Saturday, February 13, 2016

We Don't Need a Cancer Moonshot

Addendum: My father died a horrible death of lung cancer. There's plenty of cancer in my family and I expect to die of it myself someday. But I'm still against a "cancer moonshot."

Recently, Joe Biden called for a moonshot to cure cancer. Without dwelling on the fact that we've already had one failed moonshot to cure cancer (Nixon's), which is still underway, I'd like to explain why I think the new call for a Hail Mary Pass on cancer is just plain poor public policy.

It's bad policy, first of all, because it reflects muddled thinking: Cancer is not one disease. It's a multiplicity of complex, disparate conditions with distinct etiologies. [Insert much longer discussion here.] You might as well declare war on disease itself.

But beyond that, we should be clear on why we're choosing to attack cancer. Is it because we want to increase human life expectancy? Is it because we want to reduce suffering? Yes and yes, I presume.

What if we could achieve both of those goals more easily, which is to say in quicker fashion, less expensively, and with greater likelihood of success, by pursuing other agendas? If resources are scarce (so that we have to choose moonshots carefully), shouldn't we go for the low-hanging fruit first?

Life expectancy will not increase dramatically if we find a cure for cancer. The CDC has known for a long time that total elimination of cancer, if it happened tomorrow, would increase American life expectancy by only 3.3 years. (See my earlier post, Taeuber's Paradox and the Life Expectancy Brick Wall, for details.) While this is not a trivial increase, it merely brings U.S. life expectancy up to where the rest of the OECD countries already are.

The U.S. does have a life expectancy problem, but it is not shared equally across all segments of society.

Life expectancy (USA) at age 25 versus income as a percentage of the Federal Poverty Level.
From Overcoming Obstacles to Health, Robert Wood Johnson Foundation. Click to enlarge.

The highest-earning Americans (defined here as those making in excess of 4 times the federal poverty level) are already living 6.7 years (women) to 8.0 years (men) longer than the lowest-earning Americans (those earning less than the federal poverty level). Eliminating this gap (or the majority of it) would at least be equivalent to curing cancer, in terms of boosting life expectancy. It would arguably be better than curing cancer, in terms of reducing human suffering, because cancer suffering lasts a comparatively short time, whereas the depression, chronic illness, and other down sides to economic privation last decades.

Percent of adults in poor/fair health (USA) versus income as a percentage of the Federal Poverty Level.
From Overcoming Obstacles to Health, Robert Wood Johnson Foundation. Click to enlarge.

Speaking of chronic illness: Many studies have shown that as income levels go down, chronic illness rates (for diabetes, heart disease, etc.) go up, and as the above graph indicates, this is not an effect limited to a particular race; it cuts across ethnicities.

The above graph suggests that a moonshot aimed at increasing economic wellbeing would also, in effect, be a health moonshot, potentially. People who are economically better-off tend to be physically better-off. If you want to make a dent in heart disease or diabetes, start by getting people's incomes up.

A cancer moonshot transfers money to a relatively elite cadre of scientists and doctors (and their institutions). A prosperity moonshot puts money in the hands of ordinary people.

How do we do it? How would we do a "prosperity moonshot"?

Let's look at how not to do it. The Federal Reserve has done a moonshot, since 2007, called Quantitative Easing, a program in which federal dollars are devoted to buying back mortgages and Treasury debt. (And by the way, if $4.5 trillion allocated to a single project doesn't qualify as a moonshot, I don't know what does.) It's now fairly well accepted by economists that the main effect of the QE moonshot project has been to move "risk money" out of the bond market, into the broader equities market. This has resulted in innumerable pointless stock-buyback programs and a general increase in wealth inequality. The intended goal of getting banks to lend more money (and corporations to grow their businesses) has not happened.

Lawrence H. Summers
Governments, meanwhile, have been tightening their belts, cutting off fiscal flows (via "austerity programs") when they should actually be stimulating the economy through deficit spending. As former U.S. Treasury Secretary Lawrence H. Summers puts it: "The reality is that it’s government’s responsibility to be countercyclical—that when private saving is substantially exceeding private investment, that is precisely when government should be borrowing and investing." Now is just such a time. In fact, the timing couldn't be better. As Summers said in a recent interview:
This is a moment when the United States can borrow money at less than 3 percent for 30 years, in a currency we print ourselves. It is a moment when materials costs are extraordinarily low. It is a moment when construction unemployment rates remain high.

Has there ever been a better moment to fix LaGuardia or Kennedy Airport? It is crazy that at a moment like this, the United States has the lowest rate of federal infrastructure investment, relative to the economy, that we’ve had since 1947. And on a net basis—that is, taking into account depreciation—we’re essentially not investing at all.
This is the perfect time to be investing in rebuilding our infrastructure, forgiving student debt (or extending payback terms indefinitely), and yes, getting people out of poverty by direct grants, if necessary. We desperately need to see a drop in obesity (which is correlated to low income), a drop in pain-killer suicide rates, less diabetes, less alcoholism, less heart disease, less mental illness—we need to see health care costs start trending the other way. We can achieve that as a side benefit of doing a prosperity moonshot. And get a boost in life expectancy along the way.

The hard way to achieve longer life expectancy and lift the economy is to do a "cancer moonshot." We tried that once, already. It didn't work. It's not likely to work this time either.

Let's get out of "moonshot thinking" mode. We have serious work to do. We have a country full of people who want (and deserve) to earn more money, we have out-of-control health care costs, and we have a ton of decaying infrastructure to fix.

Let's go for the trifecta: longer life expectancy, less suffering, and a healthier economy.

Put money in the hands of ordinary people.

Presidential candidates, please discuss.

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