Many Republicans, and Democrats, never thought the automatic across-the-board spending cuts known as sequestration would take effect. After all, they might produce dangerous, if unintended, consequences such as potentially bankrupting the U.S. health care system, along with millions of families.
Typical Washington hyperbole, right? It actually is happening under sequestration, which kicked in three months ago, a product of America's political dysfunction.
Because the cuts only affect the margins of a wide array of defense and domestic discretionary programs, there mostly hasn't been an immediate pinch; the public backlash has been minimal. The long-term consequences, in more than a few cases, are ominous.
Alzheimer's, the most common form of dementia, is the sixth leading cause of death in the U.S. Five million Americans are afflicted with the disease. It costs about $200 billion a year, creating a severe strain for public health care and many families. Then there's the emotional toll: The Alzheimer's Association estimates that caregivers had an additional $9 billion of health care costs last year.
"As the population lives longer, Alzheimer's is the defining disease of this generation," says Sen. Susan Collins, R-Maine, who's trying to fight the sequestration restraints and sharply increase spending for research.
The latest annual report on health statistics from the Centers for Disease Control underscores her point. There's been a lot of progress, in large part because of earlier NIH efforts: The number of deaths from strokes and heart disease is down more than 30 percent over the past decade, and cancer deaths have declined almost 15 percent. The reverse has occurred with Alzheimer's. Over a decade, deaths have risen sharply, up 38 percent for males and 41 percent for women.
It's expected to get worse. A report this spring by the nonpartisan RAND Corp. estimates that by 2040, the number of Americans afflicted will have doubled, as will the costs. Other experts say that as grave as those projections are, they may be underestimated. The Alzheimer's Association says that under current trends the cost will exceed $1 trillion annually by 2050. That either would bankrupt Medicare and Medicaid or force huge tax increases.
Much critical health research in the U.S. generally emanates from the NIH, which has compiled a record of success with many diseases that has been the envy of the world.
The NIH's funding is cut by 5 percent, or $1.55 billion this year, across the board. That means 700 fewer research grants are approved and 750 fewer patients will be admitted to its clinical center. The longer the automatic cuts go on, the worse it will get; medical breakthroughs rarely are instantaneous. They take years and build on previous studies and experiments.
Alzheimer's research, pre-sequestration, was slated for a healthy increase this year. By moving a few discretionary funds, the NIH has avoided cutbacks.
Still, the funding falls dramatically short of the promise.
"In recent years, there have been some extraordinary advances, from genetics to molecular biology, that have given us insights into Alzheimer's that we didn't have before," says Richard Hodes, a physician who heads the NIH's National Institute on Aging.
About five in six grant applications currently aren't funded. Hodes says money for some of those grants and increasing some of the clinical trials, also being cut by sequestration, would capitalize on these advances.
Collins says that aside from the human dimension, this is a simple cost/benefit analysis.
"We spend only $500 million annually on Alzheimer's research and it costs Medicare and Medicaid $142 billion," she says. "It's going to bankrupt our health care system and we're spending only a pittance on prevention."
She wants to double the Alzheimer's research budget immediately and then double it again — to $2 billion annually — within five years. For most federal programs, huge increases in spending would cause reckless waste and inefficiency. NIH is an exception. Fifteen years ago, its budget doubled in five years and the results were better than ever.
For NIH, there are other critical advances, in areas such as Parkinson's or diabetes and some forms of cancer, that are slowed by the budget cuts. And the mindless sequestration, which doesn't touch entitlement spending or the tax benefits enjoyed by the wealthy, forces reductions in programs such as Head Start for low-income kids, the nutritional program for women, infants and children, or the meals on wheels initiatives for lower-income senior citizens.
Congress did act once to reverse the damage wrought by sequestration: It undid some cuts affecting aviation.
There was an emergency; members couldn't be inconvenienced by flight delays or cancellations when getting back to their districts. They don't seem as motivated to help prevent or slow the spread of a wrenching affliction that costs a fortune.
(Albert R. Hunt is a Bloomberg View columnist.)