Friday, April 1, 2011

Newt Gingrich and Serious Medicine--Vindicating the Upward March of Science and Technology

Newt Gingrich has taken a bold stand on behalf of scientific advancement, better public health, and economic growth: As reported in Politico this morning, he stood up for funding of the National Institutes of Health.   At first blush, Gingrich’s stance might seem like standing up for apple pie--not bold at all.  But in fact, the politics of science, left and right, are prickly and tricky.  It seems, today, that it’s a lot easier to find opponents of science than proponents, at least in policy circles.  And yet of course, it’s science and its handmaiden, technology, that opens the door to both better personal health and more economic growth.   

From the left, Gingrich is confronting a peculiar school of ideology that holds that medical science is less important than social science. That’s the sort of politico-bureaucratic thinking that gave us Clintoncare and then Obamacare; it’s an obsession with health insurance, as distinct from health itself.  Furthermore, it’s the idea that scientific advancement is less important than social justice; indeed, it’s the fear that scientific advancement will somehow waylay the march toward equality and social justice.   On top of all anti-technological thinking come the Greens, who see just about any sort of progress as a transgression of their steady-state worldview.  

And on the right, Gingrich confronts a strain of libertarian purity that rejects the idea that collective political action can accomplish anything worthwhile.  Such a vision would be news to the leaders who mobilized science and technology to win, say, World War Two, or to eradicate smallpox or to build the Internet, but it’s a strong and well-funded impulse in Washington today.  The Cato Institute, for example, has called for abolishing the NIH.   The scientific establishment, to be sure, does itself no favors when it embraces the “magical thinking” of the Greens on carbon dioxide, but that’s an argument for checking-and-balancing Big Science,  and for pointing it in more constructive directions--not eliminating it.    

Ideological blips aside, the last three centuries of the industrial revolution have demonstrated the power--and popularity--of scientific discovery, technological innovation, and a rising standard of living.   Indeed, as China and India remind us, the rest of the world is now joining in.  We can all benefit from techno-marvels (even as we defend against some of them), but we know for sure we will have to compete to reap the greatest benefit. 

It’s to Gingrich’s enormous credit that he sees the value of that big-picture reality, even it costs him politically in the short run.   As Politico’s Kate Nocera reports:

Gingrich differentiated himself a bit from cut-first-ask-questions-later Tea Party Republicans, saying he helped balance federal budgets in the 1990s through a combination of smart reductions and targeted funding increases to critical research agencies that help improve care and contain costs long-term, the Institute of Medicine and the National Institutes of Health.

Gingrich said he was “deeply opposed” to the proposed billion-dollar cuts to the NIH and while the medical center needed bureaucratic reforms, investing in research now would save incredible amounts of money in the future – especially relating to diseases like Alzheimer’s and Parkinson’s.

Gingrich is right.  We won’t save much money on healthcare by chipping away at existing treatment models.  Instead, we will save money by transforming existing treatment models, to the point where the disease itself is transformed out of existence.  That is, we will cure diseases, not just care for them.  It’s cheaper to beat than to treat.  

Let’s take Alzheimer’s Disease (AD) as an example.  As former Supreme Court Justice Sandra Day O’Connor wrote last year, we are spending nearly $200 billion a year on AD care, mostly through  Medicare (plus another $200 billion a year, we might add, in uncompensated costs for caregivers), and yet we are spending only around $500 million a year on AD research.   That’s penny-wise and pound-foolish.  

Obviously, it’s cheaper, as well as more compassionate, to cure the malady than it is to care for it.   As O’Connor observed, we don’t spend money on polio anymore, not because we streamlined treatment, or because we are heartless, but because we eliminated the disease itself.   Or as the Alzheimer’s Association puts it: 

Meeting unmet medical needs for both prevalent and rare conditions promises even greater benefits. Consider again Alzheimer’s disease. In addition to the heartbreaking human toll, without a disease-modifying breakthrough, the cumulative costs of care will exceed $2 trillion in the next decade and $20 trillion from 2010 to 2050. The number afflicted will soar to 13.5 million. A breakthrough by 2015 that delayed the age of onset of Alzheimer’s disease by just 5 years, however, would mean 1.6 million fewer affected by Alzheimer’s and savings of $42 billion a year to Medicare and Medicaid by 2020, and more than $362 billion a year by 2050.  Research into Alzheimer’s treatments and even potential vaccines is underway in America and, with enhanced and sustained support, provide our greatest promise for reducing the spiraling Medicare and Medicaid costs associated with this disease.

To put it another way, in 2010, AD is costing America about 1.2 percent of GDP, headed toward four of five percent of GDP in the coming decades.    Speaking of the financial impact of AD treatment last year, one top researcher chose a vivid metaphor that’s even more vivid this year:   "We have a tsunami coming at us, and we're sitting in a rowboat," said neurologist Richard Mayeux of New York's Columbia University to the Washington Post in 2010. Surely that can’t be a good idea.  So a “cure strategy” might seem like an obvious approach.   We will all still die, of course, but we live longer and better first.  As an economist might say, in living longer, we will more fully amortize the investment we and society made in our own human capital.   

And there’s an important lesson here for conservatives and libertarians: The reality of rising costs is what drives people to seek health insurance of various kinds, and to seek government help in paying their bills.  And that treatment, as we have seen, is expensive.  It’s expensive because disease is expensive.  In February, I elaborated on this point for The Washington Examiner, citing Baumol's Law.  So the goal is harness the power of industrialization and mass-production to make goods cheap.  That’s why aspirin and bandages, for example, is cheap.   The wondrous inventions of one era are the commonplace of a later era.  That’s part of progress.  

As we have seen, the left has sought to address health concerns by overlaying social science on top of medical science, even if such spending is a) unpopular, and b) not the real solution.  So Gingrich was on to something when he said in the same Politico piece: “When Obamacare is repealed we can’t go back to a world that led us there, which was the same world that led us to Hillarycare which is why we have to have a replacement.”  In other words, even if Obamacare is repealed--and Gingrich hopes and expects that it will be--the same political forces that propelled its enactment will still be in place, waiting for a future opportunity to re-enact a similar bureaucratic program. 

For his part, Gingrich’s healthcare solution is more than just cures:  In the same talk that Politico reported on, he also called for tort reform, which would help end the Serious Medicine Crash.  And he advocates rooting out Medicare and Medicaid fraud, suggesting that anti-fraud efforts could save  $70 billion to $120 billion a year.  

And he further added, “And the cost of defensive medicine today is $800 billion a year.... If we fixed these two things we would have more than enough money to cover the uninsured.”  Eliminating defensive medicine is another way of saying, “improve treatment.”  And one key to improving treatment is the profound acceleration of medical technology, to Silicon Valley levels of productivity and achievement, as argued here at SMS.

So when Gingrich talks about healthcare overhaul, he is talking about many interlocking elements: funding medical research leading to cures, weeding out fraud and abuse, squelching abusive and counter-productive lawsuits, and then using information technology to improve healthcare delivery across a nation of 300 million Americans.  This is a huge challenge, of course, because these gains must be frameworked within a proper respect for ethical and privacy concerns.   To that list we can add, by the way, a thorough overhaul of the way that both the FDA and the NIH do business--as Gingrich has advocated many times.  The FDA is too restrictive, and the NIH, in the mordant phrase of Lou Weisbach, co-founder of the American Center for Cures,  “seems more interested in doing curiosity studies” than in focusing on translational research.   It would, indeed, be easier to justify NIH spending if it thought of itself in more of a DARPA model.  That is, decide what needs to be done, and then finance the doing of it.  

In other words, this medical agenda won’t happen without a lot of thought--including thought by governments at all levels.  We might ask ourselves: Is anybody going to trust private companies to do all this?  Give insurance companies, for example, the power to push aside lawsuits?   No.   True reform will only come from massive buy-in across the whole of our society.  And the process of achieving that buy-in is inevitably political.  Indeed, American history shows that what’s popular, and what works, and what endures is a productive cooperation of the two sectors, public and private. 

And there’s abundant recent evidence that this public-private approach has succeeded in healthcare--that is, the fusion of medical research and entrepreneurship, for the betterment of both.   

Harvard health economist David M. Cutler has been prominent in quantifying the economic gains of better health; he has showed that the gains vastly exceeded the economic cost of healthcare.  This is an important point: If one only looks at the cost of healthcare--$2.6 trillion at last count--and not at the benefits (not limited, of course, to economic benefits), then healthcare looks fantastically expensive.  Yet if one calculates the value of better and longer living, then the picture looks completely different---like a bargain, in fact.    

As Cutler wrote in his 2003 book, Your Money or Your Life,  "The conclusion is clear: We spend a lot more on heart attack care than we used to, but we get even more in return.”  And the same applies to other kinds of medicine: “We spend a lot on medicine, but we get more in return. . . . a central feature of the medical system is the increasing value it provides over time.”   

We might note, of course, that not all healthcare is that productive.  It’s smarter and cheaper--and ultimately more compassionate--to deal with disease before it strikes.   That’s the logic of vaccines.  But at the same time, the requirements of compassion necessitate spending money even on “futile care.” The challenge, then, over time, is to improve health so that we spend money on genuine rehabilitation.  Helping the paralyzed to walk again, for example, is vastly superior to merely financing wheelchairs.

Other economists have done similar work on other illnesses, showing how cure is cheaper than care.   Two academics, the University of Chicago’s Tomas Philipson and Stanford’s Eric Sun, estimate that the savings in the US from a single treatment for AIDS--the so-called HAART “cocktail”--have totaled at least $330 billion. Once again, healthy people live longer, produce more, and pay more taxes.   Another study on cancer found similar results: For a single decade, 1990 to 2000, researchers calculated that improvements in cancer survival generated a social surplus of between $1.6 trillion and $1.9 trillion.  
Who made money from that progress?  We all did.  Out of those gains, health care providers and pharmaceutical companies did well, but in fact, they captured only between 6-19% of that total.   In other words, of all the economic gains from enhanced cancer survivability, individuals, and the economy as a whole, captured between 81 and 94 percent.   That’s a lot of money--in the trillions.  So we can see, greater wealth for a healthy workforce is a spillover of Serious Medicine.  

And the prospect of using Serious Medicine to nurture a healthier workforce should attract the attention of political leaders looking for solutions to the deficit crisis.  Otherwise, when they tell the truth about fiscal challenges they will be greeted with partisan criticism--and little science-based support, because science was not engaged in the policy formulation process.  

Last summer, for example Rep. John Boehner, then the Republican Minority Leader, observed that an entitlement-cost solution should probably include raising the retirement age to 70.  Many Democrats rounded on Boehner, even as “deficit hawks” agree that a raising of the retirement age is an obvious solution.  So Boehner and like-minded leaders would have been well advised to embrace the idea that curing AD is cheaper than paying for its ill effects.  And how much would it add to the GDP if everyone works ten years longer?   Unfortunately, the prospect of science as a transformative agent is little heard in Republican circles these days.   It’s just not found in the talking points.   Some on the right seem to think that rhetorical escalation and ideological zeal will do the job of crushing Big Government.  They are wrong.   The problem of AD, to name just one costly illness, is not a problem of ideology, or market forces.  It is a problem of science and medicine.   If people get AD, they will suffer--and we will pay.  In such an instance, the financing mechanism is less important than the costly reality of the disease itself.   

For his part, Gingrich has always understood that conservatism can’t flourish without a modernizing, pro-technology spirit.   After all, it was the bourgeoisie--the Tea Partiers of their era, some might say--that championed the Scientific Revolution of the 17th century (Newton, Van Leeuwenhoek, Leibniz, Boyle).  And it was the enlightened fusion of science and statecraft in that era that led to the institutionalization of scientific and economic progress.  In 1660, for example, the Royal Society for Improving Natural Knowledge was established.  For three-and-a-half centuries, the Royal Society as been the intellectual equivalent of a holding company for just about every English scientist.  And Britain, of course, was the mother country of the industrial revolution.   

As far back as his book Window of Opportunity, published in 1984, Gingrich argued that the American right, by itself, was not strong enough to change the political culture.  The right needs to keep a principled alliance with science and technology, because it’s in technology that the invisible hand of the market is so often manifested.   That is, people know that market-capitalism works better because they can look around and see its fruits.  That’s a political winner: aligning the right with the forces of change and progress to do battle, if necessary, with the anti-technology left.  (Although one can always hope, of course, that pro-technology Democrats, in the FDR/JFK tradition will join the effort, and make scientific advancement a consensus issue, as opposed to a partisan issue.)   That's the Reagan model; the Gipper always wanted to associate himself with science and technology.   

Indeed, technology is the great game-changer--consider the device on which you are reading this blog posting.    And oh yes, it's better technology that enables wars to be won at less cost.

If we want to be healthy here at home, if we want to shrink federal spending, if we want to avoid defeat in the brain race with China--to say nothing of an actual conflict with China--we will have to embrace science.  In  a better America, support for science and technology would be completely bipartisan and mostly non-controversial. 

Unfortunately, that’s not the case.  So we should be all the more grateful that someone such as Gingrich stood up and said what needed to be said.   Politics aside, the fate of the nation is at stake.  We should all be able to rise above the blinders of ideology to see that centuries-old reality.   


  1. State Politicians are taking away the disabled's crutches to balance their budget with very little impact on school districts. NYS just did it. Hurray for the unions! :-(
    This is just one state. In how many more will the teachers unions win at the expense of the handicapped?

    I applaud Gingrich for his position. And yes the fate of our nation is at stake as you say.

    All “Hill People” need to rise above their blinders of ideology to see reality. Because if they don’t, we are done as a country. For the time being, all we can legally do is keep voting for individuals who will support the quest for cures of these decimating diseases.

  2. I did have to read far down your fine post until I reached the point about defensive medicine burning up gazillions of dollars. For physicians like me at 'Ground Zero', defensive medicine to proctect me is an aura hovering over me, and all practicing physicians. It wastes tons of cash and exposes patients to the risks of medical care that they don't need. Medical malpractice reform is a key element that was left off Obama's table.

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