Yes, it's the doldrum-y middle of August, but this is a great season for political junkies. But for those with real illnesses, or who worry about real illness and incapacitation, there's little news to be interested in--other than the usual grim news about the new deaths from swine flu and the hoped-for progress toward a swine flu vaccine,or the threat of new strains of HIV. That's where the real action is.--or, as we shall see, is not.
But in the hurly-burly of thepolitical arena, the White House is reeling from a revolt by liberals over the administration's apparent willingness to abandon "the public option." Meanwhile, a top Blue Dog Democrat says that any health plan will have to be "deficit neutral" (which means, your choice, a) that it won't spend much, b) that it would be coupled with a tax increase, or c) that the future costs will be extremely well hidden.) And Gallup has a new poll showing that conservatives outnumber liberals in every state in the union--even Vermont. And oh yes, there's even a little scandal brewing in the White House--call it "Spam-gate," which has united both Fox News and the American Civil Liberties Union. Those of us who are political junkies think back to 1993-4, when another Democratic White House overreached on health care, and the Democrats lost Congress.
But from a strictly Serious Medicine Strategy point of view, none of this matters too much. To borrow some computer programming lingo, the current political battle is a battle over "inputs" and "throughputs." That is, how much money do we spend in the name of health care (inputs), and how is it spent (throughputs)? So the whole debate over "the public option" is a long debate over throughputs. By contrast, Serious Medicine is about outputs--outcomes. Do people get better? Can they live better and longer?
Serious Medicine is about waging war on Serious Illness. As in, nuking diseases, the way that we nuked tuberculosis, or polio, or smallpox--or, for the most part, AIDS. Medical triumph over those illnesses made life immeasurably better, and longer, for billions of people. (And so it's a shame that we have backslid so much on TB in recent years, and it's an open question what will happen with AIDS, here and worldwide.) Such medical victories require Serious Resources: money, talent, regulatory streamlining, leadership, and a general sense of mobilization. That's how you win a war.
Some, such as Betsy McCaughey argue that the Obama administration is showing its egalitarian impulses here. That is, if the diagnosis of top Obamans, such as Peter Orszag and David Blumenthal, is that health care is too expensive overall, well, one way to reduce the growth of spending is reduce the rate of medical advancement. Hence, keep the NIH under control. Is that an unfair explanation of Obama budget priorities? Who has a better one?
Now of course, some will argue that NIH spending is just another kind of government spending, and that as such, it is mostly wasted. This is a purist argument that most Americans reject--there is a good enough connection between "input" and "output." And so the burden is on the purists to identify another, better, way to move resources into the Serious Medicine sector. But let's never be complacent: If there's a better way to run and fund the NIH, or something different altogether, let's have a debate. If there's a need to look at the FDA and the overall regulatory climate, let's do that, too.
And there's an opportunity here, too, for politicians. Why do all our leaders want to argue about throughputs? Why can't they argue about outputs?
Making our lives longer and better. That's a real bottom line, and we should lose sight of it, even in August.