Commentary Magazine


Newt’s Wrong: The NIH Needs Reform, Not a Blank Check

If you want to see various weird ways the government wastes your money in the name of science–and engage in the nanny state version of gallows humor–you can search the term “NIH” at the Washington Free Beacon’s website. That would be the National Institutes of Health, of course, the government-funded medical network that does a lot of vital work and was also at the center of the management of last year’s Ebola crisis. But those two aspects of its work–fighting deadly disease while also spending millions on developing video games where you have to strategically eat your way out of a fat city called Diab–are connected, and they help explain why Newt Gingrich’s call in the New York Times to double the NIH’s budget misses the mark.

Two things should be conceded right off the bat. First, the NIH’s good works far outdistance its colossal money-flushers. Second, the NIH is one of those government agencies where more money could conceivably make a world of difference to ordinary Americans. But even the NIH’s response to the Ebola outbreak does not mean it deserves a blank check. In fact, the agency that spent half a million bucks text messaging alcoholics needs a form of rehab itself.

Here’s the crux of Gingrich’s argument:

Even as we’ve let financing for basic scientific and medical research stagnate, government spending on health care has grown significantly. That should trouble every fiscal conservative. As a conservative myself, I’m often skeptical of government “investments.” But when it comes to breakthroughs that could cure — not just treat — the most expensive diseases, government is unique. It alone can bring the necessary resources to bear. (The federal government funds roughly a third of all medical research in the United States.) And it is ultimately on the hook for the costs of illness. It’s irresponsible and shortsighted, not prudent, to let financing for basic research dwindle.

For example, the total cost of care for Alzheimer’s and other dementia is expected to exceed $20 trillion over the next four decades — including a 420 percent increase in costs to Medicare and a 330 percent increase in costs to Medicaid. Even without a cure, the premium on breakthrough research is high: Delaying the average onset of the disease by just five years would reduce the number of Americans with Alzheimer’s in 2050 by 42 percent, and cut costs by a third. And that’s not even counting the human toll on both patients and caregivers (often family members), whose own health may deteriorate because of stress and depression.

Yet the N.I.H. is spending just $1.3 billion a year on Alzheimer’s and dementia research — or roughly 0.8 percent of the $154 billion these conditions will cost Medicare and Medicaid this year, more than all federal education spending.

I get it, I really do. And I’m sympathetic. I, too, support such research. But as far as reforms are concerned, all we get is Gingrich’s aside near the end of the piece where he says the “increase should be accompanied by reforms to make the N.I.H. less bureaucratic, to give the director more flexibility to focus resources on the most common and expensive health problems, and to place a stronger emphasis on truly breakthrough research.”

That, it should go without saying, is not nearly enough. And honestly, the need for far better management from the NIH was made apparent even while winning generally positive reviews for its role in containing Ebola.

In October, I noted a comment by NIH Director Francis Collins that blamed lack of taxpayer funding for the fact that the NIH has thus far failed to end the disease. “NIH has been working on Ebola vaccines since 2001. It’s not like we suddenly woke up and thought, ‘Oh my gosh, we should have something ready here,’” Collins told the Huffington Post at the time. “Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready.”

Sometime in the last decade, we would have had a vaccine for Ebola and so many lives might have been saved if the NIH just had a certain amount of additional money. But here’s the thing: the NIH had the money. Collins was openly admitting to a corollary of his outrageous attempt at public extortion: if the NIH had directed the money it already had to better use we would’ve had an Ebola vaccine and all those lives could have been saved.

Pointing out all the silly ways the NIH spends your money can seem like a cheap shot. But why? It’s public money, after all.

The answer is because the administrative state relies, like all such bureaucracies, on the perpetuation of a declared crisis state in order to avoid oversight and to defend its decisions with a false choice: either you want to give them more of your money, or you want to deprive lifesaving efforts of that cash.

In fact, the NIH could have more money for its important projects without reaching into your pocket when you’re not looking. It’s a win-win. All that has to happen is the NIH has to be managed with seriousness of purpose and setting the right priorities. A blank check never teaches anyone fiscal responsibility, and it won’t start now.

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