US Debt bomb: Financing Armageddon or invest in Preventing it?

 America’s national debt didn’t appear overnight. It’s been growing for decades and accelerated dramatically in the past twenty-five years. Nearly every discussion reduces the problem to taxes versus spending.  One question deserves urgent attention: Why not invest in prevention?  We’re spending enormous amounts reacting to problems after they become crises.  WTF?

 This absent mindedness must stop.   We know the problem.  An ignore it.   Wake up!  

So called ‘Healthcare’ offers the first and perhaps clearest example of our delusional insanity. “Healthcare spending” is mostly disease care, injury care, and crisis management. We spend heavily treating conditions that in most cases could have been reduced through earlier wiser choices and actions. Obesity-related illness, preventable forms of heart disease, complications from diabetes, smoking-related disease, substance misuse, avoidable injuries, unmanaged stress, and delayed preventive care is one of the greatest thing killing us, our children’s economic future, and our immediate national security.   In the late 1990s after being elected to the Action Board of the American Public Health Association (APHA) I made this observation in a board meeting with the other elected board members. It met with silence. Jesus was right when he said  'The Truth will set you free."  I was not re-elected.  

Not all illnesses are preventable. Genetics, environment, and simple bad luck. And sometimes bad decisions (I've made many. The worst, falling 30+ ft from a tree without dying...but sustained a burst fracture to the L2 vertebrae, then, as a paraplegic, taking a few years to rewire and regain much of my nerve endings from the waste down. - Note to self. Check knots before climbing, and so great to have 'health insurance'!). 

Our nation's healthcare costs are not high just because Americans make bad choices.  Compared with other developed countries, the US also pays higher prices for medical services, medications, administration, and technology.  Bad laws play a key role as well.   But prevention remains one of the highest return investments available.

Every reduction in smoking rates prevents future cancer and heart disease. Good nutrition reduces chronic illnesses. Physical activity lowers medical costs, and moderately intense fitness reduces cancers, heart disease, diabetes, and mental health issues. Cleaner air and water prevent disease before treatment becomes necessary. Early detection is almost always cheaper than late intervention.

This logic extends beyond medicine.  Our national budget increasingly reflects reactive spending to many other problems.

Military spending has expanded not only because of wars but because modern defense is expensive, especially because of lobbying, virtually no audits, fondness of legacy systems quickly obsolete from advances in technology, replacing depleted weapon systems, maintaining global readiness, investing in cyber defense, research on developing autonomous systems and drones, protecting supply chains, strengthening space capabilities, and preparing for new or reemerging threats.

Defense is necessary, but the question is why don’t we spend enough upstream to reduce the conditions that create instability in the first place. High infant mortality rates are the single greatest cause of nation state failure. American can’t be first in the world when over 10,000 children die each day from cheaply preventable malnutrition and infectious disease.

Our delusion of independence keeps us from investing more attention.  And easy successes are invisible due to lack of media coverage.  Compassion doesn’t sell.  And no one holds a parade for a war that never happened. A disease stopped from being pandemic isn’t newsworthy.  No one thanks an engineer for infrastructure that didn’t collapse.   No one notices a genocide that didn’t happen because a nation’s economy improved, or a weather system didn’t create chaos.  Yet these invisible successes are among the greatest sources of prosperity.

Worse yet, interest payments now add another layer to the challenge. Debt itself creates future spending obligations. Money spent servicing yesterday’s decisions cannot be invested in tomorrow’s opportunities.  This is not an argument for austerity. It is an argument for wisdom.

A healthy society requires defense, emergency response, hospitals, jobs, and the capacity to deal with crisis.

A wise society would ask: “What investments reduce the need for tomorrow’s expenses?  Preventive budgets include:

Public health.

Education.

Infrastructure.

Scientific research.

Community resilience.

Environmental stewardship.

Early childhood support.

Mental health.

Diplomacy.

Preparedness.

The old saying “an ounce of prevention is worth a pound of cure” is ignored and America’s debt challenge is simply - we the people elect leaders that are reactionary budgeters.  Way too much of what we spend arrives after the damage is already done.

Our nation’s success should be measured not by how effectively we react to crises.  But investing to prevent crisis in the first place.  GDP does not measure progress or wisdom. It measures a nation’s overall wealth, not its overall health, or our civic wisdom.

 Environmental prevention demands the same wise long-term investment. Climate change, biodiversity loss, water shortages, soil degradation, pollution, and ecosystem disruption increasingly function like delayed invoices rather than distant or hard to imagine environmental concerns. When prevention is delayed, societies pay later through disaster recovery, rising insurance costs, damaged infrastructure, agricultural losses, migration pressures, health impacts, military instability, and economic disruption. Whether one views climate change primarily as an environmental issue, a national security issue, a public health issue, or an economic issue, the principle remains the same: Everything is connected...except our budgets and our wisdom.  And prevention is always less expensive than repair. The question isn’t whether society will pay, but whether we choose to pay earlier through preparation and mitigation or later through reaction and recovery, or economic default as a nation.  It’s possible.  And it is also preventable. 

We can roughly estimate savings from prevention efforts, but we cannot calculate it precisely.  “Quality of life” and culture are not directly convertible into dollars. We can make a reasonable back-of-the-envelope estimate.

 Over the last twenty years, total U.S. healthcare spending has been roughly $60–70 trillion cumulative (public + private combined). Recent years have been nearly $5 trillion annually.   The US typically spends about 17–18% of GDP on health, while many comparable industrialized democracies spend roughly 10–12%.   If the U.S. had spent at the average level of peer countries while maintaining comparable outcomes, a rough estimate suggests:

• Lower-bound estimate: about $10 trillion saved over 20 years
• Middle estimate: about $15–20 trillion saved
• Aggressive estimate: $20–25+ trillion

These are rough scenario estimates, not audited calculations.  But there is a second part of this question that matters even more:  Would those savings come from Americans simply becoming healthier? Not mostly. But research consistently suggests that America’s higher spending is also driven heavily by higher prices, administrative complexity, fragmented insurance structures, expensive technology adoption, and payment incentives—not just unhealthy behavior. Americans do not necessarily visit doctors more often than peers; but we often pay more when we do.  But culture does matter.

 Around the end of the Cold War, Carl Sagan argued that the US had spent on the order of $20 trillion (in then-current dollars) on the Cold War arms race and military buildup. He said that was roughly twice as much as the value of “everything in the US except the land.”   Today both of those numbers would likely be doubled. And most of the military spending will never be used...and if it were... there would be few people or dollars left to invest in anything.  This more than any other issue represents the insanity of humanity.  Simply because we as human beings have not yet learned to be the landlord over our mind’s lethal mental constructs that once helped our social species tribes thrive - like religion, politics, and economics.  But now simply justify the mass murder of our human family members -when we have the wealth, and technological capacity to maximize both human and environmental health -- to create heaven on earth - without risking AGI creating hell on earth.

It may not be too late to prioritize investment in achieving the UN Sustainable Development Goals.  But too few - often very smart Americans - don't even know they exist.