Diseases Are Bad. That's Good Politics.
Did you catch that line from Mike Huckabee during the last Republican presidential debate in which he calls for a declaration of war on four major diseases?
"I really believe that the next president ought to declare a war on cancer, heart disease, diabetes and Alzheimer’s," he said, "because those are the four things that are causing the greatest level of cost.”
Until he repeated it a few minutes later, I didn't take much notice. But it turns out he's not alone. A "cures caucus" is building within Republican ranks.
Michigan Representative Fred Upton, who heads the House committee that oversees biomedical research, sponsored the 21st Century Cures Act, which overwhelmingly passed the House in July. It authorizes $9.3 billion over five years to establish a Cures Innovation Fund at the National Institutes of Health. That's in addition to the $30 billion-plus the NIH already receives annually.
On the Senate side, Mississippi Republican Roger Wicker recently offered a measure to let the NIH award prize money for research breakthroughs and public-private collaboration on potential cures for Alzheimer's.
Billions more federal spending on biomedical research? More U.S. coordination with private-sector efforts? A government-wide challenge to help sick people, a la JFK's man-to-the-moon challenge?
It seems some Republicans are betraying conservative dogma -- perhaps most emphatically pushed by Cruz -- that says government agencies are inept and federal spending inane.
But the cures caucus makes eminent sense. The goal is an eventual reduction in federal spending on expensive health-care programs by reducing the incidence of killer diseases. The bulk of Medicare and Medicaid expenditures go toward treating chronic diseases like cancer, heart disease, Alzheimer's and diabetes. Alzheimer's and other forms of dementia alone eat up 68 percent.
There's ideology at work as well in a push to deregulate the Food and Drug Administration, which Republicans see as overly risk-averse and bureaucratic. That's even though the FDA's approval rate, by one estimate, is close to 90 percent, up from 56 percent in 2008. By overhauling the FDA, the cures caucus believes, it can reduce the crushing cost of winning government approval for new medicines -- about $1.4 billion on average today. “We need a supply-side revolution that spurs medical innovation,” Cruz told a meeting of pharmaceutical scientists last month.
Ultimately, the aim may be to take the spotlight off the need to repeal and replace Obamacare and its costly Medicaid expansion -- something Republicans say they want but that increasingly eludes them.
But there may be something even more fundamental going on here: Promising an all-out effort to find cures has special appeal to a Republican base whose demographic skews older and sicker. Indeed, life expectancy of Americans in red states is slipping below that of blue states, a new study by economists at the New York Federal Reserve Bank shows.
From 1989 to 2007, U.S. average life expectancy grew by 3.1 years, but it seems that geography matters when it comes to individual improvement. People in counties with the greatest improvement in longevity live about a decade longer than those in counties with the least improvement. And the longer-living counties are predominantly in the blue states of the East and West coasts and the upper Midwest. The shorter-living counties are mostly in the red states of the Southeast and Southwest.
When life expectancy is plotted against personal income, the pattern reveals that people with higher incomes have better health and therefore live longer, leading the economists to connect health inequality with income inequality. Almost 31 percent of Texans are obese, versus 24 percent of Californians, where income levels are higher and inactivity levels lower than in Texas.
The Fed study also notes another piece of evidence showing that people with shorter life spans have become more concentrated in the Southeast. As late as 1989, it says, "the lower tail of life expectancy had many people outside the Southeast." By 2007, "there were very few people outside the Southeast in the lower tail of the life expectancy distribution."
As Bill Bishop wrote in "The Big Sort" in 2008, Americans are gradually sorting themselves by ideology, with liberals attracted to liberal regions and conservatives to conservative regions, to be closer to people who live, think and vote alike.
Is it possible that the sorting trend is pulling older, less active people with lower incomes into the South, resulting in shorter life expectancy and higher rates of disease than the rest of the U.S.? And might this explain the cures caucus?
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