I. Winning is Cheaper Than Losing—and Better for our Health!
As I seek to develop my ideas of a Cure Strategy against disease, it has come to my attention—that is, I have read the readers’ comments—that many Breitbart readers regard my vision or healthcare abundance as liberal, as in, you know, on the left.
And I’ll admit it: Those comments kinda stung. Because me, a liberal? Nothing could be further from the truth.
A little background on me: Beginning in 1979, I was a volunteer for the Reagan for President campaign in Los Angeles. That’s Reagan as in Ronald Wilson Reagan. That experience meant the world to me, personally and professionally; I was thrilled when, in the following year, 1980, the Gipper not only won the GOP nomination but also, of course, the national election, defeating Jimmy Carter.
Nearly four decades later, whenever I land at LAX airport, I make a point of driving by the building that contained the headquarters, 9841 Airport Boulevard, and I have a little moment of misty-eyed nostalgia.
Beginning in 1981, I served as a policy aide in the Reagan White House. Later on, I worked on President Reagan’s re-election campaign, reporting directly to Ed Rollins and the late Lee Atwater. And of course, I was delighted that our campaign carried 49 states—although, of course, it’s the Gipper himself who deserves all the credit. Since then, I have also worked on the presidential campaigns of Bush 41 in 1988 and 1992 and Mike Huckabee in 2008. I have been a Contributor to Fox News since 1996. I am pro-life and anti-welfare. I think global warming is a crock; I support the death penalty; so I trust you are getting a good idea of where I am coming from, ideologically.
So while you still may or may not agree with my ideas on healthcare, I hope you will at least see that I am coming from the same ideological quadrant as the bulk of Breitbart readers.
So now, let’s talk a little bit more about the healthcare issue. As I wrote in my August 8 article for Breitbart, I think we should cure disease; I think providing medical cures to people is more valuable than extending insurance coverage.
In fact, I’ll go further: I think our national strategy should be to cure disease—the Cure Strategy. Curing disease is a good conservative idea because it’s smart to do so—it’s the best approach for society, and it’s also the most economical. By contrast, what we’re doing now—we are financing illness—is not particularly smart and certainly not inexpensive.
My ideas on strategy come straight from Carl von Clausewitz, the 19th century Prussian military strategist, who stressed the need for an efficient approach to national strategy.
Clausewitz’s point was that nations have to align their goals and their means to achieve their ends. That’s how they can win. And I agree.
Clausewitz died in 1831, so it’s a bit risky to apply his wisdom to situations he didn’t live to see, but here goes—after all, strategic scholars do it all the time.
For Americans, I think that Clausewitzian clarity can be applied, even in situations in which Germany was the enemy. That is, Clausewitz the timeless teacher transcends whatever kneejerk nationalism the actual man might have felt.
So if we apply Clausewitz to the issues of US grand strategy in World War Two, for example, we can see that America was wise to focus on Hitler’s Germany. That is, the main enemy was not the Nazi German client state of Bulgaria, even though the US was technically in a state of war with the pro-Nazi government of that Balkan country. Instead, the big foe was Nazi Germany, and the quicker we saw that, the quicker we could go about defeating the Berlin regime. And that’s what we did: We defeated Hitler in less than four years.
Meanwhile, at the same time, in the Asian theater, we needed equal clarity about our true foe. We were technically at war with the Japanese puppet state of Manchukuo, but that didn’t really matter: The prime enemy, of course, was Japan. And it’s a good thing that American leaders saw that strategy clearly back in the 40s. That’s how we were able to win in the Pacific, also in less than four years.
Similarly, in the Cold War, our enemy was not the Warsaw Pact countries such as Poland or Czechoslovakia, which had been forced into an American stance by Stalin. No, our rival in that chilly conflict was the USSR. Opposing Moscow at every turn was the central idea of American foreign policy for four decades, and it worked.
And so, now, to the geopolitics of today: I agree with those who say that you can’t defeat what you can’t or won’t name. And so if we are in a war with Islamic radicalism—be it Al Qaeda or ISIS or simply some Jihadi free-lancer—we can see with the clarity of Clausewitz: If we want to win, we need clear thinking about mobilizing our resources, and getting them aimed at the right targets—the radicals and terrorists. As an aside, I might ask: Does this sound like a “liberal” approach? I did’t think so.
Okay, now let’s shift to a different grand strategic issue: healthcare, or, to put it even more simply, health. Surely health—which is to say, the fate of each and every one of us—is an issue that lends itself to grand-strategic analysis.
Specifically, let’s ask: In the same way that we zeroed in on Germany, and Japan, and the Soviet Union during past wars, do we have a focused strategy for the war against disease? Do we have a plan for curing certain dreaded and costly diseases, starting with, for example, Alzheimer’s Disease (AD), which costs America hundreds of billions a year, headed toward trillions a year? Surely, good sound Clausewitzian healthcare strategizing—that is, zeroing in on the real enemy—would include a vision for victory over AD.
Yet once again, we can see that we can’t defeat an enemy if we can’t or won’t name it. That is, if the issue is preserving public health, then let’s confront the causes of ill-health—most obviously, disease. And here’s where we as a nation fall weirdly short: we can’t seem to bring ourselves to talk about the real enemy, which is illness. The finance of healthcare is an interesting and important question: But the actual science of curing disease and fixing the problem is even more important.
If you want to see what I mean, take virtually any news article on Obamacare, and search—on my computer, one uses the F2 command— for the words, “research,” “medicine,” and “cures.” Chances are, you won’t find those words in the text of the article, because neither side in the healthcare fight—not the pro-Obamacare Democrats, nor the anti-Obamacare Republicans—have chosen to bring them up. That is, the Obamacare combatants want to wrangle about the individual mandate or some other aspect of the program, but not about whether there’s a cure for, say, Alzheimer’s. And yet surely it’s the diseases themselves that are the big driver of healthcare costs.
Once again, it’s axiomatic that if you can’t or won’t name the enemy, you’re not going to defeat it. So we can have a fight over the management and ideology of financing healthcare costs, and yet still discover that if that’s all we end up with— that is, if we continue to ignore the diseases themselves—then the result will be pretty darn expensive to society, no matter which entity, public or private, is paying the ultimate bill. Which is another way of saying that the status quo of today—in which we have lots of finance, not not nearly enough in the way of cures—is both wildly expensive and not very good. We spend more three trillion a year on healthcare, but we don’t have cures, or even treatments, for big-ticket illnesses, starting, as noted, with AD. In other words, we haven’t done a very good job of organizing our resources for victory.
Michael Milken, the inspiring medical philanthropist, nicely illustrates the point about how a cure is cheaper than care:
When I was a child in the early 1950s, economists estimated that by the year 2000, treating polio would cost the United States $100 billion annually. Today’s polio immunization programs cost one thousand times less than that and have virtually eliminated the disease.
Eureka! That’s how you save money on polio: Make polio go away. You won’t be spending any money on wheelchairs, braces, and iron lungs, and that will, indeed, save a lot of money. (Thank you, Dr. Jonas Salk!)
Milken continues:
Thanks to medical research on all diseases…we live longer, more active lives with fewer years of disability. In economic terms, improvements in life expectancy added approximately $3.2 trillion per year to America’s wealth over the three decades beginning in 1970, according to University of Chicago economists Kevin Murphy and Robert Topel.
Wow, did those economists really say that better health has added more than $3 trillion a year to the economy? That’s real money!
Yes, it’s strange that so many articles get written about “healthcare policy” that don’t mention the actual stuff of health—whether or not we have a cure for the maladies we face. And it’s even stranger that wonky policy-papers and whole books get written on health policy, and yet never mention the dread diseases that afflict us, and cost a lot of money. For example, we have no real treatment for Alzheimer’s, a disease which, as we have seen, costs us as a country well over $200 billion a year. So one might expect that the think tanks would be hard at work with thoughts on policies aimed at developing a cure for AD, or at least a good treatment. But in fact, we get mostly silence, as the DC think-tank class prefers to argue about financial mechanisms. After all, finance is what the nerd-class in DC knows, so of course that’s what they want to to talk about. As the Talmud tells us, You see the world as you are.
So no wonder we are losing the battle against healthcare costs. To pursue our Clausewitzian grand-strategic analogy, it’s as if we had waged WW2 against Bulgaria and Manchukuo, while ignoring Germany and Japan. Or it’s if we waged the Cold War against Poland—not the Soviet Union.
Yes, health insurance is important, but health itself is more important. So as strategists, if we are to be effective, we have to properly define the objective. The objective should be to do to Alzheimer’s, for example, what we did to polio—make it go away.
And the funny thing is: Ordinary people understand this; only the healthcare experts seem not to get it.
To illustrate, when you—or any other real person—goes to the doctor with a complaint, the first words out of your mouth are likely to be about the lump or the pain or about the dread you might have about the disease that killed your relatives. Questions of finance come later.
Yes, it’s a war—diseases are, in the most literal sense, trying to kill us. And our survival matters more to us than money.
Only in the ivory tower imaginings of DC policy wonks is healthcare an abstract intellectual or ideological exercise about the budget, as opposed to what it really is to real people: a fight of flesh and blood.
I would venture that no real person—not even the most loyal liberal—goes to the doctor with a serious complaint and says, “Doc, whatever you do, don’t spend too much; you must help me follow President Obama’s injunction to bend down the curve of healthcare costs.” And similarly, no real person—not even a deep-red conservative—says, “Doc, please use my treatment to help vindicate the free-market theories of Friedrich Hayek and Ayn Rand.” Instead, the more serious the disease, the more likely we are to speak in martial, militaristic, war-like terms.
And so if, God forbid, we get cancer, we don’t say, in bland bureaucratese, “I am consuming oncological services.” Instead, we say, with no small amount of vigor, “I will beat this cancer.” Or even, “I will kill this cancer.” Yes, that’s how real people talk. And that’s good! Any doctor will tell you that patients with a fighting spirit live longer.
So here’s the essence of the Cure Strategy: Let’s make sure that the system—public, private, everything—approaches serious illness the way real people approach it: Again, as a war.
As for me, I’m glad that President Richard Nixon launched a “war on cancer” back in 1971, and I’ll bet you are, too. I’m delighted to note that the death rate for cancer has fallen substantially since then. Thanks to the War on Cancer in the 1970s, we have cut the death rate from cancer by 40%—you can look it up. Yes, plenty of people still die of cancer, but that’s because they’re living longer, because they’re not dying of, for example, heart disease the way they used to since we dramatically cut the incidence of heart disease thanks to the combination of aspirin, fish oil, garlic and statin drugs—a process smartened up and speeded up by Big Data.
In fact, some of the top leaders in medicine today, such as Dr. Robert Gallo, the co-discoverer of the AIDS virus in the 80s—which is to say, the discovery that made effective treatment against AIDS possible—will tell you that Nixon’s “war on cancer” was the foundation of their scientific success. It was at the Nixon-strengthened National Cancer Institute that young Bob Gallo first became familiar with the category of viruses known as retroviruses, of which HIV/AIDS is one.
And now, of course, we are in new and costly struggles, against, for example, the Ebola virus. Our goal, of course, should not be to finance Ebola care, it should be destroy the Ebola contagion. Until we do, we simply aren’t safe.
And as we think about the enormous expense we saw mounted to keep Ebola from infecting the general population last years, we are reminded that the only cost-effective goal—that is, the only goal that truly makes sense—is victory against the actual disease. Yes, in Clausewitzian terms, a decisive victory against a disease is much cheaper and better than a protracted defeat, no matter how inexpensively it is waged. In healthcare, winning is always cheaper than losing.
So the Cure Strategy can also be called the Medical Victory Strategy.
In the 20th century, back in the 50s, the world set out to eradicate—that is, destroy, annihilate—smallpox. And we did. One of the great plagues of world history was finally done away with in 1980, officially declared planetarily eradicated by the World Health Organization. And so not only has nobody suffered from smallpox since, anywhere in the world, but we haven’t spent a penny. So again, good strategy is not only humanitarian, but also a money-saver.
More recently, in 2012, then Secretary of State Hillary Clinton said that she looked forward to a world without AIDS. That’s a great goal! And so why not, now, also, a generation without cancer? Or without Alzheimer’s? Those are great goals, too.
II. Size Matters: Big Data, the Bigger the Better
And as the overall outlines of a better grand strategy for health—namely, cure the disease!—come into focus, there’s a reality that we need to bear in mind: To be blunt and crude about it, as I wrote earlier this month, Size Matters. It’s Big Data—the bigger the better—that enables modern medicine to advance.
And this is a point understood by Clausewitz and every other smart strategist in history: At the moment of impact, it always helps to have a greater force than the enemy. Even great generals, such as Robert E. Lee, who were usually outnumbered in the battles they fought, nevertheless arranged their forces to hit the enemy in a weak spot and hit him with a decisive force. Once again, Size Matters.
Now as it happens, these days there’s a line of thinking on the right which holds that big systems are inherently liberal and to be avoided; you know, like the federal government. And yes, today’s federal government is liberal, and that’s to be fixed. Because big things don’t have to be liberal.
The Roman Empire wasn’t liberal. And speaking of non-liberals who nonetheless wanted to make sure they could win, President George Washington told his fellow citizens that they must always stay together, lest they become divided and lose their freedom, perhaps to one of the European powers. As our First President put it, “The name of American, which belongs to you, in your national capacity must always exalt the just pride of Patriotism, more than any appellation derived from local discriminations.”
More recently, another conservative made the same point about the value of bigness. In 2013, Lincoln scholar Lew Lehrman—those with long memories might recall that Lehrman was the Republican nominee for governor of New York in 1982, running on an unabashed tax-cutting supply-side conservative platform; in a terrible year for the GOP, Lehrman came close to defeating Mario Cuomo—argued that our Sixteenth President not only transformed American history but also enabled the United States to prevail against every foe of the twentieth century:
Without his leadership and resolve, separate slave and free countries might have competed as neighbors on the same continent. Thus, there might have been no integrated, continental American economy, and without a united industrial power, the means would not have existed to contain Imperial Germany as it reached for European hegemony in 1914. Neither would there have been a national power strong enough to destroy Hitler’s Nazi Reich, nor to crush the aggressions of imperial Japan.
So for these reasons alone, Lincoln deserves our admiration.
In World War Two, we were blessed with great generals and brave soldiers. But unfortunately, the enemy had great generals and brave soldiers, too, even if they were fighting for an evil cause.
And so how did we win? We won because we kept focused on the real enemy, as noted earlier, but we were also strong enough to win.
As one historian of World War Two noted, the “Big L”—Logistics—was a key to our victory.
A remark by a captured German soldier best summarizes the importance of logistics in the battle for Europe in World War II. As he was marched past one of the many roadside supply dumps that dotted the Normandy landscape in the wake of the invasion, he was heard to remark “I know how you defeated us. You piled up the supplies and then let them fall on us.” He was right. The war in Europe was what the Germans called materialschlact, “matériel battle.” It was a “matériel battle” on a scale greater than any other conflict in history, a contest pitting the industrial capacities of Germany and the United States against each other. In the end, triumph was the result of the ability, of the United States to mobilize its industrial capacity” to provide the instruments of war for its troops and those of its allies and to deliver them where and when they were needed–to pile them up and let them fall.
We might note that the alternative to unity and bigness is not very attractive. As the tough-minded conservative philosopher Thomas Hobbes declared back in the 17th century, life in isolation is “solitary, poor, nasty, brutish, and short.”
So we can see: The challenge to conservatives today is not to secede, or otherwise hide, from the United States; instead, the challenge is reclaim our bigness and tilt it, once again, to the right. And one of the arguments for a right-wing takeover is, yes, the acceleration of cures. We can note the drying up of the medical-cures pipeline under Obama. In particular, we can ask, is it really a good idea that we are in the post-antibiotic era?
In the game of piling up Big Data for big breakthroughs, it helps a lot, as Donald Trump would say, for the system to be “yuge.”
As an aside, I would say to those who are absolutely determined to find personal freedom in the crowded world of the Third Millennium, you might take the advice of Robert A. Heinlein, and go to space. And this conservative with a libertarian streak will support your efforts to carve out a libertarian Shangri-la on Luna.
III. Brains Matter More than Size
Here we might clarify: size matters, in terms of achieving industrial scale, but in the end, what matters more is brains. Just as armies with better weapons and training tend to do better in battle, so, too, with the logic and architecture of our Cure Strategy—the smarter we are, the more likely we are to beat disease.
And we can start with a political point: In 2015 and beyond, are we Republicans wiser to attack the Democrats on Obamacare because it has covered 15 million more people? Do we really think more people being covered is the Achilles Heel of Obamacare?
This old Reaganite remembers Ronald Reagan speaking at the Republican convention in 1980, that year, saying, “Our message will be: we have to move ahead, but we’re not going to leave anyone behind” That’s not only good Judeo-Christian thinking, it’s also good politics. And, as a practical matter, in a world of AIDS and Ebola, it’s good money-saving health strategy.
In the words of Rep. Fred Upton, the chairman of the House Energy and Commerce Committee, who has successfully pushed a Cure Strategy bill through the House,“We have all said too many early good-byes to people we love and treasure. Every single person has a common goal: we want more time with those we love.” Amen!
So yes, brains matter, but so does heart. If we want cures for ourselves, we had better find a way to make sure that those same cures are offered to everyone. And especially with Big Data, as I argued earlier, the goal of universal cures is cheaper than ever. That’s good politics, for sure. It’s also, of course, good theology. And since we are all going to die eventually, we might as well have a good plan for going to heaven.