M e d i c i n e A ve 2 themselves generally pay only a small portion of the total cost of healthcare, but that portion is increasing technology is essential to bring the full benefits of the new biology to patients and the general public. Not surprisingly, the very rapid doubling of the NIH budget was not sustainable; the inflation-adjusted budget was basically flat for the next 5 years, resulting in NIH appropriations of just $30 billion in 2008, though estimates of private health sector R&D expenditures continued to increase to a level of $44 billion. Following the financial meltdown of 2008, the huge federal spending stimulus package of the Obama Administration, combined with the special leverage of Senator Arlen Specter of Pennsylvania, gave the NIH a special appropriation of $ 10 billion to be spent within 2 years on short-term scientific jobs, construction, and renovation. It remains to be seen what the baseline NIH budget will be in FY 2011; perhaps the most likely outcome would be about $35 billion (the 2009 baseline of $30 billion plus the average expenditures over the two years from the stimulus). Biomedical Research Advances, Healthcare Payors, and Increasing Societal Demands The currently polarized status quo is unsustainable. On one side are the growing aging population, the needs of the uninsured, the demands of the insured population for better healthcare, and new devices and drugs with high per patient prices. On the other side is the limited willingness and ability of payors to pay. Patients themselves generally pay only a small portion of the total cost of healthcare, but that portion is increasing. The rest is paid by taxpayers, who are anxious about their tax burden, and employers, who insist that their health insurance premiums are making them globally uncompetitive. The US passed one test of its capacity to meet basic coverage needs a few years ago when the Congress and 28
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