Lou Weisbach on The View earlier this year:
This commentary on the American Center for Cures includes eight sections: 1) the great opportunity for cures; 2) the current state of the mission; 3) steps for completing the mission; 4) the need to convert potential energy into actual political energy; 5) the three great hurdles to ACC success; and then, in 6), 7), and 8), three potential “landing zones” for success are identified. In addition, three appendices.
1) A Win-Win-Win for America
Lou Weisbach is on a mission to save lives. How? With more medical cures. Cures for killers such as cancer, Lou Gehrig’s Disease, and Parkinson’s. Also, cures for such slow-acting destroyers as Alzheimer’s and arthritis.
Weisbach, a Chicago business legend, includes all those missions, and more, in his brainchild, the American Center for Cures (ACC).
His is not only a compassionate goal, it’s also a money-saving goal. And it’s even a money-making goal. So it’s a win-win-win. How so? Let’s take a look:
First, that cures are compassionate is self-evident. It’s nice to live longer and better. This country is better off when infant mortality, and maternal mortality, plummet, as they have, and when overall life expectancy increases—as it has.
Second, cures are less expensive—much less expensive—than care. Taking an antibiotic is a lot cheaper than sepsis, or some other debilitating or deadly infection. Getting vaccinated for polio is a lot cheaper than being in a wheelchair, or an iron lung, for the rest of one’s life. It was also nice that smallpox, a dread killer and disfigurer, was first minimized by vaccination, and then eradicated altogether. Some are critical of vaccines, of course, arguing that we use too many vaccines. And that’s a question worth studying. And yet few would honestly wish to live in a world with no vaccines.
Moreover, some kinds of cures are so simple that we barely remember that they are medicines: Vitamin B-9 stops spinal bifida, Vitamin C stops scurvy, Vitamin D stops rickets, and hookworm can be prevented by better sanitation. In this cynical and age, ACC holds up an unironic truth: Oftentimes it really is that simple—figure out the cause of a disease, develop a simple treatment, and voila! the malady goes away.
Other times, it takes more work, as with the fight against AIDS, but that, too, was and is a success, offering healthful spinoffs across many medical sectors. Yet the common thread in the ACC’s vision of betterment is that yes, indeed, science and medicine can make for better—much better—living and longevity. Not everyone agrees with this proposition, but the vast majority do.
Third, when new medicines come along, a new product and perhaps a whole new economic sector springs into existence. Maybe the medicine can be sold at a profit, or perhaps it can be discounted or even given away. Yet whatever the approach, there’s positive economic activity; as well as the virtuous cycle of greater learning, augmented knowhow, and brighter prospects for future gains. To be sure, not everyone likes the U.S. pharmaceutical industry, and yet it racks up sales of some $1 trillion, and employs some millions Americans, directly and indirectly. Our purpose here is not to wrangle over the sectoral politics of pharma; we can simply say that everyone agrees that medicines save lives.
So yes, cures are a triple play: a win-win-win.
2) Man on a Five-Part Mission
In a string of TV appearances and media hits—the most recent being on News Nation with Chris Cuomo on July 15—Weisbach makes a strong political argument, and also a sound civic argument, for the ACC.
The political argument is that we can use all the wealth and tools—including, now, AI—to conquer diseases. This might seem obvious, even trite, and yet it’s evident that the conquering is not happening. The lack of cures for many diseases is well observed; perhaps most glaringly, more than 600,000 Americans die each year of cancer—and while there has been progress, there hasn’t been enough.
The problem, Weisbach believes, is a lack of political accountability. To put it bluntly, nobody has the exact job of curing disease. As he says, “If we don’t cure Parkinson’s, if we don’t cure Alzheimer’s, tell me one person who is going to lose their job.”
The answer, of course, is that nobody’s post is at risk, because responsibility for advancing medical cures has been smudged and smushed by politicization and bureaucratization. So Weisbach’s idea is to make it someone’s job. Give that person the responsibility, as well as the authority, to make it happen.
In Weisbach’s crisp formulation, the American Center for Cures needs five things: money, leadership, a business model, accountability, and urgency.
Let’s take a closer look:
Money: Weisbach suggests funding the ACC with $750 billion, to be raised, over a number of years, by selling bonds. That’s a big number, to be sure, but as Weisbach emphasizes, it’s to be phased in over a number of years, in conjunction with other investments. And actually, $750 billion is relatively small number compared to the $6 trillion Americans will spend on healthcare this year. And it’s even smaller compared to the $32 trillion U.S. GDP. And smaller still compared to world’s $126 trillion GDP, with a good chunk of that immense total spent on healthcare, somewhere.
To put the money matters another way, we can consider the current cost of diseases. Weisbach cites, for instance, diabetes, which in 2022 the American Diabetes Association calculated as costing the country $413 billion a year. So over five years, on a purely static basis, that’s more than $2 trillion.
All these numbers that start with “t” start to put Weisbach’s “b”-starting number in useful perspective.
Fully mindful of the size of the global market, for both patients and investors, Weisbach sees bond sales as a catalyst to a worldwide industry, albeit hubbed in the U.S. With that much money, there’s at least the possibility for real progress—more on the dead hand of the FDA later—and also the prospect for new tranches of industry. After all, if the U.S. alone spends $6 trillion a year on healthcare, that’s a tantalizing market for investors with a better idea. Even the smallest rejiggering of the way those trillions are spent could prove a windfall for someone with the right product.
So what, exactly, is the ACC? Would it be a public entity? A private entity? Some sort of hybrid? Weisbach sees it as more private than public, as a sort of philanthropic activist organization. This aspect is admittedly a little bit fuzzy, and yet Weisbach’s goal is to get the discussion going, to engage creative and committed minds, not to try and proscribe the exact format. As is said, Where there’s a will, there’s a way. And that takes us to . . .
Leadership: Weisbach has had a long career in business, and so he’s a fan of the CEO model. Put a CEO firmly in charge, and yet at the same time make it plain that he or she will held to account for results.
A Business Model: A good CEO, along with the rest of us, can see many ways for the ACC, slated to be a non-profit, can nonetheless be a positive-return enterprise. Most obviously, if we save money on disease—Alzheimer’s treatment in the U.S. alone is currently costing the U.S. $781 billion annually—that’s money saved by government, as well as by individuals, as well as insurance companies. Indeed, including insurance companies in the ACC mechanism holds out the prospect that savings to life insurance could be transferred to health insurance, and from there to cure companies.
In 2025, veteran policy expert Jeremy Shane published Life for Health: How to Solve Chronic Disease and Increase Healthspan Using Life Insurance, outlining all the ways in which better and fuller accounting could identify an ACC as throwing off gains across the economy and society.
Accountability: The ACC would be accountable to its board of directors. And yet at the same time, key organizations would be accountable to it. And that’s a good thing, because the National Institutes of Health, to name just one outfit, has drifted off course. Some say the NIH, which spends nearly $50 billion a year, has become too pork-barrel-y, others says it’s gone woke, and still others say it has simply lost sight of actual health for humans. Weisbach’s solution is to put the ACC’s chief on the mission. And the same with the U.S. Food and Drug Administration—it needs a shakeup, or more (much more on that later).
Urgency: Each one of us has plenty of experience with medical crisis and tragedy. So there’s plenty of urgency, even if, of course, it’s been diffused, due to a lack of clear-cut accountability.
Yet Weisbach makes a further urgent point: The ACC is good civics. He says in every appearance: Yes, the American people are divided on many political issues, but they are surely united on their own personal medical issues: The desire to live a healthier, longer, life. Medical cures might be, in fact, about the only issue that still unites Americans. And that’s why the ACC is so well named—at least up to this point—as well as perfectly timed. As we shall see, it’s possible that American politics aer so polarized that any specific mechanism will be too divisive to enact nationwide, and yet even so, the potential products, cures, would be popular. So in that sense, the end would justify the means.
Fittingly, Weisbach himself is not a partisan figure: He has supported both Democrats and Republicans, and so he can advocate for the ACC without falling prey to the magnetic field of one partisan polarity or the other.
3) Completing the Mission: From Center to Centers
Weisbach developed the idea of the ACC alongside his co-founder and thought-partner, Dr. Rick Boxer, MD, back in the late 1990s. So for a quarter-century. Weisbach has been pushing the idea. (As an aside, this author has been supportive of a “cure strategy” for more than a decade-and-a-half; in 2010, for instance, in the pages of National Review, I argued, “A healthier population is a wealthier population.”)
Still, for all the good efforts of supporters, little measurable progress has been made. A bill to establish the ACC was introduced in Congress in 2005, and yet it did not come close to enactment. And it’s hard to find tangible political action, in terms of action in either the legislative or executive branch, since. That’s a sobering point.
So what needs to happen to finish the mission?
The challenge is to overcome three huge hurdles: first, $750 billion is a lot of money; second, if the ACC were to advance, the bureaucracy has plan to swallow it; and third, the FDA is a serious roadblock to medical progress. Indeed, just by itself, the FDA could thwart the ACC.
Let’s look at each in turn:
First, $750 billion: Even if put in a relative basis next to healthcare costs, and even if rendered as bonds, three-quarters-of-a-trillion dollars is a lot dollars. At a time when the federal deficit is approaching $2 trillion, when there’s a war in Iran, when Social Security is facing a looming shortfall—and other priorities, too, from spending hikes to tax cuts—are clamoring for attention, it’s hard to introduce a new spending plan, even if it really is a bond-borrowing plan.
Moreover, it must be noted that American politics are so polarized that anything that one side proposes is going to be opposed by the other side. If President Trump, joined by other Republicans, accuses the Democrats of being godless communists, and the Democrats respond by deriding his administration, MAGA, and Republicans in general of being warmongering crooks bent on subverting elections, well, maybe this is not the environment for bipartisanship. In the words of centrist Noah Smith, a notably thoughtful, and widely followed, Substack pundit, “My basic concern is that the U.S. has entered a political era in which reasoned assessment of the evidence, concern for the common good, and deliberation among intellectuals has relatively little effect on policy.”
It can be argued, of course, that the political environment during the Trump years is uniquely toxic to bipartisan action. So maybe a new president, and a new Congress, would be different. Yet of course, “different” could be worse. That is, even more divided.
Yet even so, the ACC offers a glimpse of hope. It’s still the case that every American—left or right, blue or red—wants to be healthy. So there’s always the hope of something better. Aristotle called it entelechy, the vast future potential of even a thing as small as a seed. That is, for sure, a hopeful way of looking at the matter, and yet as we shall see, the ACC seed needs some new kind of nurturing.
Indeed, it might need some new kinds of grafting, even transforming.
One challenge is the name, American Center for Cures. If the name includes “American,” then then it’s perfectly reasonable—or at least plausible—that every American lawmaker will think that a “fair share” of the ACC’s $750 billion should go to his or her state or district.
Abundant political science, as well as actual political history, tells us that as a practical matter, Congress will never appropriate that much money for a broad purpose and have it go only to a single location, or a few locations. Moreover, Congress, being parochial—all politics is local—will write in an infinity of set-asides, covering everything from racial preferences to environmental preferences to gender preferences to Naderite preferences to MAHA preferences. It’s just not going to happen that a national public entity is going to give a blank check to anyone.
We can add two, as it were, footnotes:
First, the final form of the ACC does not have to be a national public entity; it doesn’t have to be national, and it doesn’t have to be public. More on that later, in 6) below.
Second, there is a partial exemption to this rule on national security projects. The Pentagon has plenty of pork, and yet it’s still the case that on national security matters, the executive branch has more leeway than on domestic matters. That’s why the military’s DARPA was a success, and why the Biden administration’s ARPA-H (“H” for “Health”) was not. More on this point below, and we will return to it again in 8).
In the meantime, we should scrutinize the premise that the ACC needs to be a centralized thing, run by the federal government. And in fact, the entelechy of a more adaptive vision is encoded in an alternative rendering for the ACC, the American Centers for Cures, plural.
We can illustrate this possibility if we pause over the wisdom of the biological philosopher D’Arcy Wentworth Thompson: Form enables function, but then form limits function. That is, the form allows for growth, up to a point. But then, if growth is to continue, a new form is needed.
In fact, the ACC is at such a juncture, which some term an inflection point. The current form of the ACC has brought it this far. Yet now, to reach its fulfillment, ACC needs to take on a new form, just as a butterfly transitions into different forms (egg, larva or caterpillar, pupa or chrysalis, and adult) during the course of its life.
So it’s in that spirit—ends stay the same, even as means change—that we Similarly, we should be open to thinking of the ACC in much more diverse forms—more on those possible new forms in sections 6), 7), and 8), below.
Second, the bureaucracy and its turf: Back in the 1930s, the National Institutes of Health was justified to the public as a pro-cures endeavor. That’s why there’s a National Cancer Institute, a National Institute on Aging, a National Institute of Arthritis and Musculoskeletal and Skin Diseases, and so on—a total of 27 institutes and centers. The implication being that each unit is working on better treatments and cures in its domain. And without a doubt, the NIH and its many parts do much good work. Yet also without a doubt, bureau-sclerosis has set in.
A case in point is the fate of President Biden’s cancer “moonshot,” which he intended as a dynamic tribute to his late son, Beau, as well as all the other cancer victims—past, present, and future. As ABC News explained, “Biden made fighting cancer his life's mission with his ‘moonshot’ initiative.” Yet as soon as the 46th president proposed his plan, turf-y politics subsumed it. The project became known as ARPA-H (inspired by the Pentagon’s DARPA, a legendarily successful unit since it first launched as ARPA, back in 1958) and while there was talk of locating the effort outside of Washington, D.C.—to, say, tech hubs in California or Massachusetts—all such imagination was soon swallowed by the bureaucracy. With the Biden’s acquiescence, ARPA-H was simply folded into the National Cancer Institute, and it reported to the Secretary of Health and Human Services. For all practical purposes, the “moon shot” just became a funding boost for the NIH. Today, it’s hard to identify any real change, to say nothing of real breakthroughs.
Which is to say, in the end, for all its high-hoped branding, ARPA-H had nothing in common with DARPA, which was successful because it made actual products, delivered into the hands of warfighters. It didn’t just finance “research,” it did things. The same can’t be said at all for the now invisible ARPA-H
Third, the Food and Drug Administration: The FDA is by far the greatest threat to American medical innovation of any kind. To put that another way, the ACC is not viable if the FDA has jurisdiction over it.
We can prove this point by the numbers. 1949, FDA approved 360 new drugs, as well as 38 new molecular entities. So a total of 398. Seventy-five years later, in 2024, the FDA approved 50 new drugs, including new molecular entities. So that’s a decline of 87 percent. This at a time, of course, when the real GDP of the nation grew by more than 800 percent.
How did that happen? How could drug-approvals have go down so much while economic growth has gone up so much? A lot of it has to do with the “efficacy” provision inserted into the FDA statute in 1962, which at the time many, including the American Medical Association, and warned against. In 2012, Nature magazine surveyed the ongoing regulatory debacle, introducing the neologism of Eroom’s Law, which is Moore’s Law spelled backwards. Yes as that backward spelling suggests, for all the gains made in electronics, the exact opposite is happening in pharmaceuticals. As Nature put it, “The number of new drugs approved per billion US dollars spent on R&D has halved roughly every 9 years since 1950, falling around 80-fold in inflation-adjusted terms.” Such is the tangle of bureaucracy, plus trial lawyers, whistleblowers, headline seekers, sensation-mongers, and conspiracy theorizers, all surrounding the FDA.
The FDA, layered and barnacled as it is, has proven itself impervious to reform and streamlining. Hence the fate that befell the 21st Century Cures Act, which passed Congress by enormous margins (94:5 in the Senate, 392:26 in the House) and was signed into law by President Obama in 2016. Yet for all that momentum, actual results for patients, in terms of cures, were stopped cold by FDA.
Okay, the Trump administration? Has his urgent deal-making spelled any change? Especially in his second term, when he says that he has learned the ropes of governance? Let’s take a look: In 2025, the number of approvals went down, to 46. The lesson is this: The Trump administration, and Secretary Kennedy’s MAHA, are a mixed bag when it comes to medical innovation. They have some deregulatory impulses, but they also feature price controls and a suspicion of corporations, as well as a distrust of government research.
But there’s no great point in picking on Trump or Kennedy. As we have seen, it’s been a decline over eight decades. In fact, from 1949 to 2025 a fall of nearly 90 percent.
Okay, so why of the future? What about AI? On July 12, The Wall Street Journal took note of Eroom’s Law in an article headlined, “Can AI Make Better Drugs? Not on Wall Street’s Timeline.” The point being, the FDA can defeat AI.
In fact, hostility to innovation is literally written into FDA’s statutory authority. This point on legislative language is important, and worth a close examination, because it is possible to write it better, even if, as a practical matter, such a rewrite is probably impossible, at least any time soon. Appendix A, below, provides a case study.
4) Turning Public Opinion into Political Outcomes
Weisbach’s tireless activism has put the ACC on the mental map. There’s a reservoir of support and good will, and yet it needs to be channeled and so put to work.
So if we can depart from Wentworth Thompson’s naturalism, we can shift metaphors and think of a model that allows for human activism:
Diffused public opinion is like water in a river—it can go in any direction, or no direction, unless it is property directed. If flowing is to create hydropower, it must enter into a very specific turbine and turn very specific wheels. Only then can we expect the result we want: electrical power. Anything else is just . . . water over the dam.
To state the point more concretely: General appeals to write or call Senators and Members of Congress sound good as a clarion call, but they don’t mean much in the absence of a specific, binary, yes or no, “ask.” That is, if a constituent write or phones in, “Support the ACC to cure cancer!” it’s all too easy for a lawmaker to simply ping back, “I’ll take a look at the ACC, and in the meantime, please know that I am against cancer; in fact I have voted for X and Y appropriations to the NIH.” Plus the legislator might point to whatever other anti-cancer measures come to mind, from anti-smoking to breast-cancer screening to Agent Orange.
Moreover, in this era in which so much internet and telephone traffic has been taken over by spam and bots, there’s serious question as to whether or not any sort of mass-communication is effective. All too often, it’s just algorithms answering bots, and vice versa, with no human input needed.
To be sure, solons do pay attention to input from constituents and political players, but they are likely to heed in-the-flesh voters—whom they might meet at town halls, learn about in polls, or deal with as organized blocs. Legislators also pay attention, of course, to lobbyists and campaign donors.
We can add that the more sophisticated the petitioner, the more likely it is that a specific idea, or bill, will be at issue. Smart pressure-players distill their “ask” into something very specific; e.g. a declaration on a specific issue, as well as, often, a signature on a specific bill. Under such circumstances, the politician’s response, yea or nay, will be manifest—and players then act affirmatively to either reinforce or dissuade.
On these sophisticated metrics of Washington power-playing, the ACC is not a player. So while Weisbach’s media appearances are a great help, and they have gotten the ACC this far, there’s serious question as to whether or not continued repetition of a news-media-only approach will actually succeed in closing the deal.
This requires targeting and pinpointing. The message can be blasted out far and wide, but there needs to be a way of harvesting and organizing that support. Or, to return to the earlier metaphor, for turning turning the turbine.
In this day and age, such turbine-turning means pledges and a mechanism for keeping up with people. That is, a citizen and voter can go to the ACC website, register, and be given a toolkit for action. And that action needs to be directed toward a very specific goal: Support candidate X, support bill Y (the ACC). If this equation is anything other than simple, even binary, nothing will happen. Generalized calls to acton do not equate to tangible results.
This sort of recruitment and activation is familiar stuff in politics; it’s in the vein of corporate CRM. If the goal is to get something done, there’s no way around this sort of list-building and relationship-building.
So ACC message needs tightening and pinpointing, and also metric-ing and follow-upping. Otherwise, the risk is just crying in the e-wilderness, as a thousand TV channels overflow with a million personalities and influencers, which in turn are submerged in a billion social-media campaigns, and then are drowned by a trillion feeds—all of which are then obviated by quadrillion bots.
5) The Three Hurdles
Let’s take a closer look at the three hurdles to the ACC cited above:
First, $750 billion price tag. As we have seen, if the $750 billion has to come from, or via, the federal government by legislative action, it just ain’t gonna happen any time soon.
Yet at the same time, course, it must be immediately pointed out that the world is actually awash in capital; it’s estimated that total assets under management, worldwide, come to $22 trillion. And annual capital expenditures amount to as much as $900 billion. So there’s plenty of capital out there, for good investments. (Or to be precise, for investments that seem good at the moment the money is greenlighted.)
The challenge is to convince investors that medical cures are one such good bet. As we shall see, the convincing will take some changes in Washington, D.C.
So the $750 billion is doable, if we are agnostic as to exactly where it comes from. We can hold this thought as we consider the next two obstacles.
So now we come to the second and third obstacles, the NIH and the FDA. For reasons noted, both are simply not going to change. Both agencies have been in existence for many decades, both are fiercely protected by “iron triangles,” made even mor ferrous by the additional annealing of trial lawyers, social media, and every other hardening force in American life today.
To repeat: The FDA is simply insuperable. So any plan for the ACC that involves putting up the ACC’s resources, such as they prove to be, against the FDA, such as it is, will fail. But here’s an encouraging point: The FDA itself may be unreformable, but what could be adjusted is the FDA’s tentacular reach. That is, this hopeless octopus of an agency could find its tentacles clipped off. Not all of its tentacles, just enough of them to enable positive action somewhere.
So what to do? How to proceed? We can draw inspiration from the famed management guru, Peter Drucker, who famously said, “Don’t solve problems—pursue opportunities!” By this reckoning, the problem is the NIH, and even more, the FDA. Moreover, before we could even get to the problem of the FDA, there’d be the problem of a polarized and parochialized Congress. Too many problems to solve! So of course the NIH and even more, the FDA, are going to remain choked and unresponsive agencies, as unsolvable problems.
Yet at the same time, beyond the problems, there are the opportunities. So let’s pursue them! As we shall see, this is where the ACC can score big breakthroughs.
6) Laboratories of Democracy— and Cures
Nearly a century ago, in a 1932 Supreme Court decision, Justice Louis Brandeis described the U.S. states as “laboratories of democracy.”
In the nine decades since, we’ve seen the states experiment on just about everything: from education to taxation, from social spending to criminal justice, from gambling to health care. The result is a wide diversity of consequences and results, which we can each judge through our own mental prism.
Interestingly, just the year before Brandeis made that famous declaration, Nevada legalized casino gambling. Back in 1931, Nevada’s choice was very much outside the “Overton Window”—that is, what’s deemed to be normal and acceptable in American politics. And yet it happened. One reason Nevada succeeded, in fact, was that the Silver State was seen as so small and inconsequential that nobody else really cared. That’s a point to file away for future purposes: Sometimes it helps to not attract attention, to make a new action piffling and, well, not worth the bother of the majority.
In fact, it was not until after World War Two that Las Vegas took off.
To use Aristotle’s term, its entelechy, or seed, took the better part of two decades to blossom.
Today, of course, Las Vegas is an international destination. And so the city, and the state, serve as inspiration to federalist Brandeisians everywhere. We can see this case study and fairly conclude: New political frameworks are possible. If it happened once, it can happen again. As the philosopher Kant put it, “The actual proves the possible.”
In fact, the Tenth Amendment to the Constitution has always guaranteed the right of states to experiment; the question has always been, how bold, and yet also shrewd, is a state in its push to experiment?
Here we can pause to observe that many states have “right to try” legislation, which aims to bypass some FDA requirements. These are meritorious efforts, 100 percent in the right direction, and yet recent history shows that their actual impact has been muted. It seems that right-to-try states have yet to escape the dark regulatory shadow of FDA, and that, in turn, puts a shadow on investment enthusiasm. It’s going to take more of a lift than we have seen so far.
Yet still, guided by adept politics, the states can assert themselves to make change. In fact, they already vary greatly, from California to Florida as they have varied on issues ranging from wokeness to wealth taxes.
And it’s not just those two high-profile states: In July 2025, former Alaska senator and governor Frank Murkowski made the Tenth Amendment argument on behalf of his state’s sovereign right to mine rare earths. Those of us who believe that free enterprise is the key can celebrate states opening themselves up to entrepreneurship. So laboratories of democracy can also be celebrated as laboratories of prosperity.
Yet however we feel about economic issues, we can see that different states are choosing different paths, just as Brandeis would have expected. For instance, during the Biden years, the Florida of Governor Ron DeSantis was hostile to the national administration—and expressed that hostility in many ways. Conversely, during the Trump years, the California of Governor Gavin Newsom has been hostile to the national administration—and expressed that hostility in many ways.
This sequential respective hostility can be seen as lamentable polarization. That’s a familiar enough point, and it’s not wrong.
Yet at the same time, states’ hostility to the central government, however situational, can be seen as a kind of liberation. That is, we don’t need to pick a side in the Florida vs. California feud to see that both states, at one time or another, have deep and sincere differences with the federal government. And maybe that’s not so bad, since many states, and their populations, truly seem to be at odds with national policies. Maybe we should respect that hostility, and build on it, in the Brandeisian sense of experimentation.
Indeed, maybe the polarization, or liberation, suggests a new path forward. If the federal government is frozen by hostility, then maybe it’s for the best, because that means that the states can try new things, even as they are compartmentalized.
So yes, if the federal power is not trusted, perhaps people will trust the government that’s closer to them. Is that so bad? For the foreseeable future, it’s unlikely that the feds will be able to muster the political muscle needed to subdue the states—both DeSantis and Newsom are remarkably un-subdued, as are, of course, many other governors, on both sides of the aisle. If this is a crisis of confidence in centralized government, it’s also an opportunity for decentralized government.
In which case, mindful of the Tenth Amendment, we can make the best of it: Maybe we shouldn’t be trusting the federal government to make so many decisions. Maybe the respective states, blue or red, should be deciding for themselves.
With all this in mind, let’s consider a possible scenario in which the overall wisdom of the ACC can be narrowed down to more manageable form. Perhaps the ACC can become an FCC—the Florida Center for Cures. The point here is not to dwell on Florida to the exclusion of other states. So let’s just think of Florida as illustrative of the entelechy in each the states.
Suppose Florida asked for an executive order from the White House, or a waiver from HHS/FDA, concerning FDA regulation within Florida. The idea being that drugs created and dispensed within Florida are to be regulated by the Sunshine State, not the federal government.
Executive orders and waivers, to achieve various goals, are common. Surely President Trump, if presented with a clear argument—sign this executive order and billions and trillions will flow to cure disease, save lives, and change history, with him getting credit—would love it.
So now we see Florida fully flexing its Tenth Amendment sovereignty, in the same way that Nevada did, back in 1931.
Next, the courts reexamine the FDA’s regulatory reign—which has stretched far beyond the actual statute with an endless skein of rule makings and guidances—in light of the 2024 Loper Bright decision, which reversed the Chevron Deference, and many other related cases, all of which also chipped away at governmental overreach. More on this point in Appendix B.
We can observe that a Florida Center for Cures might take on some new form that the ACC as we know it does not presuppose. That is, the FCC could be virtualized and privatized in some way that we can’t yet foresee. But that’s fully in keeping with the businesslike, entrepreneurial spirit of the ACC—what matters is getting the cures done.
We can also add that this federalism approach involves more than just Florida, or some other libertarian-leaning state. There are other variables, too, involving, potentially, just about every other state. Notably, HHS Secretary Kennedy has proven himself to be a opponent of mRNA technology. And to a large extent, he has persuaded conservative red states to join with him in hostility to mRNA. And so that, in turn, could open up a path for, say, California, or some other blue state, to seek out an FDA waiver to work on mRNA products. If so, it’s a safe bet that private capital would come flooding in.
Here we can pause to make an important point about the ACC as a concept. As 6) shows us, and as 7) and 8) will also show, the key variable is that ACC can morph, as from a caterpillar to a butterfly.
After all, the point here is to advance cures, not to get stuck on a name.
7) The Tribes: Laboratories of Territoriality
If the states are laborites of democracy and prosperity, we can make a similar point about Indian tribes. Thanks to their territoriality, they, too, are laboratories of possibility and opportunity. Far more than we’ve already seen.
The best way to know that something can work is that it’s worked before. And that’s the case with Native American gaming. As recently as the 1970s, gaming revenues on Indian reservations were little more zero. However, just half a century later, in 2023, gross gaming revenues were $41.9 billion. And that whopping number doesn’t include all the associated revenues and benefits that come from such robust economic development.
The key is the inherent legal authority of the 574 federally recognized tribal entities. Could these be more than gambling zones? Could these be 574 medical enterprise zones for cures?
In fact, we could be on the edge of a new era of tribal assertion, thanks to the Supreme Court’s 2020 ruling in McGirt v. Oklahoma.
The lesson of the McGirt decision is that good lawyering opens up the realm of possibility in more places, by reviving long-neglected legal rights. In fact, the implications of McGirt extend far beyond the actual geographic metes and bounds of many tribes; that is, we might discover Indian rights in unexpected places—after all, at one time or another, the entire U.S. was Indian Country. So once again, an Indian Center(s) for Cures might look completely different from anything ACC advocates have envisioned heretofore. A closer examination of this in Appendix C.
8) New Medical Enterprise Within the Federal Government
The ACC could also find a route within the federal government, through an agency with enough prestige or cachet to push its way through. Typically, this extra oomph is associated with national security, which explains why the Department of War (Defense) can get more done. Yet we can see that this penumbra extends to the Department of Veterans Affairs, as well as to NASA.
That DOW/D and NASA have special medical needs is obvious: combat is a spectacular medical issue, as is space travel, given the profound health variables of radiation and zero-g. NASA, and also the U.S. Space Force, might point out that it’s far from clear that FDA has jurisdiction in outer space, anyway.
As for the VA, the issues are just as real, even if, as veterans age, many of their medical needs blend in with those of the general population.
The common idea is that these agencies seek a special dispensation to pursue medical research unique to their mandated missions: health for warriors, astronauts, and veterans. This medical fast-tracking would be akin to the way DARPA operates: It’s not enough to just finance research, the actual product—cures—has to be delivered. Trump-friendly tech mogul Joe Lonsdale has argued for exactly this approach, which could be done by executive action.
For instance, the VA mindful that Alzheimer’s takes such a toll on vets, could develop its own special program, using VA facilities, as well as AI, in new ways. The VA could call it the Gene Hackman Initiative, in honor of the late actor, who served in the Marines from 1946 to 1951, and in 2025 died a miserable death from AD.
So where would the financing come from? Here’s where the ACC, in whatever new form, could be vital: As a direct funder, as a catalyst, as a broker, as a distributed network, etc.
^^^
Appendix A: Comparing the Commercial Space Launch Act to the FDA
By the early 1980s, NASA was well past its Apollo-era peak. We had been to the moon, and there wasn’t anything there of immediate value. Moreover, the faltering of the Soviet Union in the “space race” meant that the competitive political juices were drying up. Moreover, NASA was no longer the nimble agency it once was; it was suffering from the “hardening of the arteries” that comes from the bureaucratic equivalent of middle age.
As a result, the commercial space business stagnated. The kludgy NASA bureaucracy was no longer able to keep up with demand for space activity and innovation.
So what happened? Two young Members of Congress resolved to find a fix. This duo was Rep. Newt Gingrich (R-GA) worked with Rep. Daniel Akaka (D-HA). Neither had much seniority, but they had something more powerful: A good idea.
Thanks to their diligence, in 1984, Congress passed the Commercial Space Launch Act, a fully bipartisan triumph, which President Reagan signed on October which relocated regulatory signoff for satellite launches from NASA (and a barnacled-up passel of other agencies) to the Office of the Secretary within the Department of Transportation—typically, the DOT secretary is a nimble operator.
To enact that legislation, the bill thus passed the Democratic House and the Republican Senate and was signed into law by President Reagan on the eve of his own re-election, October 30, 1984. In his signing statement of Reagan declared, “One of the important objectives of my administration has been, and will continue to be, the encouragement of the private sector in commercial space endeavors.”
That sort of hortatory language matters, as it sends a clear signal to the civil service that the bias is to be toward “yes,” as opposed to “no.” Moreover, the language of CSLA itself was written to be bullish. The actual statute, 51 USC Ch 509, uses the words “promote” and “facilitate” in regard to the space-launch industry 10 times each, and “encourage” 15 times. So that’s 35 usages of a positive word.
The result was a huge spike in space launches, and the growth of the trillion-dollar industry we have today. Whereas in the early 80s, only five or six space launches occurred in the US, in the four decades since CSLA, the number of launches has surged upward; in 2025, Americans launched more than 200. We can see: sometimes seemingly small changes, engineered by insiders, can create enormously valuable vectors.
Okay, so that’s the bullish space biz. Yet now we can compare space to medicine. Title 21 of 21 USC, growing out of the Pure Food and Drug Act of 1906, never uses the word “promotion” in a positive way to refer to the drug industry; almost all the references are against promotion, as in, limits on promotional advertising.
So we can see the difference in the way space-bureaucrats would see space launching and the way FDA bureaucrats would see drug approving.
Some might argue, of course, that the success of CSLA proves that it is possible to reform regulatory agencies—including through the expedient used in the CSLA, which was bypassing the regulatory agency, NASA. And that is, for sure, a point to ponder. Yet for reasons cited above, this author is skeptical that FDA reform will amount to much.
Appendix B: The Opportunity in the Fifth Circuit
In 2023, the Fifth Circuit Court of Appeals, covering Louisiana, Mississippi, and Texas, ruled in a case concerning the freedom to prescribe and consume Ivermectin as a treatment for Covid. The court emphatically sided with patients and their doctors. “FDA is not a physician,” the court wrote. “It has authority to inform, announce, and apprise—but not to endorse, denounce or advise. The doctors have plausibly alleged that FDA’s posts fell on the wrong side of the line between telling about and telling to. … Even tweet-sized doses of personalized medical advice are beyond FDA’s statutory authority.” Surely the liberty-loving culture of Florida agrees with that!
As this author wrote at the time, “That’s the sound of freedom, potentially, far beyond this specific case.” Specifically,
We can see this larger and more profound potential in those words of the appeals court, FDA is not a physician. There’s a heckuva thought there, the idea that the FDA does not know more about treating you than does your doctor—or maybe you yourself. It might seem obvious that doctors and patients know more about localized facts than some distant bureaucracy. Indeed, in this era of personalized medicine, aided by big data and all the other advanced techniques, it’s all the more obvious that FDA is an inferior source of knowledge, especially about an individual’s unique medical situation. And yet the law—including the sneaky accretion of law that is the essence of the administrative state—says otherwise. According to the current regime, the FDA knows better, for all 335 million of us, and it must be obeyed.
I added,
The Constitution should, indeed, be a bulwark against the one-size-fits-all bulldozer of the federal government’s administrative state. At the same time, the Constitution should provide protection for heterodox opinion, including on medical matters. Here we can learn from Supreme Court Justice Oliver Wendell Holmes, Jr. who wrote famously in 1929, “If there is any principle of the Constitution that more imperatively calls for attachment than any other it is the principle of free thought—not free thought for those who agree with us but freedom for the thought that we hate.” That’s the sometimes uncomfortable essence of free speech: If it’s really free, it includes the speech we hate.
So now, why shouldn’t the same principle apply to medicine? Why shouldn’t doctors be free to prescribe what they think best for their patients? Why shouldn’t patients themselves be free to choose what they see to be the best path? And if someone else thinks that path is abhorrent, well, here’s where that Holmes quote comes in. Just as with free speech, free medicine might well include things we hate.
Needless to say, a ruling from a three-judge panel on the Fifth Circuit is not the final word—even for the three states affected, to say nothing of the other 47 states. However, there’s an encouraging thread of jurisprudence here. And it could lead to an actual state-based “ACC” that looks nothing like the theoretical national ACC.
Appendix C: The McGirt Case
The Supreme Court’s ruling in the 2020 case of McGirt vs. Oklahoma vastly expanded the potential power, the entelechy, of tribes. In the words of Justice Neil Gorsuch, writing for the majority, this is fitting and proper: “On the far end of the Trail of Tears was a promise. Forced to leave their ancestral lands in Georgia and Alabama, the Creek Nation received assurances that their new lands in the West would be secure forever.”
Gorsuch’s point being that the promise in question—The Treaty of New Echota, signed in 1835 by the United State and the Cherokee—did not have an expiration date. As such, it is valid in perpetuity.
Okay, that might be good legal, and yet the implications of the McGirt case were, for sure, profound. Writing in dissent, Chief Justice John Roberts spoke to these concerns when he declared, “The decision today creates significant uncertainty for theState’s continuing authority over any area that touches Indian affairs, ranging from zoning and taxation to family and family law.”
Roberts was no doubt correct; and yet the existence of contemporary controversy doesn’t change the black letter of the letter. McGirt is, for sure, disruptive, as it opens up many new vistas as lawyers and visionaries think long and hard about what kit be possible. To be sure, McGirt only covers state regulation, and yet at the same time, the issue is the sense of possibility, the same sense of doing new things that animated Indian gaming as it went from bingo games to billion-dollar enterprises. So now, maybe, a relentless application of McGirt logic could lead to new trillion-dollar health enterprises.
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