Matt Bivens, Pox Americana

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With up to 61% of Americans, according to a recent poll, convinced that things are going badly indeed in Afghanistan and an official 9.8% of Americans unemployed, Congress is set to respond. This week, it’s slated to pass a $636 billion appropriations bill for the Pentagon that will include another $128 billion for our Afghan and Iraq Wars. Meanwhile, the president and his advisors are about to consider the latest plan by our Afghan War commander, General Stanley McChrystal, to gainfully employ up to 40,000 more Americans in Afghanistan.

By the way, as in the Bush years, all dollar figures associated with the Pentagon budget and our wars should be considered underestimates. Various military expenses like the upkeep of our nuclear arsenal aren’t even in that budget. Depending on who is doing the figuring, estimates of all U.S. defense-related expenditures — and this first budget of the Obama era is already larger than the last monster one from the Bush era — can run upwardsof a trillion dollars. As for the war expenses, they invariably prove short of the mark and end up having to be supplemented.

When it comes to the Afghan War, this is practically guaranteed. Being prosecuted many thousands of miles from home over long, often embattled, supply lines, it is proving staggeringly expensive. According to one recent estimate, for instance, it costs more than $750,000 a year simply to keep a single U.S. soldier in the field, while the cost of delivering a single gallon of gas to the war zone is estimated at up to $100.

And then, don’t forget the Afghan army. Its U.S.-NATO upgrade program is already costing an estimated $8 billion a year and is clearly about to be expanded by the Obama administration. As the Afghan government is essentially poverty-stricken, that means its army is going to be U.S. property for years to come.

Consider this a small introduction to TomDispatch newcomer Matt Bivens’s striking analysis of American investment practices. Tom

Follow the Money
Cure Millions of Leprosy — or Just Give Hank Paulson a Tax Break?
By Matt Bivens

There are many possible responses to the news that we have committed more than four trillion public dollars to Wall Street.

Mine is a roar of admiration.

Four trillion dollars! Holy hell! I didn’t even know that was possible!

U.S.A.! U.S.A.!

After all, the cost of World War II in inflation-adjusted dollars was $4 trillion. This bailout thing is just getting started, and already we’ve burned through that.

Without even noticing.

Certainly without rationing sugar or collecting scrap rubber or any of that nonsense.

Who’s the Greatest Generation now, baby?

Admit it. You feel it too. Just imagine someone snatching your laptop off a table and throwing it, Olympic-discus style, hundreds… and hundreds… and hundreds of feet. Sure, you’d be upset (and stuck with the bill). But however briefly, you’d feel admiration for the physical feat: Look at that thing fly!

So it goes with our bailouts, wild tax cuts, and war budgets. The money in play is staggering, but everyone acts like that’s something to mope about. Where’s the excitement?

Often, after reading an incomprehensible dollar figure, I’ll Google “What does a trillion dollars look like?” to get myself fired up. One example of where this takes you shows a million dollars (pathetic, wouldn’t fill a grocery bag), a billion (interesting, I could fit it in a truck), and then a trillion. (Wow, it spreads for acres! Look at that tiny human included for scale!)

It turns out that the United States can pick up that sort of weight and just smash it down on whatever the hell we want. Like Optimus Prime with giant square green paper fists. Slam! Slam!

Yet we’ve committed not one trillion dollars to the incompetent and/or corrupt, but more than four trillion dollars. That’s according to a report to Congress from special inspector general Neil Barofsky, the overseer of the bank bailout program.

Technically, Barofsky adds, Wall Street’s IOU to you and me is at about three trillion dollars these days, since some of it’s been paid back. Relieved? Don’t be. As these tsunamis of public wealth pour out, ignore the slosh and focus on the order of magnitude. The entire Gross Domestic Product — the number reflecting all wealth generated in this nation for this year — is only $14.1 trillion. So whether the sum of our money that’s now their money is $3 trillion (1/5th of all wealth generated in America in a year) or $4.7 trillion (1/3rd of all wealth generated in America in a year), it still means that, for a big chunk of the year, every single one of us was working for Goldman Sachs et al.

Barofsky’s report also suggests that Wall Street’s tab might ultimately work out to $24 trillion, which would be $80,000 per American, or $320,000 for a family of four. But that’s, like, totally the worst-case scenario. (Still, wouldn’t it be impressive? I envision huge, five-foot-cubed, shrink-wrapped pallets of dollars dropping from the sky onto my neighborhood, smashing houses, crushing cars, killing beloved pets, blasting craters into asphalt streets. Yeah!)

Smallpox and Bikinis

And yet could we employ this financial muscle in a more constructive way?

For an illuminating example, consider how we dealt with smallpox. That airborne virus, with its fevers reaching 106 F and signature pus-filled skin eruptions, was the greatest killer of man ever known.

In the 20th century, smallpox killed more people than all of that bloody century’s wars combined.

In fact, if you tally the worldwide death tolls for World Wars I and II, the Korean and Vietnam wars, the Iran-Iraq war and the Mexican Revolution, the civil wars in China and Russia and Spain, and all the other wars of the last century, from Afghanistan to Zaire, the total is less than one-third of the smallpox death toll.

And that’s just a single 100-year period, for a disease that disfigured Egyptian pharaohs, allied with Hernando Cortes to rout the Aztecs, left a young George Washington scarred, later stalked his Continental Army, and left Abraham Lincoln pale, weak, and dizzy as he delivered his Gettysburg Address.

And yet, in the 1960s, smallpox was targeted by visionary public health experts — and in just 10 years it was gone. An excellent new book by D.A. Henderson, the doctor who led the effort, tells the story: Smallpox: The Death of a Disease.

This was a signature achievement, up there with defeating the Nazis or walking on the moon. To track down a virus in every corner of the planet, encircle it with vaccinations and kill it… I began to wonder how many five-foot-cubed pallets of Benjamins the world had brought to bear. After all, this was mankind’s greatest killer — the Joker to our Batman, Lex Luthor to our Superman. The amounts of cash flung about must have been awe-inspiring.

Chasing down the cost of the 10-year eradication campaign was not easy. Eventually, Dr. Henderson himself steered me to a 1,450-page official history of smallpox maintained as a PDF in a sleepy corner of the website of the World Health Organization (WHO). The answer, hidden away on page 1,366: $300 million.

Three hundred million?

Not trillion? Not even billion?

Such a tiny sum of money for such a tremendous feat? It’s like hitting a home run at Fenway Park using a chopstick for a bat.

The price paid to defeat humanity’s greatest foe wouldn’t cover a 24-hour day of Iraqi combat operations. In Wall Street bailout terms, there’s no way to even talk about sums this tiny. To do that, we have to go the level of overcompensated individuals. So, sure, $300 million could eradicate history’s greatest killer of humans — yet the same sum wouldn’t cover the bonus pool for the executives of the insurance company AIG after its great meltdown. It’s less than what just one man, Lehman Brothers CEO Richard Fuld, pulled down over the past 5 years.

It’s even more striking if you remember that this was a price tag for a worldwide program whose cost was shared by multiple governments; and also a total cost over a 10-year period. To think about it in annual budgeting terms, it works out to $30 million a year. Which is approaching the ridiculous. Hell, the Sports Illustrated Swimsuit issue for 2006 featured a blond in a bikini of diamonds worth $30 million.

We Fight Over There So We Don’t Have to Fight Here

These are sad economic times, sadder still when you consider the tsunamis of wealth going to waste: four trillion dollars for Wall Street welfare queens; somewhere from one to three trillion for anyone affluent enough to own a top hat and a monocle; another trillion or so (and counting) for our current military escapades abroad.

But it’s also just damned exciting. Because, frankly, it’s a helluva lot of money we have to play with! Even now, at one of our darkest economic hours, we could be performing miracles with the spare change left behind the national couch cushions.

If you’re an engineering type, you might prefer that those miracles involve shoring up our creaking national infrastructure. Good! Go write your own article.

I’m a doctor so I’ll stick with medical possibilities. Since the smallpox triumph, public health experts have been inspired to target other diseases for eradication. One is polio, a virus known for paralyzing a minority of its unluckiest victims, among them former president Franklin D. Roosevelt; two others are Guinea worm and leprosy, plagues dating back to the Bible.

The World Health Organization and the volunteer service organization Rotary International have spent two decades tracking down and vaccinating billions of people against polio. They calculate that they’ve prevented the paralysis of five million children worldwide.

Just this May, a 10-day frenzy saw the immunization of more than 222 million children in Africa and Asia. It was possible to watch the campaigners’ march through Africa on Google Maps. Among the foot soldiers in that vaccine war: Ali Mao Moallim, who more than three decades ago became the last person on Earth to contract wild smallpox. (Others have caught smallpox in the laboratory since.)

Think about that: inoculating 222 million children in 10 days. For comparison, there are only about 80 million children in the entire United States.

Imagine inoculating every child in America in 10 days. In 10 days, we couldn’t even get every voter in Florida to figure out whom they chose for president.

Not so long ago, polio roamed the globe, and each day would paralyze 1,000 children. Today, there are only some hundreds of cases each year, mostly in underdeveloped areas of Africa and Asia.

The entire 21-year slog has so far cost five billion dollars. By comparison, Wall Street executive bonuses last year — not salaries, but bonuses, for a single year that saw the whole mess collapse and the taxpayers handed the broom — came to $18 billion.

If you look at the polio campaign costs on an annual basis, it’s about $240 million a year, or less per year than it has cost to occupy Iraq per day.

The United States has been polio-free since 1994. But if the polio campaign falters, the virus could return. This, unlike Iraqi military operations, truly is a case of having to fight them overseas so as not to face them at home.

And why would the polio campaign falter? Because there are huge demands on the public purse and we must spend judiciously; otherwise, Wall Street CEOs would have to pay for their own $87,000 area rugs and $68,000 credenzas. (What’s a credenza? I had to look it up. Turns out it’s that sideboard thing you only see in the movies, where Wall Street villains keep their decanters of fine whiskey for toasting the paralysis of small children.)

Casting Out the Fiery Serpent

Consider another life-saving success-for-pennies program that’s evolving right now, in fact racing against polio to be the next public health triumph. We are on verge of eradicating Guinea worm, a parasite believed to be the “fiery serpent” that torments the Hebrews during the Exodus. Go read your Bible, it’s in there.

A female Guinea worm matures in its victim’s gut, growing two feet long. Then, over a year marked by cramping, nausea, and fevers, it burrows out of the intestines, down through a leg, and to the skin surface. A blister forms accompanied by a burning sensation — hence the “fiery serpent.” The agonized victim immerses the leg in water for relief; on cue, the worm releases a cloud of larvae. Others drink downstream, and the cycle repeats itself.

Treatment involves digging into a blister to seize the worm’s head, then extracting it over days to weeks by wrapping it around a stick — a therapeutic image that some argue may have inspired the Rod of Asclepius, the physician’s symbol of a snake coiled around a staff.

Guinea worm still plagued millions when former President Jimmy Carter organized a charitable foundation and challenged his advisers to suggest a disease to stamp out. They nominated Guinea worm: Humans are its only host, so if the cycle is broken in people, the parasite will be gone.

Thanks to larvicides, nylon water filters, and education, we are almost there. Today, there are fewer than 5,000 recorded Guinea worm cases in six African countries. The total cost of this 23-year campaign to date has been $225 million. Or less than $10 million a year.

This sort of chump change is so small, you can’t even talk outsize salaries; you have to focus on the tax breaks on those outsize salaries. So, consider that the following celebrities have saved the following estimated sums each year on their taxes, courtesy of Bush-era tax cuts: movie producer Jerry Bruckheimer, $5.8 million; L.A. Laker Kobe Bryant, $1.6 million; rapper 50 Cent, $6 million; real estate mogul Donald Trump, $1.2 million.

Imagine a sort of a Congressional reverse earmark — one that canceled the Bush tax cuts only for Bruckheimer, out of punishment for Armageddon and Pearl Harbor — and steered the resulting millions to disease control efforts. Really, would any of these men notice the slightest changes in their lives if they returned to paying Clinton-era tax rates?

When Curing Millions of Leprosy is “Failure”

But wait. Aren’t some of these public health campaigns wasteful failures? Sure they are. Let’s look at one public health failure: The drive to eliminate leprosy.

Caught early enough, leprosy can be cured today with the antibiotics dapsone, rifampicin, and clofazimine. Over 25 years — courtesy of Novartis pharmaceuticals and the Japanese Nippon Foundation — these medicines have been handed out for free, and have cured more than 14 million people of the disease. They work so well that the WHO now recommends integrating the world’s 250,000 known leprosy patients into primary-care settings, just like those with any other illness.

Treatment is so effective, in fact, that several years ago the WHO launched a campaign to eliminate leprosy entirely. Ultimately it sank 15 years and about $200 million into the project. (I cannot find a link for the $200 million figure, provided to me by WHO officials in e-mail correspondence.)

But there’s a logistical nightmare when trying to eliminate leprosy. Other targets such as smallpox, polio, and Guinea worm exist in one reservoir only: sick humans.

Not so with Mycobacterium leprae, a bacterium that attacks skin and nerve cells. Even today, we don’t know everywhere this bug lives. It has been found in the oddest places: in armadillos in Louisiana and Texas, in the noses of healthy people in some parts of the world, and even in some soil samples.

Such a bug was never an easy target. Even so, in 1991, the World Health Organization vowed its “elimination” — and then defined “elimination” to mean less than 1 case per 10,000 people. At such a low background level, it was hoped, the disease might dwindle into irrelevance. It hasn’t worked. That 1-in-10,000 target was arrived at via politics and hopeful thinking. It was achieved worldwide in 2000, putting the WHO in the risible position of claiming “elimination!” and then seeking more money to, like, eliminate it some more.

The organization was bitterly criticized. Earnest, indignant treatises have been written noting that there is too little money to go around, and accusing the WHO of risking the credit of the more promising drives against polio and Guinea worm.

So, the anti-leprosy push was a $200 million failure.

Because it didn’t eradicate leprosy.

It only cured 14 million people.

Of leprosy.

For half the price of an Alaskan bridge to nowhere.

Oddly enough, $200 million is reportedly the tax deferral enjoyed by former Goldman Sachs CEO Henry Paulson — he of bailout infamy — when he joined the Bush cabinet as treasury secretary.

So there you have it, finally: For $200 million of public money we can take a walk in the footsteps of Jesus Christ himself, curing millions of leprosy. A truly inspiring future is, as always, easily within reach, if we choose it.

Or we can just give Hank Paulson a tax break. Maybe throw in a credenza by way of thanks.

Matt Bivens is in his intern year at a Harvard-affiliated emergency medicine residency at Beth Israel Deaconess Medical Center. He is a former editor of the Moscow Times who lived for years in Russia, and who covered the war in Chechnya for the Los Angeles Times. His journalism has appeared in Harper’s, Playboy, the Nation, and many other publications.

Copyright 2009 Matt Bivens

Matt Bivens is in his intern year at a Harvard-affiliated emergency medicine residency at Beth Israel Deaconess Medical Center. He is a former editor of the Moscow Times who lived for years in Russia, and who covered the war in Chechnya for the Los Angeles Times. His journalism has appeared in Harper's, Playboy, the Nation, and many other publications.