Thursday, November 6, 2008

The New President and Healthcare - Part I - Research

Now that the United States has elected a new president, it is time for Mr. Obama that his talk of change is more than just talk. Mr. Obama has also implied that the US Federal Government can have a powerful and positive impact on healthcare.

The Federal Government is already a major force in healthcare ranging from basic research to direct provision of medical services to reimbursement of fee for service medical services. While enormous amounts of money are thrown into US healthcare, the results are have been less than stellar for the past 30 years. It is time to clean this mess up, and he should start will what the Federal government directly controls.

US Government research has been corrupted by politics for decades. The NIH, CDC and DoD value filling out forms more than the quality of the minds engaged in research. The peer review panels guide funding to politically connected individuals and entities or influenced by professional conflicts. The research is often conducted in the districts of well-connected congressman at third and fourth tier universities by third and fourth tier researchers. Much of the research is funded without results. Failure is fine and expected but what is unconscionable is that so many projects do not advance the field. Alzheimer’s disease, Traumatic Brain Injury and AIDs research are all examples heavily funded scientific political cesspools that have shown unremarkable progress in the past 20 years.

It is time to turn back the clock when NASA, NIH, DARPA, DoD, ONR and CDC when these organizations were led by people who were public intellectuals and visionaries. It was their mandate to identify the best talent and facilitate conquering an objective. Proficiency in filling out forms was low on the list of priorities. Speed and intellect were what counted. The average age of the team of scientists and engineers that put a man on the moon was 26. The average age of NIH grantee is approaching retirement age. Scientists and engineers make their great leaps forward in their 30’s and 40’s and generally extend the same line of work for the balance of the careers. Of course, there are exceptional minds that are super intellects (1% of 1%) and should be given unique permanent funding to indulge their interests. For the rest of the scientific, engineering and math communities, funding should be limited to 3 to 5 years renewable for 5 years. The funding should be based on clear objectives. Progress should be judged by peers in other fields as well as those in the art. Panels used by funding agencies tend to be filled with people who are third and fourth tier minds in the art who have nothing better to do than sit on a government panel. Identify people that don’t want to serve and who have something better to do and encourage them to identify and support the next generation of big brains.

People in the field, if infected with any degree of humility, can identify the most talented minds and people outside the field can generally identify those that are truly gifted from those that are merely hardworking. This will disturb many in Congress because the balance of funding will be concentrated on the coasts at the leading US research institutions like Columbia, Harvard, Yale, UCal, and Stanford and leave out East Podunk University. On the other hand, some of the most creative thinkers find their homes in the most unlikely places as their radical thoughts run contrary to orthodox views. It is incumbent on the federal government to find skilled administrators to find the talent and support it regardless of location or political influence. It is time to move the ball forward. It is also time to move it quickly and cost-effectively. More money without better methods will get us nowhere.

Part II – will deal with the US federal government’s provision of healthcare.

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