Rachel's Democracy & Health News #845
March 9, 2006
THE MODERN APPROACH TO PROBLEMS: PREVENTION
[Rachel's introduction: For 200 years, industry has relied on "trial and error." Try something new, make a mess, find the money to clean it up. But now the world has changed -- there is no longer enough money to fix all the problems like cancer and diabetes, toxic waste, and leaking landfills, rusty bridges, and outmoded wastewater treatment plants. This new world requires us to prevent problems, not merely manage them.]
By Peter Montague
For the last two hundred years -- the age of machines -- humans have muddled along creating new problems, then devising remedies. The basic approach to progress has been trial and error -- try something new, wait for trouble to occur, then find the money to fix the problems. For a long time this seemed to work; more often than not, the goods seemed to outweigh the bads (at least from the viewpoint of those who created the original problem).
Now this basic trial-and-error approach to the world no longer seems to work, mainly because we can no longer afford it. We just don't have the money to create new problems and then pay for remedies. We need to prevent problems because that's all we can afford to do. It's a new world, and we're all learning how to adjust.
Take health care. We are now spending 16% of all our money on health care. The total annual money-flow within the U.S. (measured as GDP) is about $12 trillion -- and health care is eating up at least $1.9 trillion of that. By the year 2015 (10 years from now), we'll be spending 20% of all our money on health care. Only one percent of this money is spent on prevention -- 99% is spent on treating disease after it occurs.
Despite these enormous expenditures, the system is said to be failing. Here is how the American Public Health Association described the U.S. health care system in 2003:
"National health groups today said the United States has the science and ability to address some of the top health and health system problems, but has failed to act. Excessive costs, widening disparities in health status, high prevalence of chronic disease, high numbers of uninsured and inadequate investment in the continuum of health services contribute to a poor state of national health.
"Health care costs consume more than 14.1 percent of the U.S. budget representing $1.4 trillion and financing some of the most scientifically advanced health services in the world. Yet despite spending more money on health care than other nations, in 2000 the United States ranked 25th among all nations in life expectancy."
And the president of the American Association for the Advancement of Science (AAAS) said in 2003, "As numerous strong reports from the Institute of Medicine over the past 4 years have repeatedly pointed out, the U.S. health system is failing in front of our eyes, despite consuming a very significant and growing percentage of the gross domestic product, and representing the biggest employer in many communities."
TOXIC WASTE CLEANUP
Now consider the problem of cleaning up toxic waste sites. In 1980 Congress created the "Superfund" program to clean up chemically- contaminated land. The first step was to identify sites, then evaluate them and eventually clean them up. In some cases full cleanup has been impossible to achieve because contamination has seeped into groundwater, which often proves impossible to clean.
The "discovery" phase of Superfund continues. According to the Government Accountability Office (a federal agency), as of July, 2003, U.S. Environmental Protection Agency (EPA) had identified about 45,000 "potentially hazardous waste sites" in the U.S. and the agency still discovers about 500 new contaminated sites each year.[GAO-03-850, pg. 1]
However, in 2004 the head of the Superfund program, Thomas P. Dunne, estimated that perhaps as many as 355,000 contaminated sites would need to be cleaned up in the next 30 years at a cost of $250 billion. The 30-year estimate seems optimistic: the program is currently spending about $1.5 billion per year (or less) -- so it will take 165 years to spend $250 billion.
Cleaning up 355,000 sites for a "mere" $250 billion also seems dubious. Between 1980 and 1999, EPA cleaned up 595 sites, or roughly 30 sites per year, and total cost of the program, 1980-2000, was $17.7 billion. [GAO/RCED-00-22, pgs. 3,5] In round numbers, then, each site has cost $25 to 30 million to clean up. Even if we acknowledge that these initial cleanups occurred at large sites, it seems somewhat optimistic to say that 355,000 sites can be cleaned up for a mere $250 billion, or $750,000 per site. Furthermore, at the rate of 30 cleanups per year, 45,000 sites would take 1500 years to complete and 355,000 sites would take nearly 12,000 years.
In addition to 45,000 toxic waste sites (or 355,000 sites, depending on who you believe), EPA has acknowledged the existence of 32,000 underground storage tanks that eventually will leak and must be evaluated and dealt with.[GAO 06-45]
About 75 million Americans live within four miles of a Superfund toxic waste site, so there are solid public health reasons for wanting to speed the cleanup of toxic waste sites. [GAO-03-850, pg. 1] There are also solid economic reasons to reduce pollution: A recent study pegged the cost of pollutant-related disease in U.S. children at $54.9 billion per year.
In sum, we cannot afford to clean up the toxic wastes that have been created so far -- and of course new sites are being created all the time. EPA has never developed a forward-looking program that says, "This Superfund site was created by X industry -- let's go look at all companies in X industry to see if they are producing similar problems today, and if they are, get them to stop." Substantial monies could be saved by such a forward-looking program.
THE INFRASTRUCTURE OF THE U.S. IS CRUMBLING
Consider, too, that the physical infrastructure of the U.S. is crumbling. We simply cannot afford to maintain all the roads, bridges, tunnels, and wastewater treatment plants that we have built.
Here is how the Environment News service reported the state of the infrastructure one year ago:
"RESTON, Virginia, March 10, 2005 (ENS) -- America's roads, bridges, water and sewer systems, dams, rail lines, and waste treatment systems are failing to keep up with the heavy demands made of them, and will take a total investment of $1.6 trillion dollars over five years to bring up to acceptable levels. This bleak report card on the nation's infrastructure was issued Wednesday by the people who build and repair these structures, the American Society of Civil Engineers (ASCE).
"Once every four years, America's oldest national engineering society reports on the condition of the nation's infrastructure, and each report card has been worse than the last.
"'Our infrastructure is sliding toward failure and the prospect for any real improvement is grim," William Henry, president of the American Society of Civil Engineers declared, releasing the society's 2005 Report Card for America's Infrastructure at a news conference in Reston.
"Grades range from a high of C+ for solid waste to a low of D- for drinking water, navigable waterways and wastewater."
Again, there's simply no money to make all the needed repairs in the nation's infrastructure. It seems apparent that we will need to simplify the nation's infrastructure if its maintenance costs are to become affordable.
TAX CHEATS ARE BEING ENCOURAGED AND ARE INCREASING
Last month the Commerce Department released two studies showing that by 2003 tax cheating had increased 37% since George W. Bush took office in 2000.
The study showed that, in 2001, Americans cheated the government out of $345 billion in taxes owed, and the Internal Revenue Service (IRS) said that estimate was probably low because the study only looked at individuals and small unincorporated businesses -- in other words, tax cheating by corporations was not even studied.
Tax cheating is not likely to diminish because both Republican and Democratic lawmakers have voted to cut the Internal Revenue Service's enforcement staff by 30% over the past 17 years, at a time when the tax code has become more complicated and laws have been passed increasing the ability of taxpayers to avoid audits. In his 2007 budget, President Bush laid out a five-point plan that, if entirely successful, could reduce tax cheating by one-tenth of one percent.
HEALTH-CARE FOR RETIRING BABY BOOMERS WILL DRAIN THE SYSTEM
As Thomas Friedman wrote Jan. 4, 2006 in the New York Times, "USA Today recently quoted David Walker, the U.S. comptroller general, as saying we are about to be hit by 'a demographic tsunami' that will 'never recede." The baby boomers total 77 million, and their first wave turns 60 this year. Unless we trim the Medicare and Social Security benefits promised to these boomers, the paper noted, America's 'national debt will grow more than $3 trillion through 2010, to $11.2 trillion. The interest alone would cost $561 billion in 2010, the same as the Pentagon [budget].""
Nicholas Kristoff wrote in the Times (May 1, 2005), "We boomers are also preying on children in a more insidious way: We're running up their debts, both by creating new entitlement programs and by running budget deficits today. Laurence Kotlikoff, an economist and fiscal expert who with Scott Burns wrote the excellent and scary book 'The Coming Generational Storm," calls this 'fiscal child abuse."
"The book says that the Treasury Department commissioned a study by two economists of the United States' long-term liabilities, for inclusion in the 2004 federal budget. The study found that the government faces a present value 'fiscal gap' -- the excess of expected payments over expected revenues -- of $51 trillion. That's 11 times our official national debt and also greater than our total net worth, meaning that in some sense we're bankrupt.
"Not surprisingly, the Bush administration took a look at the study, blanched, and declined to publish it," Kristoff wrote.
Purposefully, the U.S. does not have its fiscal house in order. The government is living on borrowed money -- almost 9 trillion dollars of it. This is part of a plan by so-called "conservatives" in Congress and the White House. They call their plan "starve the beast" and the goal is to drive the government so far into debt that it will be permanently crippled. In the summer of 2001, as the federal budget was sliding into deficit, Mr. Bush declared that the rising deficit was "incredibly positive news" because it would "put a straight-jacket on federal spending."
What this means is, we can no longer afford to innovate using trial and error. We must now think very carefully before deploying technical innovations because if they cause trouble, we can no longer afford to clean up the mess. It's a new world of tight fiscal limits, which are likely to get tighter as time passes, and it requires us to adopt a preventive, precautionary approach.