While Washington Dithers, Tony Judt Confronts Nightfall

As of now, Barack Obama and the Congressional Democrats have precisely nothing to show for their year-long healthcare effort. They had a vision of bureaucratic control that failed with the American people, and it will most likely crater completely in Congress this year. This failure was a loss for the Democrats, as recent elections make clear. But it was also a loss for the American people--because all of us would like live healthier and longer.

Such thoughts on mortality are stirred yet again by a new elegiac diary of illness, published by Tony Judt, a professor at NYU and a leading scholar of modern European history, who is now wasting away from ALS--Amyotrophic Lateral Sclerosis, also known as Lou Gehrig's Disease. Lou Gehrig, known as "The Iron Horse" for his steady playing and playmaking over a decade-and-a-half in major league baseball, died at the age of 37. That was back in 1941.

Seventy years after the disease became famous, it doesn't seem that much has changed for ALS sufferers; we have to wonder what we have done with these seven decades. Judt describes his health situation in The New York Review of Books, in a piece called, simply, "Night." He is now, he tell us, a quadriplegic:

In effect, ALS constitutes progressive imprisonment without parole. First you lose the use of a digit or two; then a limb; then and almost inevitably, all four. The muscles of the torso decline into near torpor, a practical problem from the digestive point of view but also life-threatening, in that breathing becomes at first difficult and eventually impossible without external assistance in the form of a tube-and-pump apparatus. In the more extreme variants of the disease, associated with dysfunction of the upper motor neurons (the rest of the body is driven by the so-called lower motor neurons), swallowing, speaking, and even controlling the jaw and head become impossible. I do not (yet) suffer from this aspect of the disease, or else I could not dictate this text.

Such a fate is a tragedy for anyone, but Judt is a great scholar, and we shall miss his intellectual voice. From his professorship at New York University, he earned a reputation as a humane observer of politics and culture. He was always on the left, but possessed an Isaiah Berlin-like awareness of the danger of absolutism and dogmatism of any kind, and so he was interesting and useful to all sides in a debate. Just four years ago, he completed a major work, Postwar: A History of Europe Since 1945, which I reviewed, favorably, here, for The American Conservative.

And Judt, born in 1948, is only in his early sixties. A Baby Boomer. How much will we all lose if his voice is finally stilled, way before his time?

If the US government really wanted to make America a better and healthier place, it would focus on curing diseases such as ALS. It would be working with the Chinese, and the Europeans, and the Arabs, and anyone else, on a grand project. A grand project for world health--because we all, everywhere, have a stake in cures.

But instead, as we all know, when the US government thinks about "health," it immediately slips a category--it immediately shifts to "health insurance reform," which is not the same thing. Thus a scientific project becomes a political project--even when the American people don't want it done to them. It's hard to think of a bigger lost opportunity. A new young president who campaigned on "hope," who seemed so eager to try new things, found himself sinking into the mire of unpopular bureaucratic programs. But of course, nobody made him do it--he did it to himself. That's the lost opportunity, to do something positive with all that energy. A lost opportunity to truly "bend the curve" on healthcare, by helping people live healthier and longer lives.

Truly a lose-lose. This failure was a loss for the Democrats, as recent elections show, but it was also a loss for the American people, because none of us have that long to wait. So there's a power struggle going on, between the American government and the American people. Neither side is winning, and so, as a result, we are all dying.

A Tale of Three Cities: Davos, Washington DC, San Francisco. And Three Different Visions for People: Two Positive, One Negative.

"Vaccines are a miracle." So says Melinda Gates, wife of Bill Gates and his partner in one of the great philanthropic projects of all time, The Bill & Melinda Gates Foundation. "With just a few doses, [vaccines] can prevent deadly diseases for a lifetime," Mrs. Gates adds, according to Science Daily, one of many sources reporting from the World Economic Forum in Davos, Switzerland. Yes, vaccines are, indeed a "miracle." So why don't we have more of them? How could it be that the Gates Foundation wishes to expand health and medicine for the world, while the US government seeks to restrict and constrict health and medicine here at home?

The Gates Foundation has just announced that it will donate $10 billion to the cause of vaccine research. In the words of Margaret Chan, head of the World Health Organization, "An additional 2 million deaths in children under five could be prevented by 2015 through widespread use of new vaccines and a 10 percent increase in global vaccination coverage." Well put!

But now we might note a strange dichotomy, a vast chasm between the warm outpouring of humanitarianism that we see in Davos and the chilly "austeritarianism" that's crunching DC. Over in Switzerland, Bill and Melinda Gates are seeking to "bend the curve" on healthcare costs in the best possible way--by eliminating disease, including AIDS, malaria, and tuberculosis. So it should be pointed out that in addition to the profound compassion driving the Gates' efforts, what they are doing, by promoting vaccines, will actually save the world money. Children who grow up to be productive adults are, to be utilitarian about it, good investments. Now I don't think that utilitarianism is the motivation of Mr. and Mrs. Gates; such economic abundance-making is merely a happy byproduct--good begetting good. If economic activity is ultimately a function of "animal spirits," then the higher the spirits, the more healthy the energy, the better for the world economy.

Meanwhile, what's the discussion in Washington DC, as led by Barack Obama and the majority in Congress? It's over "health insurance policy" and various schemes to ration care, all in the name of reducing costs. These "less is more" ideas were never all that popular, and they grew less popular as a) the economy worsened, and b) people learned new details of the Obamacare plan. Indeed, it now appears that Obamacare is doomed; even its best friends say it is on "life support." One might think, especially after the Clintoncare debacle, that the liberal-left would rethink its approach, and maybe now, after two huge defeats, it will. Maybe the liberal-left will embrace the "more is more" approach of the Gates Foundation.

A few days ago, here at Serious Medicine Strategy, I drew the contrast between Obama and Steve Jobs, both of whom made big announcements on Wednesday. But Jobs' announcement, launching the iPad, was greeted mostly with applause, while Obama's announcement, that he still wanted a healthcare bill, was greeted mostly with skepticism, even derision.

So now, in one of life's ironies, Jobs' great rival over the last 30 years, Bill Gates, has stepped forward with a vision that is also radically at odds with Obama's. That is, Gates and Jobs are on the same side of the optimism vs. pessimism divide; the two historic rivals are now united in their faith in a better future. Jobs seeks transformation through high-tech. Gates seeks transformation through cures. Those two visions, Jobs' and Gates', are both popular and admirable in their own ways. Meanwhile, Obama seeks only to build a bigger bureaucracy; his healthcare plan is mundane transactionalism, oblivious to the transformational power of technology, and also to the transformational power of prevention and cures.

So, come to think of it, it's a tale of three cities: Davos, Washington, and San Francisco. Optimism in Davos and San Francisco, pessimism in DC.

But wasn't Obama supposed to be the candidate of "Hope"? Indeed he was, back in 2008. But all the techno-progressivism of his campaign seems to have been leached out of him by the bloodless bean-counters he surrounded himself with when entering the White House. So yes, historians will marvel at these strange choices made by Obama. The 44th President is, after all, younger than either Gates or Jobs--and as an elected official, he is the figure most directly dependent on the affection and good will of the American people. It's Obama who will likely go before the voters again in less than three years; one would think that he would seek to propose something popular, such as a Cure Strategy, as opposed to the same old bureaucracy. Or at least that he would want to clamber onto the Gates bandwagon, or the Jobs bandwagon, or both.

So far, of course, Obama shows no such interest. But as his 2012 re-election campaign looms closer, perhaps the President will rediscover the value of Hope.

Steve Jobs vs. Barack Obama

Just published for Fox News, some thoughts on a cooler way to do healthcare.

Why Obamacare is Doomed--The Hollywood Version

Just published for Fox Forum.

Serious Medicine Strategy When The Agenda Shifts to Economics and Jobs

"Democrats Slam Brakes on Health Care Overhaul"--that's the headline in The New York Times today. “We’re not on health care now,” said Senate Majority Leader Harry Reid. “We’ve talked a lot about it in the past.” He added, “There is no rush.”

Indeed, as the chart above, from the Pew Research Center for People and the Press, shows,"health insurance" ranks twelfth on the public's list of priorities. Although interestingly, "Medicare" ranks much higher, sixth, and "health care" ranks eighth. And thus the reminder: people care about health and those who are extremely dependent on healthcare--the elderly--are extremely focused on "their" issues." But the general public doesn't rate "health insurance" as a very high priority. No wonder Reid doesn't want to talk about it anymore

And in any case, as the Pew data show, the top priorities are "economy" and "jobs."

So does that leave healthcare out in the cold? Maybe. One certainly gets the feeling that Reid has moved on, and perhaps also the Obama administration.

So should Serious Medicine Strategy find some other topic to worry about? Become Serious Economic Strategy? Nope. The argument here at SMS, all along, has been that healthcare is a great driver for the economy. It's the biggest employer, and medicine--not "health insurance"--is a product that people want to consume, sometimes desperately, ravenously. And not just Americans, but people around the world. So if that's not an economic engine, what is? Isn't that what we want?

But the argument has to be made. And alas, since, 98 percent of the discussion over healthcare has been over controlling costs--that is, shrinking the healthcare sector, perhaps provoking a recession in one of the few vibrant sectors of the economy--then it's little wonder that the country doesn't think of healthcare and medicine as an economic driver.

Serious Medicine Strategy has always been an economic strategy--now is the time to make that case.

Bernanke Confirmation Fallout: Death of the "Med Fed" Idea

I wrote this for Politico's "Arena" section:

The consensus seems to be that Ben Bernanke will be confirmed for another Fed term. And thus the Ulysses Grant-ization of Barack Obama’s presidency--substitute Wall Street, now, for railroads, then, to complete the analogy--continues apace.

But along the way, one bad idea seems to have disappeared, crashed along with the market. Which bad idea was that? A “Med Fed,” as pushed, most notably, by former Sen. Tom Daschle. In his book, Critical: What We Can Do About The Health-Care Crisis, Daschle wrote, “I propose a Federal Health Board, modeled loosely on the Federal Reserve System.” Unfortunately for Daschle, that book was published early in 2008, before the various meltdowns and bailouts discredited both financial wizardry and Wall Street.

Amidst the controversy swirling around Bernanke and the policies that he has so closely coordinated with Larry Summers and Tim Geithner, it’s almost humorous to re-read Daschle’s idea, based as it was on the premise that the Fed was such a great success that we needed more Feds. But when the Fed was riding high, the Med-Fed idea made sense to many. As Daschle put it two years ago, “Like the Federal Reserve, the Federal Health Board would be composed of highly independent experts insulated from politics. Congress and the White House would relinquish some of their health-policy decisions to it.”

It’s hard to think of a policy proposal that better reflected the pro-financialist Zeitgeist of the Greenspan-influenced, pre-crash era. Indeed, it seems like only yesterday.

How Much is an Autism Cure Worth?

Business Week's Ellen Gibson reports on accelerating efforts to find a drug to effectively treat autism. As the charts from BW above show, the affliction is destined to grow to be hideously expensive--and that's just in dollars-and-cents terms, to say nothing of the enormous human costs.

So again, looking at those sorts of costs, is it cheaper to think about saving money by shaving a few points off the growth trajectory of autism treatment? Or by tackling the problem of autism itself? The answer is obvious.

But in the meantime, Washington DC is abuzz with proposals for reducing the deficit and debt. But the question is whether or not any such budget-cutting commissions will actually think through the best way to cut spending. Will they look, for example, at strategies that involve eliminating the disease--such as a cure for autism? Or will they seek, simply, to reduce the rate of growth on future spending? A look at those charts reminds us: A huge percentage cut in future spending would still be a huge increase from where we are now.

The cheapest treatment is a cure.