It is already possible to live to the age of 120, and in the future this will remain true. The new scenario – ushered in by major scientific advances and by the growing progress in personalized medicine – is also going to introduce the problems of preserving the quality of such a long life and ensuring that the economic and social system is capable of sustaining it.
The progress made in oncology is obvious: two out of three patients diagnosed with tumors now survive. The death rate for AIDS has dropped substantially, as has that for cardiovascular disease. Much is owed to basic research, which is today oriented towards very costly personalized and genetic therapies that foresee the possibility of full recovery after the administration of a single dose.
The importance of research, especially basic research, is amply clear. It must be financed essentially by the state, but the private sector also has an important role: there are more than 200 venture capital-funded biotech firms in the Boston area alone. Collaboration between universities and industry generates a virtuous circle that leads to great discoveries as well as to applications of those discoveries to the citizen’s advantage. Artificial intelligence and data analysis are a great help in this new scenario and are opening new frontiers. In any case, the use of technology in the development of research must not be considered a cost.
In Italy, for example, 80% of current national healthcare expenditures is still based on those of the previous year. Since lifespans of up to 120 means a financial burden that the society can no longer sustain, the system needs to be revised. The concept of social welfare as we now know it – from the cradle to the grave – will no longer be sustainable; indeed, all things considered, both cradles and graves are in increasingly short supply.
Public healthcare spending in Italy reached 114 billion euro in 2017, with private spending at a still too low 40 billion. Private involvement needs bolstering since it brings in support for the public sector from another actor with the same interest in mind: affordable services. Supplementary company contracts are increasingly offering a series of healthcare services in place of a portion of pay. However, this often pushes prices up, and that is where regulation comes in, resulting in a win-win for both state and citizens. Insurance companies tend to either offer reimbursement or directly pay for services. They also help the system out through the use of technology: a full 10 billion euro has been invested in e-health, and 70% of the 2 billion companies invest in insurance high-tech are invested in health.
Globally, however, drugs are costly. Cancer drugs in particular. In the United States (though not exclusively), the pharmaceutical firms set the prices. The annual cost for one cancer patient has been estimated at an astronomical 1 million dollars. The reason for this is quickly explained: on a new drug that costs 2.5 billion, 100 million has already been spent in acquiring the start-up that did the research and owns the patent, while the other 2.4 billion is spent along the regulatory itinerary, which is the real source of the immensely burdensome cost of the process.
How is the public health service going to be able to afford such expensive drugs? The topic certainly triggers concerns of an ethical nature and otherwise, since sustainability is not only an economic issue, but also a moral and social question. There are few investments in antibiotics and vaccines because they do not have a high return on investment. That has to change, because over the medium to long term the system will cease to be sustainable. If drugs are so costly and no one buys them, there will be social unrest, especially in Europe: the Union currently counts 120 million citizens on the brink of poverty. The political class must therefore take responsibility and draft proposals aimed at finding a solution. More than ever before, health is not only a problem of prevention and quality of life but also a strategic component in social responsibility.
