Rachel's Democracy & Health News #845  [Printer-friendly version]
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.

HEALTH CARE

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.

SUMMARY

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.