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Why Dr. Hood's revolutionary 4P concept is alien to advanced American medicine

Insurance, Medicine, Science, USA

The United States is considered the country with the most advanced system of preventive medicine. State insurance includes here a large-scale layer of preventive measures - from traditional vaccinations to screenings for depression and obesity.
And the very concept of 4P-medicine, which is based on prediction, prevention of diseases, a personalized and partner approach to the patient, was invented by an American - biologist Leroy Edward Hood. However, neither the birthplace of the four “Ps,” nor the declared by the Americans, the commitment to healthy lifestyles and prevention could not stop the growth of health care costs, which annually consume almost half of the federal budget. It seems that the fact is that, despite the wide swing, the preventive strike reaches an extremely small part of the country's population.

“This is the most exciting time in my career, and I believe that I have 20 years ahead of me. I think that we are experiencing a huge turning point and are on the verge of a fantastic revolution in medicine, ”Leroy Edward Hood painted prospects for the realization of his concept of 4P medicine in an interview with Science News in April 2017.

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The Hood-driven know-how promoted is the focus of the health care system on a specific person, rather than on population groups, and the prevention of individual risks of developing diseases through genetic tests. According to Hud, the introduction of his concept should be accompanied by the development of big data systems and artificial intelligence in medicine, which will allow more precise identification and prediction of possible threats.

As he repeatedly stated in his speeches, including at the Schrödinger at 75 conference in Dublin, held in 2018, the 4P philosophy will significantly reduce healthcare costs by preventing the onset and development of chronic diseases.

And indeed, where, how can the 4P concept scale in the USA? First, almost all government insurance available to Americans, including Medicare, Medicaid, Chip and Veteran’s medical care, already includes basic screenings and large-scale preventive measures, which means that the foundation for preventive practice has been created.

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In addition, the United States is rightly considered the global leader in the development of artificial intelligence technologies in healthcare, this IT segment is already estimated by marketers at $ 320 million and promises to add 38% per year. Finally, it was in the USA that the first biohackers appeared, people who, even before the emergence of 4P-concepts, attempted to modify the processes in their own organism, first of all, the change of the genome.

The question is only one circumstance - the cost of health care, including the fight against non-communicable diseases, do not become less. According to the governmental analytical center Central Intelligence Agency, in 2017 about $ 3.5 trillion was allocated for national health care, of which $ 1.5 trillion was directly or indirectly taken from the federal budget, which amounted to $ 3.336 trillion the same year.

Chronic noncommunicable diseases, including cancer, circulatory system diseases, diabetes, cause the death of seven out of ten Americans, despite the fact that fighting these diseases takes 75% of the health care industry budget.

And no cost reduction is foreseen. According to the forecasts of the Committee for Responsible Federal Budjet, by 2028, government spending on health care will almost double to $ 2.8 trillion. One can imagine how this trend will increase the national debt, which reached $ 21 trillion in 2018.

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Why do the US preventive programs do not lead to the expected medical and economic results?

The main reason is that the seemingly generous and varied preventive offer in reality is available only to a small part of Americans. As shown by the analysis conducted by Vademecum of American insurance that is partially or fully paid by the state, the most extensive list of preventive measures is offered by the plan

B Medicare systems. This package includes about 20 types of screenings aimed at different groups of the population, for a variety of diseases - from prostate cancer and lung cancer to diabetes and obesity. For example, once a year, all owners of such insurance, including pregnant women, can take an alcohol abuse test, and then receive up to four full-time topical consultations in a year. Once a year, all insured may undergo screening for depression; once upon receiving insurance, one wellness-procedure. Diabetic patients are available for up to two hours of self-control training in nutrition and other lifestyle adjustments necessary for such a diagnosis. Adolescents can get two individual counseling on how to prevent STDs in a year.

However, according to Statista, in 2017, only 17% of Americans used the insurance plan. Why?

In accordance with US law, the Medicare insurance system is addressed to people legally residing in the country over 65 years of age, as well as to people with disabilities and patients suffering from renal failure or amyotrophic lateral sclerosis. An American who regularly paid a Medicare tax or has certain social benefits during 65 years has access to Plan A, which includes mainly emergency medical care and hospice care. The holder of insurance A gets the opportunity to purchase plan B with preventive measures by paying monthly installments calculated in proportion to his income. Package B, with no plan A insurance, can only be people aged 65 years and legally residing in the country for at least five years. Thus, the insurance plan is virtually unavailable to the working population of the United States.

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The situation is similar with the Medicaid program, funded by the federal authorities in conjunction with the state government and aimed at providing health insurance to the poor and needy. In addition to basic preventive examinations, this includes even preventive dental care. But, according to Statista, such insurance is available for no more than 15% of the US population. Medicaid applies to children, the elderly, the blind, the disabled, and other categories of people who are eligible for federal income support benefits. An American applying for Medicaid health insurance is required to provide documented proof that his savings do not exceed $ 2,000 in cash or other assets.

The main part of the US population, about 70% (one person can be the owner of several insurance at once), use private or corporate insurance provided by the employer. The price of such programs depends on the state of health and age of the insured.

For example, one of the most popular private insurance companies, Blue Cross Blue Shield, provides basic insurance plans for clients no older than 35 years with a monthly premium in the price range of $ 190-400. At the same time, the same insurance plan for a client of 45 years will cost $ 250–470, and for a 55-year-old one - $ 390–800. As the Vademecum monitoring showed, not all private insurances offer preventive medicine services in basic plans. Prevention, as a rule, requires additional payments, which, of course, does not add to the popularity of such services.

Finally, according to Statista, about 9% of Americans, and this figure is growing, do not have health insurance at all. If in 2015-2016, there were 28.6 million uninsured residents in the United States, in 2017 their number increased to 29.3 million people.

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In May 2018, Forbes magazine gave even more pessimistic data: 15.5% of the population in the United States does without insurance. According to industry analysts, the motivation to buy insurance reduces the lack of coverage of many procedures in packages, which are financially unaffordable for a person outside the insurance system and lead to huge unpaid medical bills.

According to the results of a survey conducted in 2016 by the Kaiser Family Foundation, about a quarter of Americans aged 18–64 reported difficulties in paying medical bills. The survey showed that even after a single occurrence of medical billing problems, the consequences for insured and uninsured are comparable: 44% of the first and 45% of the second noted that unpaid or not paid medical debts had a significant negative impact on the lives of their families.

The brightest attempt to increase the availability of medical care in the United States is considered the Patient Protection and Affordable Care Act, or the Obamacare Reform, one of whose ideas was to include in each insurance a significant list of preventive services. The main element of the project was the introduction of a duty for citizens to acquire medical insurance. Of course, it provided for subsidies, loans, preferential prices for the poor and special categories of citizens.

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Also, the reform defended the interests of those who already had a policy: employers, for example, did not have the right to shy away from providing health insurance or increase its value even if an employee had a chronic disease, such as cancer or AIDS, before entering into an employment contract . In addition, special “health insurance” exchanges were created where people could purchase them at a reasonable price. Also, there was administrative liability in relation to persons who neglect the requirement to purchase insurance, and to companies that refuse to sell policies.

Obamacare was calculated for 10 years and was preliminarily estimated at $ 900 billion. The initiators of the reform hoped that in the long term the program should reduce the growth rate of federal budget spending on health care and save at least $ 4 trillion.

However, in 2017, the reform was abolished by the federal court. Several states, including Texas, have filed appeals, at the time of consideration of which in these territories the provisions of Obamacare continue to operate. But the reform has no chance to develop on a national scale. The current US President Donald Trump has repeatedly opposed Obamacare and initiated a number of abolishing program regulations.

There is an opinion that Obamacare has destroyed the emphasis on preventive medicine. “The motivation of private companies to reduce the cost of preventive measures disappeared at a time when supporters of the Affordable Care Act began to support the idea of ​​a completely free list of preventive services in every insurance,” wrote David Goldhill in his book “Catastrophic Aid: How American Health Care killed My Father and how can we fix it. ”

Anyway, the model of medical insurance, which implies coverage of a significant part of the population by economically justified preventive measures, did not work. Leroy Hood himself, in the same interview with Science News, also mentioned other barriers to the large-scale implementation of the 4P concept in American health care: “The biggest problems are ignorance on the part of patients, as well as on the part of doctors and medical workers and, finally, education. If you really want to get medical school of the XXI century, then you must start with the first course. It would be good if in the first year a first-year student began to undergo a dynamic analysis of personalized cloud data, was able to generate his own data and analyze it ”.

True, when the foremost country of the world in many ways overcomes ignorance, and its revolutionary concept can become a reality, Hood has not yet spoken.

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