The Effects of the Fiscal Cliff on Primary Care (cont)

In my last blog I spoke about the fact that we need to research that tells us what works and what does not, in other words what is "cost effective" in the primary care setting.  Medical homes need to be able to explore what services really do improve outcomes.  This information needs to be gathered, analyzed and best-practices standardized. 

Today I want to turn my attention to the impact that our poor fiscal management has and will have, not only on medical research, but also the impact it will have on our nation’s health.

Sequestration, the automatic spending cuts that will occur if the fiscal crisis is not averted, will take effect in January 2013 unless the fiscal cliff is averted. .  These cuts, amounting to about 600 billion in non-defense spending would reduce funding for research agencies by $3.9 billion in 2013 alone. The NIH alone stands to lose $2.5 B next year. 

Most of the funding in the budgets for the NIH, CDC, etc, is already tied up in funding current projects.  For example, if a project was originally funded for 5 years 4 years ago, continuing and finishing that project will obviously have a much higher priority than the funding of new research.

The affect is already happening. The potential cuts from the fiscal cliff have already had a significant impact on how research labs approach the grant application process. They will spend less time crafting grants and entertaining new avenues of research. Traditionally, some of the greatest innovations have come from newer researches with non-traditional approaches to health issues.  Labs that used to write four to six proposals a will decrease that number in favor of a fewer number of stronger proposals.  Researchers themselves are reported to be leaving the country in favor of less restrictive climates abroad. Medical school will have to slow research operations if it receives fewer grants.

The impact of such cuts, coming after almost a decade of stagnant funding levels – in reality funding decreases in most agencies with associated increase in administrative costs over the same period – would be devastating for biomedical research in America. The effects would lead to:


  • The loss of 33,000 NIH-funded

  • Elimination of NSF funding for more than 19,300 researchers, students and technical support personnel.

  • Elimination of 2,500 specialized disease detectives in state and local health departments funded by the CDC

  • The loss of $111 million in FDA user fees that is vital for its evaluation activities, delaying patient access to new medical treatments.

What is not so easy to calculate is the longer-term impact when promising young researchers leave science due to career insecurity, when great new ideas go unstudied, when fewer opportunities exist to capitalize on scientific and technical advances, and when new therapeutic ideas don’t get developed to the point where they can be tested in the clinic. The Federal Government provides about 60% of funding for clinical research. As Thomas Friedman points out in The World is Flat, investments in science and engineering have produced more than half of U.S. economic growth since WWII, with government funding fostering new knowledge, industrial innovation, and the training of future scientists and engineers.

All of this comes at a time when we have clearly tried to change the focus of primary care on the still, as yet, unproven model of Patient-Centered Medical Homes within the constraints of the ACA.  While the proposals sound good, there are real concerns as to whether the model will truly save money.  North Carolina has been down this road.  The conclusion:  No savings.[1] Clearly there are lessons to be learned her and we must devote some protracted research into whether the direction we have mandated to pursue will actually save money.

My contention remains that the best savings occur when a dedicated, well-trained primary doc sits in front of a motivated patient in the setting of mutual trust. 

We are so very fortunate to have this at PrimeCare of Novi.  But the cost has been significant, the regulations, onerous, and the future uncertain.  In the near future, I will talk about the results we are achieving and which are beginning to receive much more than local attention.