With the implementation of Obamacare looming (even as American politicians argue its virtues and deficiencies and Republicans dig in to block its roll out), I’m warily watching what happens in the American labs on which personalized healthcare providers like me rely. My fear is that as the U.S. lab business repositions itself for Obamacare, critically important preventative healthcare testing could be pushed to the backburner. And that’s not good news for healthcare on either side of the border.
In personalized practice, we examine an individual’s unique genetics and biomarkers. This requires testing not covered by Canadian healthcare plans because the tests have been deemed medically unnecessary. As a result, patients must pay out of pocket if they want to know more or detect health risks before they become symptomatic and potentially develop chronic disease.
In my practice, we order these tests for patients so they can know how well their bodies are ticking. This allows for important questions to be answered. For example, many clients ask whether they should supplement their diets with fish oil capsules as omega fatty acids are good for the heart and brain. The only way to answer that is to measure omega fatty acid levels with blood tests.
And where do I get these tests? From specialty labs in the U.S. that are generally more advanced and cost effective than their Canadian counterparts. (One exception is Rocky Mountain Analytical, which Mississauga, Ont.-based CML HealthCare has recently and smartly acquired as part of its plan to be more involved in personalized health care.)
American labs have been miles ahead of Canadian labs in developing innovative and insightful tests, which help specialists and consumers to better understand health and disease. These insights are critical for preventive healthcare to be effective. They help make health care more robust for Canadians, and they’re good for the health-care system, too: patients who get sick less often are less of a financial drain.
We know this, but nothing new in testing is forthcoming in Canada because the labs are fixated on servicing their biggest customer, the provincial health plans. That means the labs perform the tests paid for by those plans and nothing more.
But with the arrival of Obamacare, a similar trend may be developing stateside. These labs are now focusing on tests the insurers will most readily pay for—and anticipating an increase in volume for such tests as Obama’s landmark health care law kicks in.
The law is having a worrisome chilling effect on the labs that were once my go-to partners in health prevention. And there’s already evidence to prove my concerns are warranted.
For the past three years my American suppliers have stopped developing new and innovative tests that I can purchase. Granted, there was a recession, but I believe Obamacare has already changed the business priority of most labs.
Don’t get me wrong—Obamacare gives Americans the one thing that we as Canadians take for granted: that we will never lose our home or otherwise be made bankrupt because a family member is ill. Morally, this landmark health care law—whatever its shortcomings or unintended side effects, such as the ones I’m addressing—is the right thing to do.
But the reality of which preventive health-care providers must take note is that there’s simply too much money on the table for doing ‘basic’ and ‘standard of care’ tests for labs to ignore; innovation of preventative diagnostics is already suffering at the hands of revenues found in disease care. The changes are varied, but include: many genetics companies halting service because insurance does not cover ‘recreational’ genetic testing; comprehensive analysis of nutrient levels (vitamins, minerals, amino, organic and fatty acids) is more difficult to cover; and two competitors have had to merge their operations to continue to offer such tests for specialty health care providers like me.
The U.S. is moving toward a scenario where, rather than asking, “Does this test benefit me, and what can I learn from it to help me stay healthy?” consumers will ask if the test is covered by their new insurance. Lab administrators will want to know if the test has a reimbursement code. Soon, like the uninformed Canadian health consumer, the American consumer may come to believe that if a test is not covered by insurance that it must be ‘no good’ or ‘investigational’ or perhaps even ‘useless’.
Canadians have lost out because of this thinking for a long time but they were at least able to access U.S. testing—and that shouldn’t change. But with basic tests being finally covered in the U.S., the volume of requests for these tests will increase substantially. Where does that leave the advanced testing needed for proper preventive health care?
Dr. Elaine Chin is a recognized leader in preventative healthcare. Her clinic, Executive Health Centre, is one of few to offer telomere testing among other specialized tests that provide her clients with the information they need to help ward off chronic disease.