Reasons for optimism in the New Year

January 2, 2024

As we head into 2024, here are a few reasons why I feel optimistic we can obtain better health and better value in health care in 2024 and beyond.

Artificial Intelligence

Generative AI, which can ingest an almost unlimited amount of data and more research than any of us can read, is likely to change our world dramatically - and largely for the better.  In medicine, AI can help clinicians avoid missing difficult diagnoses and find earlier cancers by focusing on pixels and associations that humans might not be able to figure out. It can explain medical conditions with surprising empathy. It sometimes hallucinates, but it will continue to get better. Humans make mistakes, too!

Decarbonization

We are moving away from fossil fuels to decrease the amount of climate change, but eliminating tailpipes from cars and smokestacks from power plants will bring a shocking amount of increased health. Air pollution is associated with not only increased risk of cardiac and respiratory disease, it is also associated with premature deliveries, learning disabilities, and early onset of dementia.

mRNA vaccination technology

Pfizer and Moderna mRNA vaccines likely saved the lives of tens of millions during the COVID pandemic.  Now this technology, which allows rapid production of vaccines without using millions of eggs, is being tested in personalized vaccines to treat various types of cancer.

Cell and gene therapy

The approval of what are likely to be permanent treatments of hemophilia, thalassemia and sickle cell disease is momentous, and many previously untreatable diseases are likely to also be curable in the near future. We have a way to go in figuring out how to afford all of this, but these advances offer new hope to many with terrible diseases.

Malaria vaccine

The World Health Organization recommended a second malaria vaccine, which will be less expensive than the vaccine that became available in 2022. There are almost a quarter billion cases of malaria globally each year; over 600,000 die of the disease, and 80% of these are children.  There are about 2000 cases of malaria each year in the US, and this was the first year in two decades that multiple cases of US transmission of malaria occurred. Diminishing the toll of malaria in developing countries will be an enormous public health triumph, and will help keep us all safe.

GLP-1 drugs

This class of drugs, used to treat diabetes for 18 years and to treat obesity for the last few years, appear to have positive health impacts far beyond diabetes and obesity. This includes diminishing progression of kidney disease, fatty liver disease, and even brain inflammation. The finances of this class of drugs don’t work (yet), but the clinical benefit is large.

Transparency

Transparency regulations requiring hospitals and health plans to provide information about contractual prices is why we can quantify costs for commercial health plans. We will need to use this data carefully to be sure that we lower prices at high-priced providers, rather than raising prices at lower-priced providers.

Regulatory support for market competition

Market competition can keep prices low and service levels high, but competition has decreased in many areas of medical care. For instance, most communities do not have substantial hospital competition, and lack of competition means higher prices. The current manufacturers of GLP-1 drugs are purchasing smaller companies that could otherwise become competitors, which could maintain prices at a level which means that many who could benefit from these drugs will not gain access.  Vigorous antitrust enforcement can help support market competition, which can better control unit prices.

I’m sure this is an incomplete list of things to be thankful for, and I wish all a joyous, healthy and meaningful New Year.

Thanks for reading.  You can find previous posts in the Employer Coverage archive

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