The wheel of healthcare policy is turning, slowly, from a Cut Strategy to a Cure Strategy. That is, from the old idea that the main goal should be to cut healthcare spending, to the new idea that the main goal should be to improve health--and to remind voters that healthier people cost far less.
So far the signs of this shift from Cutting to Curing are small. Nonetheless, they are unmistakable: On September 25, the White House Council of Advisors on Science and Technology (PCAST) issued a report calling for a doubling of "innovative new medicines" over the next 10 to 15 years. Doubling new medicines? Where does such a vision come from? Not, to be sure, from the current conventional wisdom that less healthcare is the goal, that we need to "bend the cost curve"--downward. And as a predictable result, the pipeline for new drugs has been drying up for years, depriving people of cures they would be happy to pay for.
The PCAST report is, indeed, quite a turnabout, given that the entire healthcare discussion over the last three years--as well as over the last two decades--has been how to make cuts in spending. The policy elites of both parties have started with the a priori assumption that our goal should be to spend less on healthcare, not more. That is, we--the general public, though perhaps not the elite--should be more like those thrifty Europeans; we should learn the wisdom of the right to die, even the "duty to die." And yet the average American has never agreed with this approach; polls show that by more than a 4:1 ratio, people want more healthcare, not less. But the average American, of course, does not write for a wonk publication; he or she is heard from only at election-time.
Yet now, in contravention of the prevailing "scarcitarian" ethos, the White House, for a change, has produced a policy document making an argument that the public would actually like. Consider this quote from PCAST co-chair Eric Lander:
With improved collaboration among all the participants in the drug development ecosystem and optimization of drug-evaluation pathways, American researchers and companies should be able to accelerate the development of safe and effective drugs while also strengthening the U.S. economy.
In other words, PCAST is saying that a positive pro-science medical strategy would be a win-win: a win for our health, and a win for the US economy, including, of course, the export economy; after all, the rest of the world needs new medicines, too.
And to the extent that such research creates new spinoffs across the economy, that's a third "win." And if real improvements in medicine--most obviously, an effective treatment for Alzheimer's Disease--could be linked to a raising of the retirement age for entitlement programs, well, that's a fourth "win." Such a quartet of wins would be a major improvement over either party's healthcare-policy track record in the last few years.
In the meantime, we might note President Obama himself is not quoted in the PCAST release, nor has he chosen to highlight this medical-abundance idea on the campaign trail. So the PCAST report cannot yet be considered a true presidential initiative, as opposed to the optimistic effort of some forward-thinking policy entrepreneurs dwelling several rungs down the White House staff ladder. After all, the Executive Office of the President is a big place, after all, and PCAST is tucked away in the Eisenhower Executive Office Building; it's possible that when the West Wing and/or the Office of Management of Bean-Counting--oops, make that Budget--gets wind of this change in healthcare orthodoxy, the PCAST report will be put away on a high shelf.
Yet it's also possible that the opposite will happen: Maybe the Obama White House will embrace the idea. Maybe the President will cite the PCAST idea in his first debate, focused on domestic policy, with Mitt Romney on October 3--as in, perhaps, "This is what I will do in a second term. I will move ahead with new cures. And as for you, Governor Romney, not only do you want to cut Medicare, but you and your running mate also want to cut the National Institutes of Health and other medical research programs."
Would such a pro-research declaration help Obama, or would it hurt him? Would a policy of science-based medical hope turn out to be good politics, or bad politics? If Obama pushes new medical solutions, it would show he is indeed running a smart campaign.
But who knows, maybe Romney and the Republicans are ready with a strong response, noting that the output of new medicines has continued its long downward trend in the past three years. Maybe Romney is ready to respond with his own ideas for doubling the production of innovative new medicines. Maybe the Romney Plan will include say, enterprise zones, X-Prizes, deregulation, and trial-lawyer shielding. Maybe the Romney Plan is so good that Romney will spring it on Obama in that debate. Or maybe not--we'll have to wait and see.
This much we do know: Nothing would be better for medical progress today--and tomorrow--than a bipartisan competition between the two parties to generate the best possible Cure Strategy.
After all, both parties have tried the Cut Strategy, without success. In 2009-10, the Democrats scared the American people with talk about healthcare rationing and cutting Medicare, and we all know what happened in the 2010 midterm elections. And since then, in 2011-12, the Republicans have been scaring--or, as some might insist, letting the Democrats and the media get away with scaring--the folks about cutting Medicare.
So if each party gets zapped on Medicare--Democrats in '10, and Republicans, seemingly, in '12--then what conclusions should we reach about the next election? Who wants to go first on cutting Medicare in time for the '14 midterms? One popular inside-the-Beltway answer, of course, is for both parties simultaneously to agree to cut Medicare and squeeze healthcare, as part of some "grand bargain." And that might work, at least in the short run--until the real Medicare cuts kick in. At that point, the public backlash will begin, and the bargain, grand as it might be, will likely unravel.
After all, as we learned with The Medicare Catastrophic Coverage Act --enacted in 1988, reviled by seniors immediately, repealed in 1989--legislation that seems like a good idea in DC can quickly fall apart if the larger public is not on board.
So we might note that the way to make, say, Bowles-Simpson 2.0 into a genuine success would be to add a Cure Strategy component to the Cut Strategy. That is, make progress on elder-diseases such as Alzheimer's, and then couple that progress with a raising of the retirement age for entitlements. That would be a win for health, and a win for the government's budget burden--again, that fourth "win." And these Medicare cuts could stick, because the elderly and their political champions--most of them, at least--would have to admit that some greater positive health-deliverable was actually being delivered.
But first the political class has to accept the eternal paradox of medicine: The road to austerity--as in, lower costs--runs through abundance. That is, just as with computer processing power--or any kind of economies-of-scale technology--"more" means not only cheaper, but also better. After all, not every problem is fiscal; some problems are scientific, and that truism applies to the toughest, and most tragic, of health problems.
Eventually, one or both of the two parties will embrace the Cure Strategy. That is, leaders will give people what they want and the economy what it needs. And when that happens, we might note that Lou Weisbach, a Chicago businessman/political activist/health visionary, will deserve a lot of the credit; for more than a decade, Weisbach has been pushing what he calls an American Center for Cures, and his efforts have encouraged leaders in both parties to take a closer look at the Cure Strategy.
In July, Rep. Bob Dold (R-IL) endorsed the American Center for Cures on the floor of the House. And in September, Rep. Rob Andrews (D-NJ) took to the pages of The Wall Street Journal to argue for an "Apollo program" against dreaded diseases such as Alzheimer's. Out of Dold's and Andrews' shared vision, one can espy a future agency--say, a Department of Cures, modeled after DARPA--tasked with a serious mandate to improve medicine and cure specific diseases. Or it could be something completely different: It could be a series of enterprise zones, offering long-term shelters from regulation, litigation, and taxation.
In other words, while the details of a bipartisan Cure Strategy are waiting to be filled in, the broad outlines of a comprehensive Cure Strategy are already apparent. After all, "more," as in "more health" is a better political pitch than "less," as in "less health." And yet, once again, over time, more health will equal less expense--just as more computer power makes computing cheaper.
It's a life-changing, politics-changing vision, that's for sure. And the Obama administration--whether it fully realizes it or not--has just made a big move in that direction.