If I have to pay for some new government program, I care a lot about whether it will be worth the money. If someone else is paying, it has to meet only the bare-minimum criterion of “sounds vaguely nice.” Which is perhaps why so much of President Biden’s address to Congress sounded more like a half-baked Democratic wish list than a coherent policy agenda.
The most striking moment was probably this one: “The Defense Department has an agency called DARPA, the Defense Advanced Research Projects Agency . . . to develop breakthroughs that enhance our national security. . . . It’s led to everything from the discovery of the Internet to GPS and so much more. . . . The National Institutes of Health, the NIH, I believe should create a similar Advanced Research Projects Agency for health.” That agency would have one purpose: “to develop breakthroughs to prevent, detect and treat diseases like Alzheimer’s, diabetes and cancer.”
“Let’s end cancer as we know it,” Biden added. “It’s within our power.”
Why was this so striking? For one thing, it has been almost 50 years since President Richard M. Nixon initiated America’s “war on cancer.” Since then, the National Cancer Institute has spent at least $100 billion on research and treatment. Though we’re certainly closer than we were in 1971, cancer remains uncured. And while I’ve spoken to a lot of cancer experts who are hearteningly hopeful, none suggests a cure is a sure thing so long as we spend enough money.
Biden’s assertion that all we need is DARPA for cancer encapsulates his administration’s style — as well as its contrast with the style of our last Democratic administration.
The National Cancer Institute is doing great work on innovative treatments, notably the immunotherapies that are already revolutionizing cancer care. If the administration thinks there are gaps in the institute’s research program, by all means identify and fund them. But what in tarnation does DARPA for cancer add that NCI won’t?
Also, can we figure out how to pay for all Biden’s proposals within the usual 10-year budget forecast window, rather than promising that sometime after the next decade, the books will finally balance?
That wouldn’t be so popular, of course. The administration has already proposed to jack up taxes on corporations and the richest Americans, and it still comes up short on paying for its proposals within the normal window. Covering the full cost in a timely fashion would mean dipping into the pockets of Americans making less than $400,000 a year, many of whom might not find these initiatives so appealing if it means their own paycheck is smaller.
More than anything else, this probably explains larger differences between the Obama and Biden approaches. President Barack Obama operated in a world in which deficits mattered politically. Biden doesn’t. Between the unfunded Trump tax cuts and a year of hog-wild pandemic spending, politicians have largely given up even pretending that they ought to pay for things their constituents want; it’s no longer even a good cudgel with which to beat the opposition when you’re out of power.
Obviously, an administration can spend more if it can avoid riling up voters by sticking them with the bill. Perhaps less obviously, constraints on quality have been removed along with those on quantity.
The Obama administration operated almost as the government equivalent of corporate takeover artists come to restructure mismanaged markets — health care, finance, the environment. It was the era of the wonk; of explanatory journalism; of long, arcane arguments over exact fiscal multipliers for various forms of economic stimulus. Behind the rhetoric, you were supposed to feel that accountants in green eyeshades were poring over details, making sure that every line item passed a cost-benefit test.
Recall that the Affordable Care Act, Obama’s signature legislation, promised to reduce the deficit by finally ending the perverse incentives and inefficiencies of our fragmented health-care system. Many critics, myself included, argued that the estimated savings were fanciful, but those arguments were detailed and technical, heavy on economic theory and empirical data. Partly, this reflected Obama’s temperament but it also reflected the moment: Voters got nervous if you said you were going to spend a trillion dollars on the health-care system. You had to work hard to convince them your plan was cheap at the price.
The less constrained Biden administration, by contrast, seems willing to float anything that promises any benefit to anyone, running as far down the Democratic wish list as bond markets or voters will tolerate. We’re barely having an argument about whether this spending is worth what it costs (and, if it is, why can’t we just ask taxpayers to pay for it?).
Because in the end they’ll have to, even if we put it off for a while by borrowing money or printing it. And when that bill comes due, it would be nice if we could look back and think that, in the main, what we got in exchange was worth it.