Alzheimer’s Disease currently imposes a $172 billion cost on the U.S. economy, and these twelve-digit costs will soon become thirteen- and fourteen-digit costs, reaching a trillion dollars a year by mid-century–and a cumulative cost of more than $20 trillion by 2050. These are immense dollar figures.
And such figures puncture any hope that Medicare/entitlement reforms–defined as shuffling payment mechanisms between the public and private sectors–can, by themselves, bend the curve of future costs. Sick people are expensive, period. So what’s needed instead is the bending of the curve of future health–that is, improving health itself. If health improves, the spending curve will improve, too; any “reform” that simply slaps downward-sloping budget numbers on upward-sloping illness is doomed to failure.
The prospect is bleak, to be sure, and it explains why healthcare costs continue to rise, even as, at the same time, the production of medicine has fallen off. After all, there’s nothing more expensive than continued but futile care.
An obvious fact: Simply financing the terminal ravages of disease is expensive. And for an aging society, elder diseases are the most expensive of all. The over-65 population is projected to more than double in the next four decades, from less than 40 million to almost 90 million–from 13 percent of the population to 20 percent. Such aging guarantees rapidly rising costs for the most serious elder disease, Alzheimer’s, the incidence of which will quadruple over the next four decades.
In other words, the fond hopes of the two parties–that they can manage healthcare costs through budget and market mechanisms–will inevitably collide with the reality that 24/7 dementia care is expensive, no matter how it might be financed.
The Democrats hope that better bureaucratic management–aka, Obamacare, aka rationing–can control such costs. And some on the “duty to die” left wing of the party–a school of thought well represented in the public health apparat–might even applaud the drastic cost-cutting measures currently being seen in Europe; one doctor in the UK recently accused the National Health Service of hastening the death of 130,000 Britons a year. Those accusations find their mirror, stateside, in discussions of “death panels,” and that’s a hard charge to refute.
Meanwhile, the Republicans speak fondly of reorienting Medicare toward the free market–that is, bringing the invisible hand to a visibly kludgy healthcare system. Yet that’s going to be a serious political challenge, to put it mildly, in a population that strongly supports Medicare the way it is.
It’s undeniable that any system, in the long run, benefits from the inherent rigor of personal responsibility and the accurate pricing of market forces. Yet it will be a long time, indeed, before it’s possible to whittle down the current system. Medicare fraud is variously estimated at anywhere between a quarter and a tenth of the program, and Medicaid is certainly no better. And yet one man’s fraud is another man’s political patronage machine. Today, 90 percent of healthcare in this country is paid for by third parties; because of the difficulty of making changes in insurance systems, Paul Ryan will have to win many elections before the financing system looks appreciably different. In other words, the long slog toward financial solutions will be just that–a long slog. At best.
And, once again, if people are sick, they are sick–and sickness costs money.
Thus the centrist “deficit hawks” are similarly destined to be disappointed if they rotely apply fiscal solutions to medical problems. The High Church Establishmentarians, who yearn for some “grand compromise” on taxes and spending, who aim at holding healthcare expenditures to some pre-set percentage of GDP, will soon discover that “deals” are not deals if they conflict with basic reality–if they simply attempt to paper over undeniable costs. Fifteen years ago, deficit hawks agreed that agriculture programs, for example, were too costly, and so the “Freedom to Farm” bill was enacted. And then, within a year, it was effectively un-enacted.
So how do we control healthcare costs? In the long run, there’s only one way: Improve health.
That’s the lesson of our success in the past. At the turn of the last century, we used public hygiene campaigns in big cities–combined with public-hygiene-infrastructure-building, such as sewage and water-treatment–to drastically reduce infectious diseases such as tuberculosis and typhoid. The main objective in these efforts was humanitarian–and political, too, since people like to be healthy–but the overall economic benefit was undeniable. To put it coldly, low infant mortality is expensive.
Similarly, during the early decades of this century, we drained swamps and killed mosquitoes all across the South, thereby virtually eliminating malaria and yellow fever. In the 50s, we used the Salk and Sabin vaccines to all but eradicate polio. In the 70s, we completed the eradication of smallpox, not just in the US but around the planet. And in the 80s and 90s, we turned AIDS into a mostly manageable disease in the US. According to Elias Zerhouni, the Director of the National Institutes of Health under Bush 43, a $10 billion investment in AIDS research has yielded $1.4 trillion in benefits to the economy, in terms not only of money saved, but also of taxes paid and economic benefits generated.
Indeed, the economists Kevin Murphy and Robert Topel of the University of Chicago have calculated that medical improvements overall, from the period 1970 to 1990, have generated an extra $2.8 trillion each year for the US economy. And it stands to reason: If life expectancy surged from 49 in 1900 to 77 a century later, that’s a lot of people working a lot longer, amortizing their human capital over more decades of productive life. Indeed, with a healthier population, we could more plausibly raise the retirement age for entitlement programs. And that’s a truly grand bargain: We could tell AARP that there’s bad news and good news; the bad news is that its members will have to work longer; the good news is that with better treatment/a cure for Alzheimer’s, they will know the names of their grandchildren. Moreover, the reality of current economic hard times seems to be requiring many folks to keep working well past 65, regardless of any official retirement age. If so, that’s all the more reason to empower people, health-wise, to keep working.
But wait just a second, some might say. It’s not as if we can just snap our fingers and cure Alzheimer’s. In fact, existing research seems stalled, at best. Moreover, major figures in American life, including Maria Shriver and Sandra Day O’Connor, have raised the cure-Alzheimer’s issue in recent years, and yet they have made little impression on the public discourse.
So what’s the hang-up? Why the hesitation even to try to tackle Alzheimer’s? One answer could be that the issue is simply too depressing–too much of a downer. Another answer is that few people believe that the government is capable of doing anything. Beyond the libertarians, who have a kneejerk dislike for anything done, even in part, by the government, there’s a huge pool of people who believe, not without reason, that Uncle Sam can barely tie his shoelaces, let alone manage a complex national effort on Alzheimer’s.
Still, just because the system is incompetent today doesn’t mean it has to be incompetent tomorrow, and forever. Perhaps necessity can be the mother of reinvention. The prospect of a “zombie nation” of tens of millions of Alzheimer’s victims, wasting away and costing away, could be the needed catalyst for a new order of competence and effectiveness.
As Paul Ryan said in his vice presidential acceptance speech in Tampa, when he thinks of Medicare, “My thoughts go back to a house on Garfield Street in Janesville. My wonderful grandma, Janet, had Alzheimer’s and she moved in with mom and me. Though she felt lost at times, we did all the little things that made her feel loved.” Not everyone will be satisfied that those sweetly expressed sentiments fully capture the fullness of Ryan’s views on Medicare, but it’s worth noting that Alzheimer’s does appear in the Republican platform in one distinctly forward-looking sentence:
We also support federal investment in basic and applied biomedical research, especially the neuroscience research that may hold great potential for dealing with diseases and disorders such as Autism, Alzheimer’s, and Parkinson’s.
So here could be Mitt Romney’s big opportunity: opening up his image, and opening up the election, by embracing a big positive vision for healthcare–that is, better science, not just better finance.
Even Romney’s fiercest detractors have to concede that he would be effective at organizing an imaginative public-private consortium, in the manner of the Olympics, on Alzheimer’s–that is, calling in moguls, medical experts, pharma corporations, maybe even an international partner or two.
And of course, Romney could attempt the same elixir–one part enterprise zone, one part X-Prize, one part corporate, and, yes, one part government–for other maladies, too. What American, for example, wouldn’t salute a serious effort to heal wounded warriors of traumatic brain injuries?
Medical progress offers something that few politicians are offering today: hope. Barack Obama had it four years ago, and he has lost it since. Romney does not have it now, but he could have it if he wanted it. Paradoxical as it seems, the hope that Romney needs today could be found in that most depressing of topics–Alzheimer’s.
James P. Pinkerton is a contributor to the Fox News Channel and a TAC contributing editor.