To have a meaningful debate on anything there has to be at least a rudimentary agreement about the nature of the problem. When it comes to healthcare most commentators seem to be based in an alternative universe. This is usually true of those on the left, but it also is spreading to the right. James P Pinkerton writing in the June 21 issue of the National Review shows the problems obstructing an intelligent discussion of how our medical care should be structured, delivered, and reformed. Start with his title: Talking Cures – To beat the Left, try beating cancer. Right away you can see the problem; medicine has not been twiddling it thumbs trying not to beat cancer for the past 50 years. We’ve even declared war on it. We lost. If we could have cured cancer we obviously would have done so. Mr Pinkerton’s exhortations will not help us do it any sooner. More on this below.
A majority of Americans appear to oppose the new one million page long healthcare act – Paradise Lost is an easy read by comparison. Despite the act’s complexity, its proliferation of costs, and its super generation of bureaucracy, Mr Pinkerton thinks that Republican efforts to repeal it are misguided. The real problem, he says, is that Americans are not getting enough medical care. He cites a Kaiser Foundation survey that says 67% of Americans believe they are not getting the tests and treatments they need. He doesn’t specify what these services are or if they would contribute anything to the nation’s betterment other than cost. His view is that if the people want it the Republicans should give it to them. As if the modern liberal democracies have incurred no problems giving their voters more of whatever they want. Why he should give credence to this survey is mysterious – 67% of American physicians don’t know what tests and treatments their patients need. Review the history of Evidence Based Medicine and the ever changing screening guidelines if you doubt me.
A more intelligent approach would be to think of the public’s demand for health care as an opportunity rather than a liability. Our economy is driven by the harmonious convergence of entrepreneurial exuberance and insatiable consumer demand. Those are good things — so let’s have more of them… It is expensive to develop cures and vaccines, but it is more expensive not to have them — and long-term extended care is truly expensive. If the policy elites want to offer something of value, they should find ways to support medical and scientific research rather than lecture us on our spending.
Mr Pinkerton rightly observes that is cheaper to cure a chronic disease than to treat it and cheaper still to prevent it. It’s here that he gets into trouble. He cites polio and AIDS as examples of medical success which we should attempt to duplicate with today’s major health problems. He uses the huge increase in life expectancy in the 20th century as an example of a medical success that we should build on. Polio and AIDS are infectious diseases; they each have a single and easily defined cause. Hence compared to the medical problems that affect today’s aging population they are simple.
Most people in the developed world will die from diseases related to growing old. Almost 20 years ago a team of actuaries estimated that if no one died from cancer, heart disease, or diabetes life expectancy would increase by only three years. When you’re 80 if one thing doesn’t get you another will. I’ve said this repeatedly, but apparently it can’t be overstated, life expectancy increased in the 20th century not because we extended life at its end, but because we did so at its start. Childhood diseases and deaths from pregnancy were almost extinguished over the last 100 years. We have more old people because young people rarely die and thus get a chance to get old. Old people do not live that much longer than old people did a century ago.
Spending all the money the Fed can create will have almost no effect on longevity unless the money is spent on preventing aging. Even here the money would be wasted; there aren’t enough good unfunded ideas on which to spend extra money devoted to research on aging. People now are coming to resemble Holmes’ One Hoss Shay; they get old and fall apart, perhaps not as suddenly as Dr Holmes’ shay, but you get the idea. Medical research is not an open ended commodity – the more you spend the more good things you get. There’s little reason to believe that there are many good ideas that will meaningfully affect health currently not being supported. You can lead an unfunded scientist to the money trough, but you can’t make think any better.
There’s also the issue of the NIH’s bloated bureaucracy. Presumably Mr Pinkerton wants all the new medical research he advocates funded through the NIH. No one likes to talk about this, but the NIH spends almost as much on administration as it does on actual research. It is also under intense political pressure to fund research that special interest groups (often well meaning) favor.
But for a moment let’s forget all that. Let’s grant the NIH administrative perfection. Suppose medical science succeeded in arresting aging. Would that be a societal good? What would be the social, demographic, and political consequences of such a discovery? Where would we put all these people who were staying young? They wouldn’t be getting cancer, heart disease, or Alzheimer’s disease but they would start to stack up. Would you need a government license to stay young? Would birth control be mandatory? This might not be a problem for Western Europe and Japan as they don’t have children as things now stand, but it would be a big one for the most of the rest of the world. Even China’s one child policy might be too much.
Mr Pinkerton says we need a policy for cures. I doubt he knows what such a policy really means or realizes what can and can’t be cured. Everybody wants to cure cancer, but it’s really hard. Lack of sufficient science not money is what’s holding us back. This lack of knowledge is compounded by the perverse reality that curing cancer would have only a small effect on longevity. Spending a lot more money on medical research would doubtless make the researchers happy, but would it yield the health benefit Mr Pinkerton envisages? The answer is almost certainly no.
