CARTER And HALL: The Quiet Epidemic


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More than 127,000 Americans have died from COVID-19, but just as many, and likely more, will die this year from Alzheimer’s dementia. Long after we have a vaccine for COVID-19, millions of Americans will continue to be afflicted by Alzheimer’s. This will have tragic consequences, not just for the afflicted, but for the entire country.

Allow us to explain.

The federal budget is on an unsustainable path. Federal spending far exceeds tax revenues and apparently will for decades into the future. This doesn’t mean an immediate budgetary crisis, but it does mean that we are knowingly “gifting” future generations with an unprecedented burden of government debt. The accumulated debt is heading towards 180% of GDP or nearly 10 times annual federal revenue in 2050. Front and center of this tremendous growth in federal spending is health care. In fact, all (100%) of the projected increase in noninterest federal spending will be from cost of major health care programs. And that was before the $5.7 trillion cost (FY2020-30) of the global pandemic and the associated worldwide recession.

The problem with health care spending is well known but not well understood. The U.S. annually spends well over $10,000 per person on healthcare – the most in the world by far. Yet we currently rank only 37th in the world in life expectancy at birth. Not surprisingly, a great deal of public policy effort has gone into trying to change the complex U.S. health care system. Ironically, a number of recent big ideas would increase, not decrease, federal spending on health care by tens of trillions of dollars. This brings us to the topic of our current op-ed. Much of the high cost of health care in the U.S. comes from dealing with a handful of devastating and costly diseases. One way to achieve better health outcomes and simultaneously reduce health care spending is to do what we’ve been doing with Alzheimer’s Disease since 2009.  Prioritize finding a cure.

Currently, more than 5.8 million people – 1 in 10 Americans aged 65 or older – have Alzheimer’s disease. It is a top 10 leading cause of death in the U.S. and the number of cases is growing – reaching nearly 14 million per year over the next thirty years. First and foremost, this is a tremendous burden for those individuals and their families. In fact, it is the single costliest disease in the U.S. Medicare spending for beneficiaries, and spending on Alzheimer’s and other dementias currently averages nearly $25,000 per year — more than three times the average for other beneficiaries. For Medicaid, payments are over 23 times as great. This year, health care, long-term care and hospice services will cost these two programs $206 billion with another $66 billion in private out-of-pocket spending. Over the next few decades when the number of Americans with Alzheimer’s balloons, so will these costs.

Curing or mitigating Alzheimer’s isn’t a budget panacea. A longer lifetime for those cured of Alzheimer’s means other costly health problems will occur. But significant budgetary benefits will be there and maybe millions will live longer, fuller lives. Plus, we will lessen the unmeasured economic cost of Alzheimer’s on the sick and their caregivers.

Since the 2009 release of the report A National Alzheimer’s Strategic Plan: The Report of the Alzheimer’s Study Group, funding for research and related dementias has grown to a record $2.8 billion per year. Lawmakers understand the wisdom of spending billions of dollars now to save trillions of dollars later.

But given the magnitude of the problem, more needs to be done. $2.8 billion is woefully inadequate. In 2017, Americans spent roughly as much on chewing gum ($2 billion), supermarket hot dogs ($2.4 billion) and repairing car damage caused by potholes ($3 billion).

Long-term fiscal health requires cost containment of federal health care programs for sure, but better to address the underlying drivers of health care spending. Recognizing that curing or mitigating Alzheimer’s and other dementias offers fiscal and economic benefits that ought not to be overlooked.

James Carter serves on the board of the Alzheimer’s Association’s National Capital Area Chapter.  Previously, he was a deputy assistant secretary of the Treasury and deputy undersecretary of labor under President George W. Bush.  Keith Hall is a professor at Georgetown University’s McCourt School of Public Policy.  From 2015-19, he served as the director of the Congressional Budget Office.