#Health decisions remain on political playing field in US and Europe

Unless you’ve been living on the moon for some time, sans TV, radio and internet, you’ll have noticed that the US Presidential campaigns are now in full swing in advance of the autumn election, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.

Republican Donald Trump has been offending everyone from war veterans to the senate leader of his own ‘Grand Old Party’ while Democrat Hillary Clinton has been engaging in damage limitation over her classified emails.

This may all seem a little unhealthy, but what of the health of the nation itself?

So-called Obamacare, otherwise known as the Affordable Care Act (ACA), has divided the country since it was brought in by the currently sitting president and it is no secret that Trump (like his entire party) is in favour of scrapping it to be replaced, in The Donald’s vision, by private plans.

Clinton, on the other hand, has said she wants to build on the plan and is, therefore, in favour of it. Among other things, she has put forward the idea of price-capping out-of-pocket drugs costs.

The Republicans have a majority in both Congress houses and want to see the ACA unceremoniously binned. That’s not so easy however as, by the time the new president sits down in the Oval Office of the White House, some 15-20 million US citizens will have ‘Obamacare’ coverage.

Issues currently being debated include drug prices, the right (or not) to abortion, entitlement programmes and even drug treatments for painkiller addicts.

But reports from across the Atlantic show that healthcare policy was largely ignored as a topic for discussion during the Democratic National Convention, held in Philadelphia recently, as it seems that nobody wanted to talk about costs, regulations, and more that would be required in expanding insurance coverage under ACA, while making treatments more affordable for patients.

As mentioned, Hillary Clinton has ambitious health-care proposals. But where will the cash come from? Could a new Democrat president get the budgets through a Congress that may still be run by the opposition? Big questions.

Meanwhile, across ‘The Pond’ here in Europe, drug prices and entitlement are always being debated, especially by those who espouse the concept of personalised medicine. Prices are too high and access, for various reasons, is too low and inequitable across the 28 member states of the European Union - covering around 500 million citizens.

Well, soon to be 27 member states after Britain voted to leave the EU (‘Brexit’) in June.

Organizations such as the Brussels-based European Alliance for Personalised Medicine believe that the population of the UK would have been much-better served by the standardized and robust health regulations, best practices, collaboration and co-operation that occur in a united Europe, and that a British departure is therefore to the detriment of all.

All lot of the argument swung around the fanciful notion that every British penny paid into the European Union would, post-Brexit, land in the lap of the National Health Service (NHS). This was rubbished even by the Leave campaigners who said it in the first place the very morning after the vote and was patently a nonsense from day one.

Shoring up the NHS by leaving the European Union was a key argument of the Brexiters. It is the fifth largest employer on the planet and UK citizens, in a recent poll, voted it the number one symbol of what is great about Britain, knocking the monarchy and army into a cocked hat. The thought of ‘saving’ this great institution clearly swayed a lot of voters. Time will tell whether the NHS, currently being sold off piece-by-piece, will gain any benefit from Britain’s departure.

Article 50 of the Lisbon Treaty - a prerequisite of Brexit - still hasn’t been invoked, and there seems to be little stomach to do it just yet - with half of the UK Press seething about the appointment of Frenchman and former European Commissioner Michel Barnier as chief negotiator on the EU team. This was declared ‘an act of war’ in some over-excited quarters, notably the UK’s right-wing press.

However the negotiations go over access to the single market, immigrant quotas and free movement of citizens, it appears that at some stage Britain will have to face the fact that the leave vote could prove to be an unmitigated disaster for the health of almost 65 million citizens, despite those seemingly empty promises of lots of cash (£350 million per week) being pumped into the NHS.

Add to this the probability that ‘supply lines’ of research and cross-border cooperation will suffer on a pan-European scale after Brexit finally starts to kick in.

During the in-out campaign, NHS England Chief Executive Simon Stevens went on record to say that he took warnings of a possible post-Brexit recession "very seriously”. Stevens even added that a ‘leave’ vote would be a "terrible moment" at a time when the NHS needs extra investment.

Across the EU, health is a national competence, although European Union legislation on matters affecting health, such as rules on IVDs, data protection, clinical trials and cross-border health care have all been designed to apply across every Member State.

EAPM will tell you that there is already a massive need for better collaboration across medical disciplines and borders, and that the referendum result in Britain will not help anyone in that regard.

There are many unknowables at this stage. The jury is still out on cross-border health care and care for British expats living in EU countries. It remains to be seen what, if anything, can be salvaged from the wreckage, although EAPM will continue to engage with personalised medicine stakeholders in the UK.

The new science that drives personalised medicine and, of course, President Obama’s Precision Medicine Initiative will, fortunately, not go away. But uncertainty over healthcare in the US, the future of the NHS in Britain and the need for more, not less, cross-country collaboration in the EU are major causes for concern.

They cannot be allowed to derail the journey that promises, at its end-point, to provide the right treatment to the right patient at the right time.

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