It seems this week is when the self-appointed serious people have decided to discuss their grand schemes for long-term debt-reduction, so allow me to get in on the act.
I do not share the conventional wisdom that this effort must entail something nasty and unpleasant. I think long-term debt- and deficit-reduction should, like short-term deficit-reduction, make people's lives better rather than worse.
The biggest short-term deficit problem, after all, is unemployment. The obvious solution to joblessness is jobs. Put the unemployed back to work and you make them happier — you give them something they fervently desire while at the same time solving your short-term deficit problem. No attempt to address America's current federal budget deficit can succeed unless it involves putting the jobless back to work, yet this unavoidable fact is ignored by most of the so-called serious people because putting the jobless back to work makes people happy and doesn't entail suffering and sacrifice and widespread unpleasantness.
For some perverse reason — I can't fathom why — the serious people have become convinced that any attempt to address budget shortfalls must necessarily entail suffering and widespread unpleasantness. They thus tend to prefer approaches that produce such suffering and unpleasantness, even though those approaches don't do anything to address the fundamental fact of our current budget deficit — 9.6 percent unemployment. And the one solution that would be effective — putting the jobless back to work now to solve our near-term budget woes regardless of the immediate expense — is rejected out of hand because it would make people's lives better.
This same perverse reasoning shapes longer-term plans for deficit- and debt-reduction, where we see the same penny-wise pound-foolish obsession with never investing in the future and the same cruelly warped insistence that any long-term debt-reduction scheme must entail widespread suffering and austerity. Ideas that might make people's lives better are, by definition, off the table.
So the serious people probably won't like my plan. My grand scheme for long-term debt-reduction would improve the lives of tens of millions of people while saving everyone else a ton of money. It's an attempt to solve problems, rather than to luxuriate in enduring them and savoring the suffering they produce. And that goes against everything the serious people stand for.
And but so anyway, here is my plan, my GS for LTDR — are you ready? — it's short:
That's it. That's my plan. Cure diabetes. Eradicate it. Create a post-diabetes world in which people say, "Hey, remember when there used to be diabetes? That sucked. Glad we got rid of that." The kind of world in which, 30 years from now, people dimly recall diabetes the way we now think of polio or scurvy. "What's diabetes?" young children will ask, mispronouncing the word in some adorably innocent way. "Oh, that's just a disease people used to have a long time ago," their parents will say.
Cure diabetes. That's my plan.
Admittedly, there are a few significant details yet to be worked out in my plan. I'll address those in a moment, but first I want to examine the benefits my plan has to offer.
1. Solving America's long-term structural budget problem.
2. Recovering America's can-do spirit and capacity for greatness and achievement (or, at least, our capacity for imagining that greatness and achievement are possibilities).
3. Creating lots of jobs and spin-off technologies that will, in turn, create even more jobs and spin-off technologies.
4. People with diabetes wouldn't have diabetes anymore and no one in future generations would ever have it again.
On that first point, America's long-term structural budget problems involve some Very Large Numbers, but the arithmetic is still quite simple. Nibbling at the edges of the deficit by attacking earmarks or discretionary spending or the proverbial sacred trinity of "waste, fraud and abuse" is pointless and ineffectual. Those things are a tiny sliver of the federal budget and people who pretend to care about deficits while focusing mainly on such things are not people worth listening to.
The big pieces are all that matter: Defense, Social Security and Medicare/Medicaid. All of the little pieces put together don't add up to any one of those big pieces by itself.
Of those big pieces, the growing cost of the first two is manageable. America's unparalleled defense budget could be made smaller and more efficient and I believe that our guns/butter ratio could stand a significant readjustment, but this isn't really the major structural budget problem. As for Social Security, the only thing — by definition — that could jeopardize that program's future ability to continue to pay for itself would be a sudden and massive decrease in America's working population. America in 2010 has a workforce of roughly 155,000 million people (14.2 million of whom are involuntarily idle at the moment). The only way for Social Security to become a strain on future federal budgets is if that number goes down, significantly, in the coming decades. So barring some kind of Children of Men scenario, Social Security does not pose a long-term structural problem for America's federal budget. (Scaremongers like to pretend it does by presenting scenarios in which Baby Boomers are immortal and will all still be collecting Social Security benefits 50 or 75 years from now. Fifty years from now the youngest surviving Baby Boomer will be 115 years old.)
Medicare and Medicaid are the real problem — the real structural threat to America's long-term ability to balance its federal budget. For decades now the cost of health care has been rising at an unsustainable rate and, therefore, the cost of programs that pay for health care has been rising at an unsustainable rate. By "unsustainable rate" I mean, of course, a rate that cannot be sustained. That, in a nutshell, is America's debt and deficit problem. Fix that and you fix the budget. Ignore that and you haven't fixed anything.
So again, here is my suggestion for addressing the unsustainable growth rate in the cost of health care: Cure diabetes.
I don't mean to argue that ridding the world of diabetes would, by itself, completely solve the problem of runaway health-care costs, but it might be the second* most significant single step we could take. Diabetes is chronic and lifelong and very expensive in its own right. Just maintaining it costs a lot of money on a daily basis for the 24 million Americans who suffer from it. But it also tends to lead to even more expensive complications — including, for example, kidney failure and dialysis (which, as Propublica's Robin Fields reports, is both very expensive and almost entirely funded by Medicare). Diabetes accounts for almost a sixth of all hospital stays in the U.S., and for about a fifth of the expense of all hospital stays each year.
The cost of caring for diabetes is rising on a per-patient basis while, at the same time, the incidence of diabetes is also rising. A lot. Today diabetes affects about 14 percent of the adult population in America.** By 2050, according to a study by the Centers for Disease Control and Prevention, that is expected to increase to somewhere between 21 percent and 33 percent.
So grab the back of an envelope and sketch out some ballpark figures. In 2007, diabetes cost America about $174 billion. Figure twice as many Americans will have diabetes in 2050, so increase the annual number of patients at a rate that will double it in 40 years — then factor in the way-faster-than-inflation increase in health care costs of roughly, let's say, 10 percent a year.
That comes out to — well, a lot of money. It's a lot of money now, today, and it will be a lot more money 40 years from now.
My plan doesn't aim at reducing that cost, but at eliminating it. It aims for a situation where diabetes doesn't cost $174 billion a year, or $348 billion a year, or $1 trillion a year or more. It aims for a situation where diabetes costs $0 a year. Nothing. Nada. Zip.
So that's the sort of potential cost-savings we're looking at. Just keep that in mind in a moment when we discuss the short-term costs of the investments to achieve those savings.
Before we do that, though, consider that CDC study and its implications for quality of life. The CDC's middle-ground projection is that 40 years from now one in four American adults will have diabetes with all the expense, pain, suffering, risk, hassle and inconvenience that entails. One in four.
Set aside for the moment any consideration of the astronomically huge potential budgetary savings of this plan and just consider which is preferable: An America 40 years from now in which one in four people is afflicted with a painful, dangerous disease? Or an America 40 years from now where they're, you know, not so afflicted?
A world without diabetes would be a world in which it would be much easier to control health care costs and therefore a world in which it would be much easier to balance federal budgets. But it would also be a happier, healthier, less painful and stressful world for one in four Americans and their loved ones.
Oh, and also for the millions of people outside of America who have diabetes. My GSLTDR is not intended, primarily, to create a joyous development bringing those many millions around the globe newfound hope, health and happiness, but I'm rather pleased with that potential outcome as a likely side effect.
You've perhaps noticed that I haven't yet discussed the tricky part of this plan. How do I propose curing diabetes?
You may be worried that I have nothing more in mind than tossing millions of dollars at researchers and hoping for the best. Don't worry, I think that would be silly. I have something much shrewder in mind.
I'm proposing that we invest billions of dollars in research and plan for the best.
Tons of money. Staggering amounts of money. Huge, eye-popping sums. Numbers you couldn't count to if you spent every minute of every day counting for the rest of your life.
How much money am I talking about? How vast an amount? I'm talking about investing so much money in this research that the annual cost of that investment will be nearly — not quite, but nearly — one fifth of what we're already spending now treating diabetes every year.
And that's a lot of money. About $30 billion a year.
Invest that money wisely, spend it well, and we can find a cure. Find a cure and we will save more than five times as much money every year, year after year, forever. Find a cure and we will save more than $1 trillion dollars in 2050.
Or we could "save" $30 billion a year now and just accept that we will have to continue spending hundreds of billions every year for treatment. (If that's your plan, then you'll have to explain to me how this "fiscally conservative" approach intends to come up with the more than $1 trillion it's going to cost us to treat diabetes every year in the second half of this century.)
It is Nov. 12, 2010, and as of right now our best scientific minds do not know how to eradicate diabetes. A bit more money for research probably won't change that soon enough, but a lot more money for research might.
This approach has worked before. There's precedent. On May 25, 1961, our best scientific minds did not know how to put a man on the moon, but we were able to do so just 98 months later. We were able to do so not because President Kennedy was really handsome and charismatic when he gave an inspiring speech in that distinctive Kennedy cadence of his. We were able to do so because we invested a ton of money and spent it wisely with zeal and focus and an eye on tangible results.
The Apollo mission cost around $150 to $175 billion (in today's dollars) over the years it took to achieve its goal. That money made it possible to recruit and deploy an army of thousands of researchers and engineers — people who relocated with their families to enlist in new jobs in Houston or Florida or California where they went to work every day with one mission in mind.
They succeeded. That approach worked then and it could work now.
The Apollo program succeeded because it was intensely focused on a single goal, but it also accomplished a great deal more than just that single goal. It didn't just put Armstrong and Aldrin on the moon, leaving behind a flag and a nice note to the universe signed by Richard Nixon. The money invested in the Apollo program also produced other technological breakthroughs and developments too numerous to list. The life of the average American in 2010 would be unrecognizable without the products, inventions and techniques that resulted — some directly, some indirectly — from the billions invested in the space program throughout the 1960s and '70s.
I would expect to see similar beneficial side effects from a substantial, sustained and concerted effort to find a cure for diabetes. I would expect to see promising new approaches to treating or curing other diseases and syndromes, next-generation dialysis, more efficient and accurate tests, less-intrusive diagnostic methods. It's impossible to say just what all those benefits might be until we actually invest the money and do the work, but it would be unreasonable not to expect such life-changing and world-changing side effects.***
To be as clear as possible on the bottom line here, my two-word plan — cure diabetes — would entail $30 billion in new spending next year and every year after that until we succeed. In exchange for the certain expense of $300 billion over the next decade it promises the possibility — the chance, but not the guarantee — of future savings of more than $200 billion a year and more than $1 trillion a year by the middle of this century while also making one in four Americans a whole lot healthier and leveraging untold developments that could improve the lives of millions more while simultaneously spurring the economy and creating jobs.
That one-in-four number is what makes me think this plan would be politically possible. That's a big block of enthusiastic support from a large share of the electorate. And it's bipartisan. Heck, it's trans-partisan. Diseases don't restrict themselves to the members of one party or another, or to one state or another. Every politician of every party in every region would be facing significant constituencies who would support this.
Another point in its political favor is the relative absence of any organized pro-diabetes lobby. I suppose there might be something like Big Artificial Sweetener with which it would have to contend, but nothing as powerful or as deep-pocketed as Big Energy. And Big Pharma would probably like the idea. (See again.***)
Yeah, you'd have the Norquist/Toomey government-small-enough-to-drown-in-the-bathtub people opposing this plan because they oppose everything. But because they oppose government doing everything, they have to be selective about which particular parts of everything they get most excited about opposing. Defending diabetes from an effort to eliminate it might not strike them as the best way to trick the public into believing they're anything more than selfish raise-your-taxes-to-cut-mine jerks, so their opposition might be a bit muted in this case.****
But the main reason I think such a plan could be made politically feasible has to do with benefit No. 2 in my list above. Yes, the math really does make sense for such an effort — this potentially really could save trillions of dollars in future spending. And yes benefit No. 4 is enormously important and morally urgent. And benefit No. 3 is tantalizingly attractive.
But I also think Americans want and need to believe that we are a people and a country that is capable of doing — or at least trying — great things, big things, exceptional things.
Curing diabetes is a lofty goal and an enormously difficult one. But it's a worthy goal. There's no question of that. The only question is whether or not we still regard ourselves as a people and a nation worthy of such a worthy goal. The political mantra today is dominated by small and smaller, less and lesser. It's the outlook and agenda of a small people, a lesser nation. I don't much care for that.
We could do this. We could at least try. We can make things better. We can make people's lives better and, in doing so, make ourselves better — a better country, a better world. If that sounds ambitious that's because it is. That's what "ambitious" means — trying to be better in the future than we are today.
The serious people probably find my GSLTDR too ambitious. They're certain we can't afford to try to make anything better. They're certain all we can afford or attempt is to manage the incremental transition to something worse. Let that be the choice then: better or worse.
I choose better. I think it's better than the alternative, which is worse. I think we should invest in finding a way to make people better.
Cure diabetes. Got a better idea?
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* Single-payer. A significant fraction of America's health-care costs are spent on billing and paperwork and another big chunk goes to compensate the health insurance industry middlemen for their service of facilitating this expensive inefficiency. This is not money well spent. This money does not provide health care. It does not provide much of anything except dividends for the shareholders in health insurance companies. It does create jobs, I suppose — massive inefficiency and waste tends to create jobs, just not meaningful ones.
** For the record, I am not diabetic and no one in my immediate family has diabetes. The closest we come is Nick Jonas who, although not an actual relative, is probably more beloved by certain members of my household than many actual kin. This makes my family rare and fortunate.
I mention this only because some people seem to think that if I did have diabetes it would somehow undermine my call for finding a cure, tainting it with a measure of self-interest. They seem to think this because, they imagine, a person with diabetes would intensely desire such a cure to be found so that they might personally benefit. Such a cure would mean they would be rid of the affliction, expense and inconvenience of it and thereby enjoy an immense improvement in their own quality of life. But the intensity of that desire and the immensity of that improvement are exactly my point here. Improving the lives of 24 million people is a Good Thing whether or not you're one of those 24 million people. Duh.
*** And here, I think, the public should learn a lesson from the career of Tony- and Emmy-winning actor James Earl Jones. Jones was paid $7,000 for his work providing the voice for Darth Vader in the first Star Wars film. Not bad for a days' work. But for the sequels, he got points — earning a share of future profits. So as part of my GSLTDR, I'd suggest having somebody like Michael Ovitz or Scott Boras or Rahm Emmanuel's brother add some language to ensure that taxpayers will see a share of future returns from the side-projects and tangential benefits arising from their investment in diabetes research.
**** My guess is that their main line of attack would be to emphasize that poor diet and lack of exercise can be risk factors for developing diabetes, attempting to reframe this as a moralistic issue by blaming the victims and accusing this plan of seeking to "subsidize" irresponsible behavior. I've mostly avoided moral arguments in this post, letting the numbers speak for themselves, but if they really want to go there, I'm more than happy to oblige and see how their bogus moralizing stands up to more credible, grown-up moral arguments. In any case, the mortality rate for slender people with impeccable diets and responsible exercise regimens remains exactly the same as it is for everyone else.