  Though the U.S. has always been the global leader in medical research, China is catching up, as well as other nations. It could be argued that the world’s leading scientists chose to open their labs in other countries due to the Trump Administration’s arcane immigration policies. Our neighbor to the north, Canada is a beneficiary of this short-sited policy and Toronto is now a hotbed for medical research.

The ARPA-H agency creation proposal is not even supported by many leading scientists, which are concerned that a huge introduction of funding without clear guidance and controls would be harmful to healthcare research initiatives. (Winter L. , 2021)

Top Causes of Death in the United States

Further, the number one killer in the U.S. is heart disease, which is largely preventable through public health education and early intervention. (Kenneth D. Kochanek, n.d.) Though cancer deaths rank number two for overall mortality, respiratory disease is third, meaning Chronic Obstructive Pulmonary Disease, people who can’t breathe because of their disease etiology which is linked to environmental pollution and smoking. Efforts to reduce particulate pollution caused from diesel vehicles have been shown to improve population health outcomes for those with respiratory disease. Why not throw the 6.5 billion into research to clear the air of climate warming health harming pollutants? Accidental injuries are the fourth cause of death for adults, so prevention of accidents through public education and resourcing would seem to be a good public health investment. Fifth place on the-cause-of-mortality list is stroke and there have been innovative ideas from the Centers for Disease Control and Prevention, an HHS Agency to reduce harmful impacts of stroke, by rapid administration of tPA (tissue plasminogen activator) to prevent long term health impairment. Alzheimer’s is the sixth leading cause of death and Diabetes is seventh, however kidney or nephritis is eighth on the all-cause mortality list and it is closely linked to long term Type 1 Diabetes. Pneumonia is ninth and frequently occurs in patients who have been hospitalized and is not always preventable.

Suicide, ranks as the tenth leading cause of death in the U.S. According to the Center for Health Statistics suicide rates for America’s young people increased by 57% between 2007 and 2018, including children as young as ten. If that isn’t enough to wake you up, I don’t know what hole there is where your heart should be. Even children can’t stand to live in the United States of America. This factoid should be considered a public health crisis and scarcely receives a mention. All we hear about are corporate profits and how we can’t afford to provide healthcare or school lunches for everyone.

Creating competition versus cooperation for funding resources among healthcare agencies is not in the best interest of public health. The tired idea that competition makes everything better and lowers costs in healthcare is not true. The U.S. has the most expensive healthcare system in the world, with results that are no better than other countries and it spends 40% more than most other industrialized nations. Yet, the U.S. doesn’t even provide healthcare to all of its people, including children, whose distribution is immorally dependent on their parentage and birthplace. The current profit-taking healthcare climate has produced nonprofit hospitals making so much money they have their own venture capital funds. (Drucker, 2020) This capitalistic climate has occurred in part because of increased government funding through the Affordable Care Act in 2010 and due to hospital consolidation in this sector. Hospital closures do have an adverse impact on community health, but often book a positive outcome for the financial statements of huge hospital corporations. The pandemic hospital bailouts exposed how poor rural hospitals were not given funds but rich hospital corporations received billions. (Winter R. , 2020)

Creating Effective Healthcare Investment

All investments and interventions in national healthcare should ask these three questions:

1.  Is this necessary?

2. Who does it harm?

3. Should we be doing it?

An amorphous healthcare agency without the same rules for government oversite is not the answer to improving population health for ALL of the American people, who actually finance all government endeavors. Before we saddle our children with another government agency, let’s fund and improve the ones we already have which have demonstrated their value.

 And this is the healthpolicymaven signing off encouraging you not to sign blanket releases when undergoing medical procedures, do stipulate that for which you consent and which you decline. This column has been in continuous publication since 2007 and accepts no money from any healthcare entity. All research and opinions are those of Roberta Winter, an independent journalist and healthcare advocate. Her guidebook on the U.S. healthcare system was published by Rowman and Littlefield in 2013, which focused on state health rankings, disparities in care, and discerning quality at the consumer level. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

 References

Drucker, J. (2020, June 8). Wealthiest HospitalsGet Billions in Payouts for Struggling Providers. The New York Times.

Kenneth D. Kochanek, M. J. (n.d.). Mortality in the United States, 2019. (N. C. Statistics, Editor) Retrieved June 2, 2021, from Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/products/databriefs/db395.htm

Mervis, J. (2017, March 9). Data check: U.S. government share of basic research funding falls below 50%. Retrieved June 2, 2021, from National Science Foundation: https://www.sciencemag.org/news/2017/03/data-check-us-government-share-basic-research-funding-falls-below-50

Research America An Alliance For Discoveries in Health. (2018, October 1). US Investments in Medical and Health Research Development 2013-2017. Retrieved June 2, 2021, from Research America.org: https://www.researchamerica.org/sites/default/files/Policy_Advocacy/2013-2017InvestmentReportFall2018.pdf

Winter, L. (2021, April 12). President Biden Proposes Creating Two DARPA-like Agencies. Retrieved from The Scientist.com: https://www.the-scientist.com/news-opinion/president-biden-proposes-the-creation-of-two-darpa-like-agencies-68660

Winter, R. (2020, October 13). Unintended Consequences of Pandemic Hospital Bailouts May Hasten Their Demise. Retrieved from Straight Talk on Health Care: http://healthpolicymaven.blogspot.com/2020/10/unintended-consequences-of-pandemic.html