Putting Waste to Work

About a dozen years ago, my wife and I set up a family foundation. Generally, we were focused on supporting four causes that we felt needed more attention: education, human rights, civic causes and medical discoveries. These days, I have become 100% focused on the last and I can’t seem to think about anything else.

While that level of fixation is not healthy and while these other causes are beyond worthy, I feel the need to explain why I’m so singularly focused.

Let’s start with money.

We spend about ~$3 trillion a year on health care in this country, and by almost all accounts (independent government studies, large Payor analyses, etc.) roughly one-third is wasted.  That means we are spending roughly a trillion dollars a year that we don’t need to be spending.

While that may seem like a manageable number since it’s only twelve zeros, it’s worth looking at the number in its entirety to fully understand its size:

$1,000,000,000,000

It’s a big number.

More importantly, I believe that we are standing at the gateway of a new era of technology and medicine, one that is going to completely upend how we treat patients and manage disease.

I believe that by bringing big data (along with machine learning and artificial intelligence) to healthcare, we can reduce mortalities by well over 50% in the next 25 years and remove a significant portion of that trillion-dollar waste.

So, what would that mean for the myriad of other causes that we, like others, support?

Let’s start with education. We spend ~$640 billion a year on education in this country. Our education budget has risen 3.5% over the past two years. That seems a bit light. Since we just saved a trillion dollars, let’s say we were to increase the education budget by 20% a year (a staggering number that would most certainly improve our schools), that still leaves us $870 billion to spend.

Want to impact crime? We spend $80 billion on prisons a year.  We could allocate another $80 billion (doubling the budget) towards working with individuals from disadvantaged communities, as well as providing job training and other opportunities to individuals who are already in the prison system, still leaving us with $790 billion to go.

How about tackling poverty.  For ~$150 billion or so we can bring everyone in this country above the poverty line.

So what do we do with the $640 billion that’s left.  Maybe we want to retire our national debt or reserve for the interest we pay.  If we chose the latter, that’s $240 billion annually.  So even after setting aside enough money to cover our national debt without using a penny of tax payer money, we still have $400 billion left.

And let’s not forget we improved education, helped those living below the poverty line and worked on fixing our prison system along the way.

But wait, we forgot to accrue for the positive benefit of (1) an extra one million productive Americans who are still alive because they didn’t die of cancer, or a heart attack, or a stroke and (2) a more educated society and (3) less people in jail and (4) no more poverty to contend with.  Even if we assume conservative GDP lifts for the above, you probably pick up $500-600 billion annually, which means we’re left trying to spend the extra trillion dollars we saved by improving our healthcare system and controlling diseases such as cancer.

In other words, remove the trillion dollars of waste and save lives with more effective prevention and treatment, and you have enough money to attack national problems with plenty to spare.

The elephant in the room is cancer (and other diseases) that endlessly consume our resources, impoverish our healthcare system, and deflate the spirit of every patient and family member battling disease.

And while up until now we were powerless to combat illnesses such as cancer, overwhelmed by its complexity, we now have for the first time, the tools we need to peer inside the body and understand what makes us healthy and what makes us sick.

Advances in molecular sequencing, machine learning, and artificial intelligence have armed us in ways that were truly unimaginable by those fighting on the front line.

It’s time to double down. It’s time to focus.

Because as you can see, if we win this battle, we win the entire war.