Building A House of Mercy and Grace
Your Majesties, Your Royal Highnesses, honorable members of the Norwegian Nobel Committee, excellencies, ladies and gentlemen.
Thank you for this honor, which should not go just to me. I accept this Nobel Peace Prize on behalf of humanity--a humanity that wishes to live in peace, and that also wishes to live long, happy, and productive lives. And so there is much to be done, starting right now, starting tonight.
Please allow me to explain what I have in mind. I am here to announce a new concept--that is, a Serious Medicine Strategy--aimed at bringing all the nations and peoples of the world together into a common cause. And that common cause is the accelerating of the search for medical cures. That’s a sure route--as sure as there can be--to world betterment.
Some might now ask: Am I here in Oslo to accept the wrong prize? No. I am neither a doctor nor a scientist, but in my reading of history, and in my public-service career, I have seen the power of collective action. And the time has come for constructive collective action, in an area where opportunities are ripe. That’s part of what many of us in America call servant-leadership--to humbly seek opportunities, and to maximize the benefit of those opportunities. And the big opportunity in front of us now is cures, medical cures.
Why? Let’s face it, the science of medicine is a lot further along than the science of peace.
War or conflict between nations is inevitable, and sometimes just. I believe that America and many other nations, today, are fighting a just war in Afghanistan. But suffering from many illnesses is not inevitable, and dying from preventable illnesses is not just. Nations can and will disagree about many things, but they can all agree and work towards eradicating illnesses and promoting health and longevity.
So we must be realistic. We must focus on what we can build and keep. And we can keep scientific knowledge, even if political understanding and cooperation fail us. Human nature is, alas, cyclical, while technology is, happily, linear. That is, we can reliably build on yesterday’s medical progress, building for today and tomorrow.
Don’t get me wrong: Peace is a great goal--and we must always work toward harmony and understanding--but peace is not always a realistic goal. Treaties and arms control agreements are valuable, but, in the minds of some, they are mere scraps of paper. And that is why we still need strong defenses--whole systems of defense, in fact. Tonight I will be talking about medical defenses.
If the last few million years of human evolution have taught us anything, it is that ending war is impossible so long as starting a war is so possible, so easy. Indeed, new technologies make war and violence easier than ever. War can come at the push of a button. Even before Pandora opened her allegorical box, it seems as if we have not been able to resist various temptations. We must realize that these deadly technologies are not going away, much as we might wish them gone.
So instead, we must turn those technologies on their head--from lethality to life. As Abraham Lincoln once declared, we conquer our enemies by making them our friends. In a crowded world, full of destructive power, we have few alternatives, other than to carve out new zones of survivability and longevity. We must honeycomb the house of war with safe rooms, perhaps whole wings of survivability. Am I a pessimist? Or, perhaps worse, a cynic? No, not at all. I am supremely optimistic that we can make a better life for all the peoples of the earth--and that the people of my country can help point the way.
If we can’t end wars waged by humans against each other, we might be able to end much of the damage that wars do. And we can end, at least, some other kinds of evils--namely killer diseases that have killed in the millions, even billions.
What do I mean? We can go on the offensive ourselves. We wage war against the leading causes of illness, incapacitation, and death.
In undertaking these medical missions, in defending humanity against a common enemy, death, we can find common cause. As a child, I watched the old movie from 1951, “The Day The Earth Stood Still.” By the end of the film, the nations of the world discovered that they had more in common than they thought. Indeed, they had everything in common.
Because, after all, the desire to live, and to grow, trumps just about everything else. As Bruce Springsteen put it in a classic song, “It ain’t no sin to be glad you’re alive!”
Back in my home country, the American people are currently embroiled in a struggle of a different kind--a battle over healthcare policy, specifically, health insurance.
This struggle, in Washington DC, is not over yet, and I hope that the cause of “universal” coverage prevails, because I believe, as do most Americans, that everyone in a nation should be insured and have access to quality care.
But I can see that “healthcare policy” will always be a divisive issue. It’s extraordinarily difficult, if not impossible, to achieve consensus on such issues as abortion, assisted suicide, and any policy that could be construed as “rationing.” This stubborn reality has been a lesson to me. And if I am going to be true to my oath--to be president of all the people--then I must learn and reassess. We are all on this journey of discovery together. And that has led me to a new appreciation for the importance of cures, because even if people disagree on the details of policy, they all agree on the goal of good health and longevity.
I now see that healthcare policy is not an end in itself. The purpose of healthcare is not just to get everyone covered; the real purpose is to get everyone cured. We must be mindful of equity issues, and social-justice concerns, but we must always remember: You can’t redistribute health unless you have first created health.
All across American society, we have allowed our preoccupation with financial mechanisms to get the best of us, and to get the better of our judgment. And yet ironically, for all of our thinking about financial issues, we have done a bad job of thinking about our fiscal future. The current focus in Washington DC on the projected unsustainability of entitlement spending is needed and worthy, but we need to be smarter about our future strategy. Proposed cuts that can’t possibly occur are not particularly useful. There has to be a better way.
And there is. But we need a new and much different approach, which finds a new unity between the imperative to cut costs and the imperative to find cures. As another Nobel Laureate, Albert Einstein, once explained, “No problem can be solved on its own level.” That is, you can’t simply shuffle around the existing set of variables and expect to get something better. “Better” requires something different--some new input of imagination or inspiration. That’s what changes the equation.
We have before us the very real prospect of changing the equation.
What do I mean? I mean we should apply the basic lessons of a once dramatic historical event, the Industrial Revolution, to a new kind of revolution--a Medical Revolution. That is, we should start with heavy research and development, followed by mass production; thus we would reap the rewards of falling costs and rising quality--and by the way, enjoy a rising standard of living. Three centuries of history tell us that this is the way the world works.
That’s the game changer, if you will.
Through this time-tested method, we can cut the Gordian Knot of healthcare--because we don’t have time to slowly unravel the metaphorical bind that we find ourselves tangled in. We can attack the underlying source of the cost increases for healthcare. That’s how to “bend the curve.” Health is cheaper than either sickness or death. Cures bend the curve.
So in recent weeks, I have been thinking about a new strategy for American health, as well as for world health. That’s a true universalism--a universalism of the best possible health.
I have been consulting with Nobel Prize winners in medicine, and other experts in health and medicine, to talk about the breakthroughs we might achieve. And the humanitarian gains. And yes, also, the financial savings. We can’t repeal the basic realities of economic scarcity, but we can bend upward the curves of medical productivity, just as we have bent upward the curves for automobiles, computers, telephones, and medicine.
In addition, in recent weeks, I have met with the heads of our leading health and public-health agencies and scientific institutes. I have met with foundation leaders and philanthropists, as well as with the chief executives of large corporations, some of which focus on health, but many of which don’t--although, of course, we are all connected to health concerns, in myriad ways. I am convinced that the latest advances in supercomputers and information technology can be harnessed to the task of improving health care, bringing the accelerating power of the microchip, --first foreseen by Intel’s Gordon Moore in the 60s, and now remembered as Moore’s Law--into closer harmony with our equally lofty goals for medical breakthroughs.
And I have met with leaders of Congress, in both parties. We have not agreed to put aside all our political and ideological differences, nor should we. But we have agreed that the delivery of cures has been a neglected area--neglected by both parties. Thus we will change. We will agree to agree on cures, and in so doing, we might well come to realize that our differences are shrinking as our common ground gets larger.
Once again, we can’t distribute--either by the market or by political action--that which doesn’t exist. Only after we create public goods, after they exist can we wrangle over the precise allocation of those goods. So let’s agree on the creation, and only then argue about the distribution. Let’s create an international medical entity, beyond the World Health Organization, to work with all the sovereign nations of the world, focusing on these great goals.
What unites all of us is the realization that the benefits of a new focus on cures are more than bipartisan; they are human. The impulses to health and life are more powerful than mere partisanship or ideology.
We call this coming together a Serious Medicine Strategy.
I say “Serious” because we are not talking here about the routine healthcare issues, as important as they are. Routine issues can be dealt with in different ways, by different people and cultures.
I say “Medicine,” as opposed to “health care,” because we are talking about those serious topics that require serious intervention. Serious illnesses require serious medicine.
And I say “Strategy,” because we need a comprehensive approach, not only for America, but for the world. The challenges to our health--the challenges to our lives--are too profound to be dealt with in piecemeal fashion.
I believe that only a Serious Medicine Strategy will help us out of the research & development rut in which we have found ourselves--a trough of rising prices, and disappointing productivity gains, as well as a bleak future of ruinous cost increases.
In democratic societies, we get the government that we deserve, that we want. As we think back on our own history in America, we see that when we really and truly want to get something done--when we have achieved an overwhelming consensus for action, backed up by real commitment and sacrifice--then that something gets done. That’s how we explored and filled up a continent. That’s how we freed the slaves. That’s how we built the railroads. That’s how we overcame the Depression. That’s how we won World War Two. That’s how we enacted civil rights. That’s how we built the Internet. That’s how we made great progress in cleaning the environment and putting the earth on a more sustainable course.
And the same is true for the world. From ending the slave trade and writing the Geneva Conventions in the 19th century, to outlawing gas warfare and establishing the United Nations in the 20th century, the world has come together to great things.
Some might say that the government--any government--is not competent to undertake this task. But I might remind those skeptics that we have been down the road of medical breakthroughs before--and government steered us there. Polio was mostly wiped out in the 50s. Smallpox was entirely wiped out in the 70s. We made great strides against HIV/AIDS in the 90s. And we could do more, much more, if we stuck with it, if we showed true and genuine political resolve.
Will we make mistakes? Of course.
But I am reminded of these lines from one of my presidential predecessors, Franklin D. Roosevelt, back in 1936:
“Governments can err, presidents do make mistakes, but the immortal Dante tells us that Divine justice weighs the sins of the cold-blooded and the sins of the warm-hearted on different scales.
“Better the occasional faults of a government that lives in a spirit of charity than the consistent omissions of a government frozen in the ice of its own indifference.
“There is a mysterious cycle in human events. To some generations much is given. Of other generations much is expected. This generation of Americans has a rendezvous with destiny.”
“A rendezvous with destiny.” More than one of our great presidents have used that phrase, and it’s right and proper that leaders in both parties should remind us of history’s call, of our need to hearken to its sound.
Yet too often, as we have deliberated over our Serious Medicine Strategy, we have heard this response: “Yes, cures are wonderful, but we can’t afford them right now. There are greater immediate priorities.” This sincere but limited response has led us to an even deeper reconsideration of our current system--that is, the current structure within which medicine and healthcare are generated.
And so we came to see that our accounting system measures the wrong things. Our accounting accurately measures the cost of everything, but it never adequately considers the value of long life and happiness. Therefore, instead, we are establishing a new accounting regime, which sets the future in a 100-year time cycle, so that we can compute the value of good health, and weigh that value against the cost of sickness. We already know that healthy people are a greater asset than people rationed out of their wellbeing. Now we must reflect that reality with our numerical assessments.
John Maynard Keynes was right when he said that “animal spirits” were at the basis of economic growth. Life, energy, and even exuberance--joie de vivre--are at the basis of everything constructive that we do on this earth. Life is the ideology at the base of all other ideologies.
And two more great economists, Kenneth Arrow and Robert Fogel, both Nobel Laureates in Economics, have argued that we shouldn’t worry about rising medical costs--provided that we make sure we are creating medical benefits that exceed those costs. As an investor would say, we need a “hard ROI,” a hard return on investment--that is, a specific and verifiable return on investment to justify the expenditure. If we can discipline ourselves on this matter, always focusing on a positive ROI, there is no limit to what we can accomplish. That’s the nature of increasing returns, as opposed to diminishing returns.
But we also have some housekeeping work, back home in America. We must address our legal policy toward malpractice and medical mistakes of all kinds. While we will never tolerate bad behavior or victimization of populations, we also understand the need for a protective armor--a conscious strategy for protecting risk-takers--is needed for the advancement of medical science. And that means appropriate legal shield and regulatory shields, even spearheads, for the strategic health and medical goals we wish to achieve. That’s what sovereign powers do; they use their sovereignty to good ends.
In addition, in America, we will be working with Congressional leaders to review our policies on anti-trust, even as we strengthen protections for intellectual property, so that the time horizons of inventers and investors can be lengthened. And we will be encouraging other countries to enact the same policies, again, with an eye toward persuading inventors and investors that we want them to cluster in the health and medical sector, so that we and all future generations can benefit from a “permanent revolution” scientific and entrepreneurial endeavors. Yet our goal is not to make corporations and investors richer. Instead, our goal is to produce more high quality medicine, and then to make sure that such medicines are distributed at fair prices to all who need them, in America and in the world.
That’s what the late Jack Kemp, a Republican whom I always greatly admired, called “The Good Shepherd” approach. Let’s use our compassion, as well as our wisdom. Let’s create win-win-win outcomes: better health, lower costs, and greater economic activity--more and better jobs--as the icing on the cake.
I share all this with you, not because everyone around the world is fascinated by American politics, but because I am convinced that what we have achieved in the United States will prove to be a microcosmic snapshot for the future of a healthier world. Every nation will be different, but in the final analysis, scientific truth is scientific truth, everywhere and anywhere. And the desire for good health, too, is universal.
And the right answer is to work on cures. The right answer is to undercut the superstructure of costs, to go right to the root of the problem, which is expensive care for chronic diseases.
OK, but one big question: How to pay for all this ambition? How can we pay for our Serious Medicine Strategy, and avoid increasing the tax burden, and adding to deficits?
Here’s how. We will seek out new sources of capital. Starting in the United States, we will be adjusting our tax laws to see about new ways of funneling funds into worthy projects. We will be selling “Health Savings Bonds” to the public to finance our effort, and working with Wall Street and other financial capitals to see what new financing mechanisms might be created, bringing money in from around the world in the most efficient possible manner.
And we will be seeking out still more sources of revenue. We are prepared to announce a special plan to repatriate the wealth of overseas tax shelters, estimated to be as much as $6 trillion, by offering tax and legal amnesty to most tax scofflaws, in return for half of the money being turned over to the Serious Medicine Strategy Fund.
And there is still more to this Serious Medicine Strategy.
I have met and spoken with leaders from around the world. Presidents and kings, prime ministers and emperors, all told me that they and their their countries will help.
In recent weeks, labor leaders, social leaders, and opinion leaders have also told me that they see the potential, here, to provide a great good to all of humanity. Religious leaders, conscious of the importance of moral and ethical frameworks, have given this project their blessing. We are grateful for this support, although we have much more to do.
That’s why we are so confident that the world will share our vision for realizing this Serious Medicine Strategy. Parents everywhere want their children to grow up strong and healthy. Nations wish to be fruitful and multiply. Good leaders wish the best for their citizens.
There is still more to our Serious Medicine Strategy. Mindful, as we must be, of new power relationships, I have also met with financial leaders, the fiduciaries of pension funds, and the of overseers sovereign wealth funds. They are fully committeed to this project. Thus we will have not only a wide variety of stakeholders, but we will have, for lack of a better word, shareholders.
I can also tell you about an exciting new joint venture we have worked out with the Secretary General of the United Nations. Under U.N. auspices, we are going to begin medical research projects within troubled zones around the globe--in the Palestinian territories, in Kashmir, Sri Lanka, Nigeria, the Philippines, Mexico. These “Medical Enterprise Zones,” or MEZ, will focus on regional health issues, while seizing on regional medical resources, such as medicinal herbs and plants. These efforts will not take the place of negotiations and peacekeeping efforts, but we can hope these efforts will take the place of at least some fighting, by providing disputants with hopefully one thing that they can all agree on--better health and cures.
These MEZ will be staffed by diverse groups of volunteers, reflecting the ethnic and religious balances of the particular region. We realize that this is a risky venture, but the volunteers who will go to these MEZ have committed their lives to this process. And we will protect these medical volunteers to the fullest extent of our ability, invoking the moral weight of the highest of humanitarian efforts. Moreover, other new inventions will “harden” these medical-research sites, in order to maximize safety. And thanks to the Internet, it will be possible, in real time, for anyone to log on and watch exactly what is happening in these places. We believe that this total transparency is not only a confidence-builder for the project, but will help keep MEZ safer and more secure.
And scientific progress, of course, is one of the great validators of human cooperation. When men and women come together in common purpose--scientific research for the betterment of humanity--well, that’s a confidence-builder. So I am also announcing a new data-sharing project, a world medical consortium, called the World Health Data Project, that will aggregate, on a voluntary basis, human medical information. As computer visionaries are wont to say, everything, in the end, comes down to information: ones and zeros. This is, after all, the Information Age. And so, too, with health information: every bit and byte of data has a value to the scientific enterprise, in terms of studying health and medical outcomes. Value, that is, if it can be accurately and ethically collected, and if it can be used in a rational and moral way. And so that’s what we will do. Soon, everyone in the world will be able to contribute to our Serious Medicine Strategy.
In the course of these wide-ranging discussions, we have shared ideas on how to do more than just bend curves; we have seen a way to break curves. To find cures.
We have decided to focus on cures for three diseases in particular: cancer, Alzheimer’s, and malaria, building on the wonderful work of the Bill and Melinda Gates Foundation. These are three great killers, afflicting people all over the world. We will add others, but we will make our start with those three.
To do all these good things, we must embrace a paradox: Sometimes the best way to get something done is through a profound mobilization of resources. That’s “the moral equivalent of war,” as William James put it a century ago, the moment when a civilization, or a planet, comes together in profound agreement: This we will do.
In thinking about this Serious Medicine Strategy, I have thought about the twinned nature of destruction and creation--two horns on the same beast, some might say.
The great Alfred Nobel took destructive power and turned it into a creative power. When Mr. Nobel, the inventor of dynamite, who grew rich from the mass production of explosives, signed his last will and testament in 1895, he set in motion a process whereby the best of human thinking--in the sciences, in economics, in literature, and, of course, in peace--has been celebrated and rewarded.
It is Alfred Nobel’s work, and the work of all great visionaries and peacemakers, which we wish not only to recognize, but also to build upon.
And so, reflecting on his legacy, I have embraced an irony, which I will share with you. I have found inspiration from a perhaps unexpected source--the writings of Carl Von Clausewitz. Clausewitz wrote a famous book, On War, which is still widely read nearly two centuries later.
Clausewitz offers a clear guide for thinking about strategic mobilization, the sort of William James-inspired pulling together for collective purpose that can apply to the moral equivalent of war, just as much as to war itself.
That’s why, together, we have forged this Serious Medicine Strategy--a systematic connectings of ways and means, something for the world to unite around.
To live in Washington DC, as I have for the last few years, is to be surrounded by war memorials and monuments to soldiers, sailors and heroes of all kinds. They all earned their place in our national pantheon, but they aren’t the only great Americans. We will have more heroes in the future, and we will, of course, honor them, too.
To my fellow Americans, I might ask: Where are the monuments to the heroes of health and medicine? Because Milton Friedman was right: the more we reward, the more we will get. So if increasing the honors for medical visionaries means more medical vision, we will increase those honors.
And that’s why part of our strategy is to endow new prizes not only for medical research, but also for the development of medications and cures, nationally and internationally. We believe in the profit motive, but we also know that men and women are motivated by many goals, other than money.
I am confident that the rest of the world will join us in this peaceful effort. Thus we could have a new kind of benign competition--not an arms race, but rather a medical race.
I recall with reverence the words of Robert F. Kennedy, who reminded us that we shouldn’t just think of things as they are and ask “Why?” We should dream of things and ask, “Why not?”
We understand, of course, that not everyone shares the idealism of the late Senator Kennedy, and that’s why we seek to knit the world together in a web of relationships, based on medical research and cures. Because if and when idealism attenuates, we will still have the glue of self-interest to keep the structure together. That glue is the most profound self-interest of all--the desire to live.
There are some, of course, who are impatient with the world as it is. They look forward to longer life, or even to life elsewhere in the solar system, or in space. To these people--who include some of our richest and smartest and most talented--I say this: You can’t get to where you want to go without the rest of us. But if you help us, we will help you. Whatever it is you wish to accomplish, on this planet or somewhere else, a strong understanding of how the human body flourishes is absolutely necessary as a platform for future advancement. It is simply not currently possible to imagine long space flights, for example, if our bodies are the way they are now. Before we can get into spaceships, we first must survive better on spaceship earth. So we see that Serious Medicine is connected to Serious Research, and Serious Space Exploration. If we all do our part, perhaps a century from now, these awards ceremonies will be heard on more than planet. That would be cool.
But today, for all of this planet, our Serious Medicine Strategy will not be an elite effort. This will be a broad-based effort, across the whole of humanity, from the richest to the poorest. For those who join us--by, for example, joining our World Health Data Project--we will offer a little pin, like the one I am wearing now. It bears the letters, “SMS,” for Serious Medicine Strategy. People who join with us are entitled to wear this pin, or to put it on their websites, or anywhere else they wish--if they have earned it with their resolve and commitment, by joining, for example, the World Health Data Project. Everyone can be a part of the Serious Medicine Strategy.
My kids tell me that “SMS” stands for “short message service,” and I like that--right to the point. And so with apologies to all those texters out there, here’s something new for you to text: SMS = Hope + Life.
In America, most of us are inspired by the Bible to act justly and to be merciful. But all the great works of religion, and all the great religious leaders, everywhere in the world, have taught the same thing: be just and be merciful. So we will build, all of us, a house of grace and mercy. A house of life. And so ultimately, a House of Peace.
We will keep our eyes on this prize.
Can we do this? I say, “Yes, we can.”
So let us begin.
Thank you very much.