Equine Opportunity?

Multiple sclerosis, a chronic neurologic disease affecting about 300,000 Americans, has touched the lives of both 2012 presidential candidates. Ann Romney, who recently credited horseback riding with her good health, remains quite active but has struggled with MS over the past 14 years; Michelle Obama's father, Fraser Robinson III, died in 1991 after fighting MS much of his adult life.

Therapy for MS has improved dramatically in the 21 years since his death, as numerous drugs have been introduced that disrupt the body's inflammatory response to an overly exuberant immune system gone slightly haywire. These medications are effective for many patients, but all have a glaring problem: they are wildly expensive. Drugs with unwieldy names like glatiramer, fingolimod, and natalizumab can cost a patient $30,000 to $40,000 per year. And while riding may have helped Ann Romney, dressage horses can go for six figures. The availability of superior but extremely expensive medications is now a recurring theme in American health care, from cancer (one popular drug runs about $50,000 a year) to heart disease (a heart transplant will cost you a cool million). Medicine has reached an odd moment when our cherished American innovation and ambition have given us products that we as individuals each would want, and probably demand, but that as a society we cannot afford.

This is not bad news, or a "crisis," or a watershed moment in human history; it is a simple, quiet fact. Yet neither Mitt Romney nor Barack Obama (or any politician) seems prepared to say it. It is hard to blame them; after all, not that long ago the menacing term "death panels" was coined to describe what might happen if doctors were allowed to encourage their Medicare patients to delineate health-care wishes should they become incapaci tated. To some, introduction of this practical discussion was nothing less than admissible evidence that Big Government is eager to trample a basic human right.

Perhaps the time has arrived for us to grow up and face our mortality, at least a little. Ann Romney has shown real bravery in speaking of her battle with MS; similarly, Michelle Obama has recalled the courage her father showed as he, like Ann Romney, confronted those frightening moments all too familiar to anyone with a chronic disease. One only wishes that the candidates themselves would demonstrate a similar amount of courage.