Initiative 181’s stated purpose is to lessen the burden of brain diseases and brain injuries in Montana. The I-181 proponents are correct that addiction, dementia, depression, Parkinson’s and other brain diseases are taking a terrible and expensive toll on families in our state, and throughout our nation.
The initiative raises two crucial questions for Montana voters:
- Is creating the proposed Montana Biomedical Research Authority an effective way to help suffering Montanans?
- Is the proposal to incur up to $200 million in debt to be repaid by Montana taxpayers — with interest — a prudent use of limited public funds?
The answer is no to both of those questions.
Primary scientific research is essential to developing new, more effective therapies and for finding cures to presently incurable diseases, but even $20 million a year is a relatively small amount. The National Institutes for Health had a 2015 budget of $30 billion for medical research, including $3 billion for mental illnesses, alcohol and other drug addictions. A bipartisan House bill, 21st Century Cures, proposes to increase research spending by $1.75 billion per year for the next five years. Leaders of the House Energy and Commerce Committee have proposed funding that $8.75 billion in research with $9.3 billion in cuts elsewhere in the federal budget.
Initiative 181 offers no such offsets or new revenue stream to cover the cost of repaying the debt it would create. The initiative proposes that up to $20 million in general obligation bonds would be issued each year from 2017 to 2027 for a total of $200 million in debt that would be repaid from general state tax revenues.
Montana’s Constitution requires a balanced budget. Under I-181, over the next three decades, Montana government would have about $300 million less to spend on everything else if it has to repay the proposed $200 million in borrowing.
Much as we would like to think that a research breakthrough in Montana would lead to cures, cost savings and job creation that would make the investment worthwhile, the truth is we don’t know. There are no guarantees. The initiative doesn’t even require that the state share in royalties from treatments developed through publicly funded research.
Meanwhile, Montana already severely underfunds its public health and human services. Medicaid reimbursement rates for Montana nursing homes are so far below the actual costs of caring for frail elders that Montana facilities can’t afford to offer competitive salaries. This causes constant turnover and understaffing.
Regional mental health centers whose clients are mostly low-income Montanans also struggle to keep their doors open because the state pays them less than the cost of having a psychiatrist evaluate a patient needing anti-psychotic medication.
Health care professionals and well as Montana leaders in child protection and criminal justice have identified a great unmet need for effective addiction treatment. But there is no identified source of payment for the many indigent Montanans who are in need.
Montana must compete nationally to recruit physicians, nurses and other health care professionals. The state must adequately support Montana medical residencies, other health professional education and college loan repayment incentives.
In a guest opinion printed Monday, Bob Story, R-Park City, and Dick Barrett, D-Missoula, argued that I-181 is fiscally imprudent and noted that most biomedical innovations come from outside Montana.
“We believe that the best way to help patients is to make sure that the most effective and promising of these innovations are available to Montanans,” Story and Barrett wrote.
We agree. The Gazette editorial board recommends that voters turn down I-181.