Second of a Spenglerian series. The first part is here.
As noted in the previous installment, the medical system--as distinct from the healthcare system--is decaying. "Healthcare" as an overall concept--defined as spending money on everything from acute care to chronic care to futile care to everything else--is doing fine; total annual outlays are heading toward $3 trillion a year. Moreover, nobody is talking seriously about curbing that growth anytime soon; even Rep. Paul Ryan of Wisconsin wants to leave Medicare as is for the next decade.
Yet amidst this continuing torrent of aggregate healthcare spending, it's worth remembering that the essence healthcare is medicine. After all, most of the time, medicine is what makes healthcare succeed--or not. A hospital without medicine is little more than a holding area. Sporadic drug-shortages notwithstanding, the overall medical situation in the US is not totally dire at the moment, at least not yet. Meanwhile, in many critical sectors--including brain diseases--the medical armamentarium is alarmingly empty.
Yet as to this shortfall of medical research and new medicine, neither party seems interested. The number of new drugs and medical devices approved by the FDA, for example, has crashed over the last two decades. Not surprisingly, at the same time, the overall life-sciences sector has also crashed. Last year stock analyst Sebastien Buttet calculated that investors putting money into the top five US Pharma companies--Abbott Laboratories, Bristol-Myers Squibb, Eli Lilly, Merck, and Pfizer--would have lost 58 percent of their investment during the previous decade. And the fate of medical venture capital seems little better; estimates of the falloff in economic activity in the biotech sector range from one third to one-half to three-fourths.
We might ask: Do politicos and policy wonks really want to see the life-science sector shrivel like this? Answer: Probably not. "Big Pharma" has plenty of detractors, but we can presume that even Naderites and trial lawyers hope that medical progress comes from somebody, somewhere.
Yet the reality of the decline of medicine is so obvious to anyone interested in healthcare that we must search for an explanation: Why has this downward spiral not drawn more political attention, to say nothing of more action?
Here's one possible explanation: Perhaps the basic model of medical progress is out of phase with larger trends in our political culture. That is, the trends toward increased polarization and even atavistic conspiracy-mongering, as at least one Democrat went so far as to say that Republicans seek to kill people as their healthcare solution, and just recently, one Republican labeled Democrats as communists. We might conclude: If the two parties see their job as fighting each other with such ferocity, it's easy to see why there's little interest in supporting scientific projects that presuppose long-term patience and the cessation, in the meantime, of political hostilities. Moreover, perhaps both sides intuitively dislike the idea of a project for which the other side might someday take credit.
In contrast to medical research, the Affordable Care Act, aka Obamacare, is much better suited to the political style of our time. That is, both sides can attack and counter-attack on the familiar turf of the last few decades: "taxing and spending," "compassion," "big government," "social justice." Nobody in the political class has to learn anything new to fight over Obamacare; they can just trot out the same basic arguments that have been used since the Carter or Reagan years.
Today, the political class on the right is hoping for a victory in the Supreme Court later this year; in the meantime, they are savoring a new poll finding that shows "Obamacare" is more unpopular than ever, supported by 39 percent of Americans, and opposed by 53 percent. Indeed, it would appear that a combination of bureaucratic incompetence and fractious multiculturalism have taken their toll on liberal-activist ambition: MSNBC anchor Lawrence O'Donnell lamented recently that "America has run out of altruism." In other words, the sort of social solidarity that supports ambitious welfare-state programs has petered out. And just on April 16, no less a liberal than Rep. Barney Frank (D-MA) allowed that it was "a mistake" for President Obama to push his healthcare bill to a Pyrrhic conclusion.
Yet let's suppose for a second that Obamacare is struck down by the Court. Or suppose that Mitt Romney wins this November and succeeds in repealing the legislation, or at least waivering it out of existence. What will happen then? We know the answer: The same liberal politicians and activist groups will rise up with the same arguments they have been making for 60 or more years--perhaps joined, quietly, by the health insurance companies, as has happened in the past. It's possible, of course, that MSNBC's O'Donnell is right, and we have entered into a post-altruistic era of atomistic social fragmentation. If so, the left, if it had to start from scratch, seeking to enact national health insurance all over again, might fail. Or maybe new healthcare finance mechanisms could be found, such as adroit use of trial lawyers and noisy street demonstrations.
In other words, we might anticipate a new and even more shrill political debate, in which the focus, once again, is financial redistribution, as opposed to medical-cure creation.
And maybe, for reasons noted, that's what politicos really want. After all, as the production-process guru W. Edwards Deming always liked to remind his pupils, a system produces the results that it is designed to produce. In other words, the current system of medical futility is working well for those who find it advantageous for the system to continue like this. And so what does that tell the rest of us?
To be continued.