While our heritage is strong, it will no doubt be challenged since we live in troubled times. Despite the remarkable and unquestioned advances in care resulting from research, both basic and clinical, our country has not yet decided how to pay for this care and how much it wants to pay. Do not believe the naysayers who doubt the existence of treatment advances. The question is not the size of the advances. It is about the size of price tag.
Despite the remarkable and unquestioned advances in care resulting from research, both basic and clinical, our country has not yet decided how to pay for this care and how much it wants to pay.
Different Struggles for Today’s Rheumatologist
With the ineffective care of the last century, costs were cheap. While a chicken or a few eggs could suffice for a co-payment (or even a payment) back then, with scientific advance, the cost of therapy for rheumatoid arthritis, for example, today ranges into the thousands and tens of thousands of dollars each year. To say the least, that’s a lot of chickens. Sadly, because of the current recession and the inadequacies and inequities of our healthcare system, many patients do not have access to the best therapy available or cannot afford it. Certainly, in the developing world, the cost of state-of-the-art care for inflammatory arthritis is out of sight for all but the wealthiest people. In some countries, a handful of rheumatologists struggle to treat patients with treatments from a half century ago.
Scientific meetings are probably not the place to address thorny and contentious issues of social and economic matters, especially when we get together with colleagues and old friends. When we drink a bit of bubbly, we do not want to have a reunion spoiled by an argument over the relative merits of the public option versus healthcare cooperatives. Meetings are times for reminiscence and sharing of pictures of children and grandchildren.
Nevertheless, politics is always in the air at the ACR meeting, especially since it immediately precedes the November election. In the United States, we are in the midst of a great struggle over the organization of our healthcare system. Unfortunately, the focus has been on partisanship, with the stakes measured in terms of the impact on the 2010 midterm elections rather than the health and well-being of millions of people.
Politicians and the press tend to pose issues in terms of the lives of people with names like Joe the Plumber or Harry and Louise. I like to think more numerically about public health issues and have to wonder how many QALYs (Quality-Adjusted Life-Years), DALYs (Disability-Adjusted Life-Years), or cumulative points on the Sharp score have resulted from the lack of universal coverage of patients with arthritis.
