How to Save American Healthcare

The future of U.S. healthcare is cheap, small, and at home.


The American healthcare system is the most expensive in the world, with some $2.8 trillion—or one sixth of the economy’s outgoings—racked up in spending each year. It’s a structure that draws endless criticisms for its inflated drug prices, regular additional charges on top of insurance premiums, and appointment wait times that rank among the longest of the leading industrial nations.

A new wave of tests and technologies, however, is slowly bringing about the kind of developments the country’s health industry has long been calling out for. Labs on microchips, home-administered HIV kits, hypertension tracking smartphone apps; these new innovations are proof that the medical landscape is capable of change, and that the 30 million uninsured Americans, and tens of millions of citizens with inadequate coverage, could face a different, better, future.

Welcome to the age of bite-sized, megabucks-saving medicine.

When it comes to shrinking down the costs and expanding the benefits of health tests, Martin Yarmush, Distinguished Professor of Biomedical Engineering at Rutgers University, is leading the charge. The so-called “lab on a chip”—a breakthrough device that vastly reduces the price of disease biomarker analysis by using 90 percent less fluid samples than tests usually require—was created after his team found they had “a specific need that could not be addressed with current technology.”

By using miniaturized valves and channels in place of the usual benchtop-sized assays (or procedures), which need much larger blood or fluid samples that are then mixed with expensive chemicals by lab personnel, the price of carrying out tests for the likes of syphilis and Lyme Disease was dramatically reduced not only in terms of the materials, but by automating much of the labor ordinarily required.

“The results are as sensitive and accurate as the standard benchtop assay,” Dr. Yarmush says.

The size of the sample is important not only in driving down the costs of tests, but in widening their scope, too. The inability to extract enough fluid from certain animal models in order to perform accurate and comprehensive testing has long proved to be a barrier to further discovery, but by being able to correctly analyze far smaller amounts, the lab on a chip could open the gateway to testing for many more biological samples of limited volume.

“Any diagnostic procedure that can provide the same answers at a lower cost will have an impact,” Dr. Yarmush adds. “This is a very active field and investigators will continue to innovate in this space.”

One of the biggest innovations in medical care has been how much of it can now be administered by patients themselves. Changes in the legislation surrounding HIV testing has led to a raft of in-home tests being created worldwide, enabling potential sufferers to undergo the procedure without the stigma going to a hospital for diagnosis can bring.

“We are seeing a trend towards more self-administered care, due to many factors, including rising healthcare costs, access to more information on health conditions and treatments, and the advancement of certain technologies that enable consumers to be able to accurately perform the tests at home,” says Ron Ticho, senior vice president of communications at OraSure, the company behind America’s first home HIV kit.

“Any technology that enables a person to learn their HIV status, whether at a clinic or at home, will help them make more informed decisions about their health, and hopefully will enable them to seek and find the follow up care that they need to live a longer and healthier life,” says Ticho.

More than 1.2 million people are currently living with HIV in America, while almost one in eight of those are unaware that they are infected. Late diagnosis means sufferers have a far greater likelihood of dying within the first year of testing positive, making the convenience of a test like OraQuick’s all the more vital.

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“I think it’s a fantastic idea,” says Steven Irving MD, an emergency physician resident in Detroit, MI. “This test has great potential if the limitations are understood by the public and there is a support system in place with appropriate resources if the test is positive.”

But he notes that there are some important caveats. “Diagnosing HIV is not as simple as a drop of blood: it’s a two-step process,” he explains. “The first is an ELISA, the antibody test, then a confirmatory test—the Western blot test—is used. At our Emergency department, we have a team that specifically focuses on assistance when a positive HIV test is performed: they help explain the limitations of the test, set up further appointments, and counsel on the next steps.”

“Newer generation tests could lead to people believing that they are HIV negative two weeks after a one night stand, and [allow them to] continue to spread the disease without knowing they are infected,” Irving explains.

This is a sense of caution shared by many healthcare professionals, who are concerned that the easy to use, quick to procure nature of new medical technologies will lead patients to believe their health issues can be entirely resolved at the click of a button. With the mobile health app market estimated to be worth $20.7 by 2018, it’s big business for potential investors, whose targets aren’t just limited to patient welfare.

Apps like Blood Pressure Monitor, which purports to measure your heart rate, depression diagnostic MoodTools and SkinVision, which assesses whether your mole is malignant, offer high risk, high reward alternatives to those willing to trade wait rooms for the app store, but tellingly, in a study of 100 apps promising to quash hypertension, researchers found that there was no correlation between ratings and efficacy. Those that pledged to measure a user’s blood pressure through the phone itself (which cannot be done accurately) saw millions of downloads and five star reviews, in spite of their inability to deliver.

“The tech industry can be very quixotic in its innovation-seeking desire to try to deliver things faster, quicker and more efficiently,” says Jonathan Lee, a Fellow in International Emergency Medicine at Columbia University Medical Center, “but efficiency isn’t always the best thing in healthcare and clinical medicine.”

That criticism certainly rings true in the light of the recent controversy surrounding Theranos—a company offering a cut price blood test that required just a finger prick’s worth of fluid and several hours to deliver the same results as the standard procedure (which usually requires several vials of blood to be taken and days or weeks for processing at a lab).

At a cost of half of the current reimbursement rates for Medicare and Medicaid, Theranos looked set to cause major disruption to the $75 billion-a-year blood testing industry. But an investigation by the Wall Street Journal found that the mysterious machines being employed to carry out this super fast analysis weren’t being used at all, and that the blood samples were in fact being collected in the usual way and then diluted for use on other, older instruments from companies like Siemens.

Theranos’ “Edison machines” were also found to be significantly less accurate than claimed, with the company’s former employees complaining to regulators about their lack of precision, and users coming forward to reveal that the results of their $5.35 test did not match up to those administered the old-fashioned way.

To that end, Dr. Lee questions whether self-administered care really saves patients the time and money they believe it will. “Do you suppose you could take your results to the hospital and say ‘here, take my word for it?’ No. The physician will test and confirm it with their own tests. Why do it at home when any clinic or hospital will do the same for you?”

Perhaps the field of high-speed diagnoses isn’t quite as groundbreaking as their in-laboratory counterparts, then, but the advancements being made in instituting low-cost medical alternatives could not have come at a more prescient time. News of the 5,500 percent price hike of Daraprim, a pill designed to treat parasitic infection toxoplasmosis, hit the headlines in September, forcing America’s absurd drug pricing laws into the spotlight.

As the only country which allows private companies to decide the cost of the pills they manufacture, leading to an estimated average profit margin of 21.6 percent (the industry average is closer to 15 percent), the current practice of doctors over-prescribing overpriced pills for patients is badly in need of reform.

Now, more than ever, this current surge in affordable medical maintenance could prove lifesaving.