Why Alzheimer’s Will Be the Fiscal Nightmare of the Century

Why Alzheimer’s Will Be the Fiscal Nightmare of the Century

And What We Can Do to Address It
Mary Hope/iStockphoto

A new study by the RAND Corporation projects that the cumulative costs of caring for people with dementia could be as high as $215 billion annually in the United States – which would exceed the combined costs of heart disease and cancer. The RAND study, published in the New England Journal of Medicine, estimates that by 2040, these costs will nearly double. 

RAND’s research is the latest addition to the growing body of evidence that shows Alzheimer’s is poised to become the fiscal nightmare of the 21st century. Perhaps most notably, their work confirms the World Health Organization’s bold claim a year ago that Alzheimer’s was a “public health priority.” The WHO, to be sure, doesn’t use this language lightly.

The RAND study also validates the U.S.’s recent launch of its “national plan” to defeat Alzheimer’s. It adds some much-needed vigor to the debate about just how much Alzheimer’s will cost. RAND’s estimates are lower than those of the Alzheimer’s Association, but both organizations agree that costs are shooting straight up.

A debate, of course, about the expenses of Alzheimer’s is welcome. Disagreement will attract attention, since for far too long Alzheimer’s has been relegated to the “back burner.”

But here’s the dirty little secret prompted by the RAND study: Alzheimer’s is about the children who are affected. They’ll be the ones who will have to pay for older Americans. It will no longer be possible, ethics aside, to hide behind the cliché, “Oh, well, they’re just getting old and…”

Why? The numbers will be too overwhelming. What the RAND study teaches more than anything is that we must de-link aging and Alzheimer’s.  

For decades, our budget debates have often pitted “guns” against “butter.” But if we allow Alzheimer’s to continue to be considered a natural, inevitable part of the aging process, it is going to consume so much national and global spending that before long, budget battles will pit “butter” against “butter.” At upwards of $56,000 of spending per year per dementia patient – and with Americans having a 1-in-8 chance of getting dementia after the age of 65 (and a 1 in 2.5 chance after the age of 85) – the fiscal balance sheets of the future will be consumed by Alzheimer’s caregiving costs.

So what can we do about dementia so that it doesn’t become the kids’ burden?

Here are two things, for starters:

Number 1:  
We need to do for dementia what we did for HIV/AIDS. The great lesson from the HIV/AIDS outbreak is that moral outrage, political pressure, and self-interest can spur research and development efforts. In just two decades, HIV/AIDS was transformed from a definite death sentence to a manageable condition.

Although Alzheimer’s has a number of notoriously difficult hurdles to clear de-stigmatizing early diagnosis, greater understanding even of its basic science  HIV/AIDs sets the model for success. It’s critical we recognize that Alzheimer’s is not a natural part of aging, and we ought to be outraged that we’re not doing more to combat it. Then we can begin to mount the political pressure to generate more funding to find better therapies. 

Number 2:
We should engage in an intense global conversation about dementia that could lead to creation of a Global Fund, not unlike the Global Community did for HIV/AIDs. The RAND study converges with other activity to spark this.

President Obama recently pledged $100 million to the BRAIN Initiative to support technologies to map the brain. Across the pond, even in its beleaguered financial state, the Dutch government is leading Europe as it will announce a roughly $260 million investment in research and care improvements – because it will save that government about $3.9 billion in future costs. 

In June, the OECD will host an “expert consultation” aimed at “unlocking global collaboration to accelerate innovation for Alzheimer’s disease and dementia” in conjunction with the Global Coalition on Aging and Harris Manchester College at Oxford University. The driver there will be how to use “big data” to solve Alzheimer’s.

On top of that, at this year’s Milken Conference in Los Angeles, a session on Alzheimer’s has been scheduled by the newly formed CEO Initiative, an organization of private-sector leaders who have joined together to provide business leadership on the fight against Alzheimer’s.  

Over the generations, Rand has been an intellectual catalyst for big social and economic changes, on topics from the environment to nuclear arms control. This could be the biggest of them all – not least for the children who will benefit from the paradigm shift in which we no longer complacently accept that aging is to be automatically associated with the crushing torture of Alzheimer’s.    

Michael W. Hodin, Ph.D., is executive director of the Global Coalition on Aging and managing partner of the High Lantern Group.