Cleveland Clinic Chief Executive Toby Cosgrove, recently expressed his reservations about some aspects of the federal Affordable Care Act — particularly measures that he believed might impede medical research. He warned the audience that provisions that tie payment for a drug or medical device to its effectiveness could drive health care innovation out of the United States.
Cosgrove, a heart surgeon who holds 30 medical patents, said it can take a decade of testing and other work to secure Food and Drug Administration approval to sell a new product such as a heart valve. Figuring out whether that heart valve bests competitors could take a decade more.
He said most venture capitalists would balk at investing in a product with a 20-year development time frame, and said the regulatory process is faster outside the United States. “I am concerned, frankly, that beginning to fund things on that basis will begin to drive a lot of the innovation out of health care in the United States,” said Cosgrove. “You have to realize that health care products that are developed here are sold all over the world and are a major export from the United States.”
Cosgrove said new medical developments involve some risk, and an extremely risk averse society won’t see innovations of the sort that have led to doubled U.S. life expectancies over the last 100 years. However, a recent study in the New England Journal of Medicine showed that “the U.S. is among the fastest regulators in the world.” and said they could not comment further on Cosgrove’s remarks without additional clarification
Cosgrove also said the health care law, which was recently upheld by the U.S. Supreme Court, doesn’t control costs or contain many incentives for people to take care of themselves.
The health system leader did put in a plug for a bill that Ohio GOP Sen. Rob Portman and Oregon Democratic Sen. Ron Wyden introduced this year that would give seniors on Medicare cash rewards for losing weight or controlling conditions such as diabetes and high blood pressure. Their legislation is based on a Cleveland Clinic program. Putting incentives in place for the Clinic’s diabetes patients, said Cosgrove, helped more of them control their condition and helped the system control costs.
Cosgrove’s remarks included touting Clinic innovations to fight smoking, obesity and other risks to longevity. He said that the Clinic won’t hire smokers, but because of the Americans with Disabilities Act, he can’t ban the hiring of obese people.
He said that right now, 10 percent of U.S. health care costs are obesity related, and that figure is expected to rise to 20 percent in the next 10 years. “My major concern is the public generally has not come to grips with the pandemic of obesity,” Cosgrove said. “If you look at the health disability of employees at the Cleveland Clinic and you take out those who have cancer, 90 percent of those on permanent disability are morbidly obese. That’s how big the problem is.”