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Martha Weinman Lear, Plumbing the Forgetful Mind

For all of us who have ever wandered into a room only to freeze, wondering blankly, "Why did I come in here, again?," Martha Weinman Lear has an answer. Lear, the author of Where Did I Leave My Glasses?, discusses the twin issues of memory loss and aging — what degree of forgetfulness is normal, and what can be done about it?

32:53

Other segments from the episode on February 14, 2008

Fresh Air with Terry Gross, February 14, 2008: Interview with Martha Weinman Lear; Interview with Scott Bittle and Jean Johnson.

Transcript

DATE February 14, 2008 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Martha Weinman Lear, author of "Where Did I Leave My
Glasses?" on memory loss
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross. Uh, what was I about to say? That
unnerving feeling, that you've lost your train of thought, is apparently a
symptom of normal memory loss as you get older, along with forgetting people's
names and the name of the movie you just saw and where you left your keys. My
guest, Martha Weinman Lear, has just written a new book called "Where Did I
Leave My Glasses? The What, When and Why of Normal Memory Loss." She's a
journalist who's written extensively about medical issues. She's also the
author of a 1980 memoir about the death of her first husband and what it was
like for him when he went from being a doctor to being a patient.

Martha Weinman Lear, welcome to FRESH AIR. Why were you worried enough about
your memory that you actually went to the doctor to have it tested?

Ms. MARTHA WEINMAN LEAR: Oh, goodness. I was having trouble remembering
names. I'd walk into rooms and forget why I had gone into them. I would
forever be asking my husband, `What was the name of that movie we saw last
week?' I would say, `What was I just going to say? All that kind of thing,
but where it really got most troubling for me was at the desk, because as a
nonfiction writer I have to take masses of research material and organize them
in a fluid and hopefully reasonably graceful way, and no one's ever accused me
of being well organized, so that was becoming more difficult. I'd have the
perfect thought of how to segue from one point to another flash into my
consciousness and in the next instant it was out, gone, goodbye. And that was
enough, finally, to worry me and send me to a neurologist. And he put me
through a battery of tests, assured me that I was fine, at least so far as my
memory was concerned, and that it was normal and universal for this kind of
memory to begin slowing down in middle age. I floated home reassured and I've
been reassured ever since, and I think my memory is probably better as a
result of relaxing about it.

QROSS: So what kind of tests did the neurologist give you to see whether you
were having normal or abnormal memory loss?

Ms. LEAR: He would ask me, for example, to enumerate as many vegetables as I
could, ask me to name fruits, ask me to recite, months backward, days of the
week backward, give me a list of words, let a couple of minutes pass, and then
ask me to repeat the words, tests of that sort.

GROSS: Now, what's the point of asking you to name fruits and vegetables?

Ms. LEAR: When people are perhaps in the early stages of Alzheimer's or some
other form of dementia, they begin typically having problems with that kind of
naming.

GROSS: Now, you have problems with naming. You forget people's names and
movies' names and actors' names, but fruits and vegetables, that's like in a
different category? That stays with you?

Ms. LEAR: Yes, Terry. We have many different kinds of memory. Fruits and
vegetables, items that we have been familiar with all of our lives, facts,
generally, facts, things that we know about the world, are parts of what is
called semantic memory. Semantic memory would be, what are eyeglasses for?
To be able to answer that, one would have to have intact semantic memory. But
if one asked, `Where did I leave my eyeglasses?' that is what's called
episodic memory, which covers all of personal experience, and that's the kind
of memory that typically begins to slow up on us in middle years.

GROSS: And where do fruits and vegetables fit in?

Ms. LEAR: They're part of semantic memory. The difference would be, `The
Empire State Building is in New York City.' That is semantic memory. `We went
on a tour of the Empire State Building last week,' that would be episodic
memory.

GROSS: You describe memory as a three-stage drama. There's acquisition,
storage and retrieval. What are some of the things that can go wrong each
step of the way?

Ms. LEAR: The very first thing that can and so often does go wrong is that
you're not paying attention, and every neuroscientist I spoke to--and I
interviewed many of the most distinguished ones in the country--every one of
them stresses that paying attention is the most important primary part of the
process, because obviously if you don't pay attention, it never gets in there.
It's never stored. It's just gone.

Beyond that, what can go wrong is that--a memory is formed by chemical and
electrical impulses traveling along the networks of neurons in the brain.
Scientists estimate--I can't imagine how they count them, but they estimate
that there are at least 100 billion--with a B, as in boy--a hundred billion
neurons in the human brain. Some think there may be as many as 200 billion.
And every memory forms its own pattern along those networks of neurons. So
you take a particular memory, Terry, every--it's been stored in long-range
memory. Now every time you retrieve it and then put it back into storage,
that pattern of signals is changed so that, over time, the memory becomes less
and less accurate. The evolutionary biologist Terry Deacon out at U Cal
Berkeley compares it to a palimpsest, or to writing over writing over writing,
and as he says, `The ink tends to get lighter as you go along so that in time,
the experience, as you recall it, as you now hold it in memory, will be quite
different from experience as it originally entered your brain.'

GROSS: Is that in part because you embellish it a little differently each
time...

Ms. LEAR: You also embellish it. Emotion. You ask what could go wrong.
Something else that can and does go wrong is the absence--say you've had--you
recall a memory that pained you, that caused you great grief or that caused
you great joy. Whenever you recall that memory, to whatever degree the
emotion is experienced again is going to affect the way you recall the memory.
And so you're going to put it back into storage somewhat different from the
way it was in storage before, which is one of the essential differences
between brain memory and computer memory because you put information into a
computer, retrieve it 50, 100 years from now, and it's going to be exactly as
it went in. That will not be the case with brain memory.

GROSS: You know what surprises me about what you're saying? I always think
that if you repeat a memory to yourself, you're making it more indelible in
your brain by constantly remembering it, and you stand therefore a greater
likelihood of having a real genuine memory; and you're saying it's the
opposite, that the more you kind of recall it and discuss it, the more changed
it's going to become.

Ms. LEAR: Probably. That is the neuroscientific view of the matter, whereas
a memory that is brand new, such as the name of someone you've just been
introduced to, that you can in fact fix more accurately within your brain by
simple repetition. Although what people do typically is, I meant you and I
saw to myself, `Terry, Terry, Terry. The name is Terry,' which won't help a
bit. What one should do is what the psychologists call spaced repetition.
You say the name to yourself, wait 10 seconds, say it again, wait 20 seconds,
repeat it, wait thirty seconds. Repeat it. Do that perhaps a half-dozen
times. You have a far better chance of hanging on to the name.

GROSS: Now, you said that, you know, when you're learning something that you
have to be paying attention, otherwise the memory isn't going to stick. So
many of us, you know, excuse the expression, multi-task. We're doing two or
three things at the same time. We're reading e-mail while we're on the phone
or listening to music while we're reading or watching a movie and reading the
newspaper on television--you know, reading...

Ms. LEAR: Uh-huh.

GROSS: ...watching a movie on television. Does that mean that everything
we're doing is less likely to make a good memory impression because we're
focused on several things at the same time?

Ms. LEAR: Well, multitasking is one of the three most common early
presenting symptoms of this kind of normal, garden variety, age-related memory
loss. Trouble with names, trouble with multitasking and having it take longer
to absorb new information because, although we talk about memory loss, it
isn't really loss so much as it is a slowing down. And so what is advised by
specialists who deal with people who are having memory problems insofar as
multitasking is concerned is to set strict rules for themselves so that you
say, for example, `I have to finish this task that is on my desk, and I am
going to ignore the e-mail and I'm not going to answer any phone calls until
this task is done.' And Dr. Margaret Sewell at the Mount Sinai Memory
Enhancement Center here at Mount Sinai Hospital in New York tells me that as
soon as the clients who come to see her are able to impose that kind of
discipline upon themselves, they're astonished by how much difference it makes
and how much more they're able to get done.

GROSS: So when you reach a certain age, multitasking becomes more difficult.
If you want to actually remember what you're doing and complete what you're
doing...

Ms. LEAR: Yeah. Yes. But as Dr. Sewell points out, it is not that you
can't do it, you simply have to organize your tasks differently, and as for
taking longer to process new information, she said to me--and I loved hearing
it--she said, `If you are physically healthy and you want to learn Italian
when you're 90, go ahead, you can do it. It's simply going to take you
longer. You're going to need to study harder. You're going to need more
rehearsal time, but you can do it every bit as well as the 30-year-old.'

GROSS: So there's certain parts of the brain that start to slow down first?

Ms. LEAR: Well, the epi--the frontal lobes start to slow down first. They
are, interestingly, the last part of the brain to develop in children and, you
know, last on, first to go.

GROSS: What do they do? What are they responsible for?

Ms. LEAR: Oh, all of episodic memory. Now, I should clarify. Memory is all
over the brain. All kinds of memory are all over the brain. But episodic
memory relies primarily on the frontal lobes of the brain, and that includes
all the kinds of things we're talking about--remembering names, remembering
what you had for lunch yesterday, all that kind of thing. But also, the
frontal lobes are responsible for what the scientists call executive function.
And executive function includes multitasking. It includes paying attention.
It includes being able to get distractions out of the way. It includes
planning, scheduling, a good many of those functions that we begin to have a
little more trouble with in middle age. Those are all part of executive
function, which is lodged in the frontal lobes, which begin to lose volume
first, as I say.

But it's not, for most of us, thank heaven, it's not a serious slowing down.
We just perceive it as serious and we get scared because there's a terrific
difference in our own perception between a brain that's functioning at 100
percent and one that's going along at, let's say, 95 percent.

GROSS: My guest is Martha Weinman Lear, author of the new book "Where Did I
Leave My Glasses? The What, When and Why of Normal Memory Loss." More after a
break. This is FRESH AIR.

(Announcements)

GROSS: My guest is Martha Weinman Lear, and for many years she's written
about medical issues. Her new book is about memory, her own issues with
memory and what the experts she interviewed across the country told her about
memory, how it works and how it fades, and her new book is called "Where Did I
Leave My Glasses? The What, When and Why of Normal Memory Loss."

You started this book because you were worried about your own memory. You
were worried about losing your memory. You got tests. They told you no, this
is just like the type of memory loss that accompanies aging.

Ms. LEAR: Mm-hmm.

GROSS: As part of your research for the book, you not only interviewed a lot
of, you know, neurologists and other experts on memory, you visited hospitals
that offer memory-enhancing clinics and looked at what the memory gurus that
privately market their techniques to remember had to say. What are some of
the most compelling, useful memory techniques that you came across?

Ms. LEAR: The single most important factors in helping us with our normal
garden variety memory--I keep saying loss, but really, let me keep making the
point it's slowing down--the key factors are diet and exercise. Most of us
are familiar with that. We just don't always follow the rules that we know
are rules. The specialists all tell me, as far as diet is concerned, that
anything that is heart healthy is brain healthy.

Now beyond that, exercise--this is where I got one of the biggest surprises
that I experienced in the two years I spent doing research--it turns out--I'm
talking now about experiments that were done by scientists at the University
of Illinois-Urbana. They took two groups of adults, middle age to early old
age, people who were physically healthy, and put one group into toning and
stretching exercises and the other group into aerobic exercises. Kept that up
for six months, and at the end of six months they found that the people in the
aerobic exercise group had gained 15 to 20 percent speed improvement in
cognitive process. Now, that's really an amazing change, and of course...

GROSS: Is there any explanation for it?

Ms. LEAR: Well, yeah, sure. There are two. The first one I think is pretty
obvious, that when you do aerobic exercise, more blood, more oxygen is going
to the brain. But the other, which surprised me, which I was told by Dr.
Yaakov Stern at Columbia-Presbyterian here in New York, who is an eminent
neuropsychologist, the other factor is that there is a chemical. It's called
B-for-boy, D-for-David, and then there are two other letters--and of course I
can't remember what they are--but this chemical helps the process of
neurotransmission, and aerobics causes more of this chemical to flow.

GROSS: So what do you do to compensate in areas where you know your memory is
weak?

Ms. LEAR: Let's take names. One very common compensation recommended by the
specialists is spaced rehearsal, repeating the name to yourself, not rapidly
but several times over a period of time, 10 seconds, 20 seconds, 30 seconds.
Another, since memory works by association, is to elaborate, in any way you
can, elaboration is part of the process of association and means simply
linking what you already know to what you want to remember. So that, if I'd
met you for the first time and wanted to remember the name Terry I would think
of other Terrys I might know and mentally visualize the two of you together
because visual memory is much stronger than verbal memory. Or, if I were
quick enough on my toes--which I'm not always--I might try to make a little
poem, `Terry is a berry,' and see you like a strawberry--or see you holding a
strawberry.

Another technique--it doesn't--it's kind of boring, but sometimes you hit the
jackpot when you forget somebody's name, you've been introduced, you forget
the name, you're talking to that person, somebody else comes along, you need
to introduce them, you don't know what to do--that's a problem we all have and
are embarrassed by--you can try going through the alphabet hoping that will
give you a clue, you know. Albert, Betty, Charlotte, David, and so forth.

What I find when I'm stuck in that kind of situation is that a little
dissembling will go a long way. So that, for example, if I'm at a crowded
cocktail party and I'm talking to A, whose name I have forgotten, and B comes
along, whose name of course I have also forgotten, and joins the conversation,
what do I do? I have learned not to do anything. I greet B and I keep
talking hoping that the two know each other. If they don't say, `Well, we
haven't met,' I'm home free. But if either of them says, `We haven't met,' I
say, `Oh, excuse me for a moment, I'll be right back,' and I run for the
nearest exit and hope that by the time I return those two people whose names I
can't remember will be talking to other people whose names, of course, I also
won't remember.

GROSS: Martha Weinman Lear is the author of "Where Did I Leave My Glasses?
The What, When and Why of Normal Memory Loss." She'll be back in the second
half of the show. I'm Terry Gross, and this is FRESH AIR.

(Announcements)

GROSS: This is FRESH AIR. I'm Terry Gross back with Martha Weinman Lear,
author of the new book "Where Did I Leave My Glasses? The What, When and Why
of Normal Memory Loss." She's a journalist who's written extensively about
medical issues.

Now, as you get older, it's really interesting to see what you remember
vividly and what memories have faded from the past. And you say that the
experts have told you that memories of physical pain are not as vivid as, say,
emotional memories. And that's kind of really surprising to me because, as
somebody who does her best to avoid pain of all types, I always think of
memories of pain as being pretty, pretty vivid.

Ms. LEAR: Yeah, well, the difference--this fascinated me too. The
difference is when we talk about remembering pain, emotional or physical, what
the specialists are telling us is not that you can't remember physical pain,
but that we are fully and unfortunately capable of re-experiencing emotional
pain years after the event that initially caused the pain. And if you've ever
lost anyone dear to you--I lost my first husband some years ago. That was the
worst thing that ever happened to me, and it was several years after he had
died, I passed a man in the street who walked rather like him and looked just
a bit like him, and I dissolved. I was simply reliving the same pain that I
had had when the experience was new.

Now, physical pain, you can remember, of course, but you cannot--we seem to be
incapable of recreating it in the same way, of re-experiencing it. You
remember when you broke your arm. You know that you were in a hell of a lot
of pain, but you're not re-experiencing the actual pain. And the specialists
suggest that the evolutionary reason is fortunate indeed, because if you
re-experience emotional pain, it's hard, but you can still get it together to
do the things that you need to do, do a day's work and get the kids ready for
school and so forth. But if you broke that arm and years later thought of it
and re-experienced the pain of it, you'd be out of commission.

GROSS: The first time I spoke with you was--it was in the late '70s or maybe
1980 and it was after the publication of your memoir, "Heart Sounds." The
memoir was about your husband, Hal Lear, who was a urologist who had a heart
condition, had bypass surgery and ended up dying at the age of about 58 of
complications from the heart condition, and this was really a death that
shouldn't have happened. There were mistakes made in the hospital that should
have never happened there. It was a very upsetting book to read and, as
you've said, the worst thing that ever happened to you in your life.

I always wonder, like when you lose somebody, what stays with you? What do
you remember, what do you forget? What do you wish you were able to remember
but you just can't get at it anymore? And so I'd really like to know, if you
wouldn't mind talking about it, if you feel like the memories that you've
wanted to stay with you have adequately stuck with you, or do you feel like
you sometimes grasp for those vivid memories of your first husband and things
that you want to remember aren't there anymore?

Ms. LEAR: Oh, Lord. I think the things that I want to remember have stayed
with me. It's not a pain that ever goes away, but what I find reassuring is
that what was sheer bitterness in the early years turns in time to a kind of
bittersweet, you know. Sure, there's the sadness, and the sadness always
remains, but there's also enormous joy in the memory and a feeling of having
been blessed to have had that life and to be able to hang onto those memories.
I don't think anyone who has ever dearly loved and lost forgets the vital
memories that one wants to hang onto. You forget a great deal of the
minutiae, and so what? But oh yeah, sure, I remember.

GROSS: I know, like, when my mother died, it took me a long time to be able
to really remember her when she wasn't sick...

Ms. LEAR: Oh boy.

GROSS: ...because when I'd think of my mother, I'd always think of the way
she was during the last couple of years of her life when her physical and
mental abilities were deteriorating.

Ms. LEAR: Yeah.

GROSS: I wonder if you went through that, and tell me if I'm--if this is too
personal--but I wonder if you went through that with your husband, that, like,
it took a while for memories of his younger and healthier days to really
surface in your mind after he died.

Ms. LEAR: Hm. For a while I couldn't bear to look at pictures, but then I
put them all back up on the wall and I surrounded myself with pictures of him
in his health and vigor. He was a marvelous looking man. And I must confess
that the memories of his appearance toward the end, when he looked skeletal,
he looked like a Holocaust survivor. You remember those movie reels we saw of
the survivors in the death camps inside those wire fences with the gaunt
faces. They looked like death. Hal looked like that in his last year. I try
to block those memories out. I don't want them. They stick, of course, but
it is those other memories of him robust and healthy and happy that are very
vivid indeed, and I'll hang onto those until the day I die.

GROSS: Now, you mentioned the photographs that you put back up. And this is
another thing I always wonder, when you lose somebody, are your visual
memories of them based on the indelible photographs that you have, are those
the pictures that you have in your mind because you have those pictures in
front of you, or are you able to conjure up what the person looked liked
during various stages of the period that you knew them...

Ms. LEAR: What an interest...

GROSS: ...that you knew them that aren't from the photograph?

Ms. LEAR: Yeah. Yeah. What an interesting question. I can remember
moments with extraordinary vividness that I don't have pictures of at all.
And there was one--his doctors had told me he had, at the outside, a year to
live. He fooled them. He lived 18 months beyond that, but he said at one
point--now, mind you, he was a doctor who knew damn well that he was terminal,
but he was operating as I think people who are terminal always do. He was
operating both with the knowledge and in denial. Even as a doctor he was able
to deny, and he decided at one point that what he needed most was to go out
and buy a new suit. And I had some appointment, I had to meet him at the
store. And I remember, Terry, oh Lord, truly as though I were there, I
remember walking in and seeing him in a gray flannel jacket, a blazer, and he
looked so handsome. And he flashed me this huge smile coming out of that
desiccated face. Oh, I remember--that has photographic precision for me.

GROSS: Well, Martha Weinman Lear, I want to thank you very much for talking
with us.

Ms. LEAR: Thank you, Terry. It's been lovely.

GROSS: Martha Weinman Lear is the author of the new book "Where Did I Leave
My Glasses? The What, When and Why of Normal Memory Loss."

Coming up, if you'd like to know what it means that our government is $9
trillion in debt but you find it difficult to make sense of the explanations,
stick around for our next interview with the authors of "Were Did the Money
Go?"

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Scott Bittle and Jean Johnson, authors of "Where Does
the Money Go?" on the country's $9 trillion debt
TERRY GROSS, host:

Earlier this month, President Bush made his final budget proposal to Congress,
the first ever to top the $3 trillion mark. Bush's plan would increase
military spending and restrain domestic programs, including Medicare and
Medicaid. It would also produce a $400 billion deficient, and our guests,
Scott Bittle and Jean Johnson, have a problem with that. As leaders of the
nonpartisan think tank Public Agenda, they're on a mission to warn Americans
of the dangers posed by the rising national debt, which now stands at $9
trillion. They believe plain talk about the budget crisis is needed to
enlighten citizens and move politicians to act. Bittle and Johnson have
written a new book called "Where Does the Money Go? Your Guided Tour to the
Federal Budget Crisis." They spoke with FRESH AIR contributor Dave Davies, who
is a senior writer for the Philadelphia Daily News.

DAVE DAVIES: Well, Scott Bittle and Jean Johnson, welcome to FRESH AIR. You
know, I've covered as a newspaper reporter city and state budgets for years,
and I find that they generally have a requirement that legislatures and city
councils pass annual budgets that are balanced, and while that can be fudged a
little with a phony revenue estimate or tax estimate, you can't just borrow
for operating expenses. The federal government is different. Why?

Mr. SCOTT BITTLE: Well, the federal government does not have a balanced
budget provision for a lot of reasons, mostly because the founders didn't
think it was necessary and no one's gotten the votes together since to do it,
but I think the main thing is that deficit spending has become routine in
Washington because there is no actual requirement other than a general belief
in good government to bring the budget into balance. It's the default setting
to run a deficit, and we've done it for 31 out of the last 35 years. There's
simply no strong political incentive to bring it into line.

DAVIES: Now, there's a view that the national debt and the annual
deficit--the numbers are gargantuan--but there's a view that what really
matters is not the size of the debt in nominal terms, but its size in relation
to the nation's economy, the gross domestic product. By that measure, how do
we stack up in our debt, and is it a fair measure?

Ms. JEAN JOHNSON: Well, I think that, you know, by that measure, the debt is
not that large compared to the economy as a whole. We have a huge economy.
But if you think of it another way, we're now spending more than $200 billion
a year on interest on the debt, and that's actually more than we're spending
on the war in Iraq, so it's beginning to be a very large portion of the
budget.

But I think the issue is not that there is a debt in any one single year, it's
the fact that it's become business as usual in Washington. And we have this
huge debt building up year after year to $9 trillion, and we are facing down
the road these humongous expenses for the baby boomer retirements and for
Medicare, 78 million Americans who will be coming up to Social Security and
Medicare benefits.

DAVIES: Let's take care of one technical question here. A lot of people say
that when the federal government doesn't have enough money to pay its bills,
it simply rolls the printing presses. It's a metaphor. That of course is not
what happened. What happens is what? They issue bonds, right, federal
Treasury notes, which are then bought by investors, right?

Mr. BITTLE: That's right, and those are available for sale for anyone. At
the moment, one of the biggest things that's going on is roughly a quarter of
this is owned by foreigners--Japan, China, Great Britain--basically because
this is a safe place to park their money. The problem down the line is, some
other place may be a safer place for them. Alternatively, you might end up in
a dispute with another country, like China, and it gives them the possibility
of an economic weapon.

DAVIES: Yeah, yeah, let's pursue that for one second because there's been a
lot of attention to China buying a lot of federal Treasury bonds and let's say
down the road they want to punish the United States for some measure and as
you say, they want their money back. Well, the fact is that what they have is
a Treasury note with a payment schedule on it. I mean, they can't simply
demand immediate repayment. What they would have to do is try to sell that US
Treasury security on the open market, right? What happens if they do that?
What's the hard in that?

Mr. BITTLE: Well, were they to try and dump their Treasury bonds all at
once, that would really provoke a world economic crisis. And I don't
think--and most of the foreign policy experts we talk to don't think--that's
terribly likely, just because China needs stable markets, too, and disorder in
the world financial markets doesn't benefit them, either. What they can do,
however, is simply slow down because all the other world financial traders are
waiting for a sign that China no longer wants to fund our deficit spending.

DAVIES: You mean they slow down buying US Treasury bonds?

Mr. BITTLE: They slow down buying more, and then other people also start
slowing down. Interest rates go up, not just on Treasury bills, because the
government would most likely raise the interest rates to make them more
attractive, but the interest rates would probably go up for everybody, which
means your mortgage would cost more, your car loan would cost more. It would
hurt the economy across the board.

DAVIES: Well, I want to talk a little bit about how we've gotten here over
the past few years. You know, we've been hearing about, you know, very
troubling and large federal deficit since the 1970s and through the 1980s.
And then the in the late '90s we saw the federal government actually begin to
run budget surpluses. Why?

Mr. BITTLE: Well, I think it was a combination of factors, and it was really
remarkably bipartisan. One was a booming economy, which helps considerably.
Another was that the first President Bush and a Democratic Congress were
willing to raise taxes to deal with the budget issues at that time, and then
President Clinton and a Republican Congress were willing to stick to some
fairly strict spending rules to control spending going forward. So that
combination of factors, that combination of bipartisanship and fiscal
discipline really brought things under control, at least in terms of the
year-to-year budget. They did very little at the end of the day about the
long-term problems of the entitlements like Social Security and Medicare.

DAVIES: Right, and they didn't chip away much at the accumulated debt, but
they stopped adding to it for a while. Now, how did we get into the situation
we're in now where deficits have grown enormously once again?

Ms. JOHNSON: Well, I think that it's, you know, in some ways, it's really no
secret. We made very popular tax cuts. They were broadly supported. We had
expenses for the war in Iraq and for all of the national security needs after
September 11th. We've added a drug benefit to Medicare. We have increased
spending for all the popular programs. And, you know, there has not been any
kind of political pressure to make the choices that would get the budget back
in balance again. And, you know, ironically this has happened when we have
had a booming economy and when revenues to the Treasury are up.

DAVIES: Well, let's talk--you mentioned the Bush tax cuts, which you said
were broadly popular. There is, of course--the argument of supply siders is
that cutting taxes, you know, empowers, you know, the entrepreneurial class,
it generates spending and therefore boosts the economy, which in turn boosts
revenues. Looking at the numbers, how well does that argument hold up? Do
the tax cuts generate enough revenue to pay for themselves?

Ms. JOHNSON: Well, you know, it's an interesting question because revenues
to the Treasury were up after the Bush tax cuts and, you know, the tax cuts
do, you know, generate some revenue. The problem is they don't generate
enough revenue to pay for themselves, so that you have even conservative
economists who've studied this, you know, coming out with studies that show
tax cuts pay for 20, perhaps 30 percent of the loss to the Treasury, so you
still have that 70 or 80 percent to cover.

DAVIES: One more question about how we moved from the surpluses in the late
'90s to the huge deficits that we see today. How much of the federal budget
deficits that we are seeing today are the result of the war in Iraq?

Mr. BITTLE: I think that is one of the most striking misconceptions we've
run into in researching the book. Certainly we've spent a great deal on the
war, but the war itself is not the cause of the financial problems. Between
2001 and 2007 the Congressional Budget Office says we've spent about $600
billion on the war on terrorism in general. That's Iraq and Afghanistan and
everything else. Over the same period, the national debt increased 2.3
trillion. It's certainly true that spending on the war has added to our
financial problems, but the fact is it's not the sole cause.

DAVIES: If you're just joining us,our our guests are Scott Bittle and Jean
Johnson. They're associated with the nonpartisan Web site Public Agenda
Online and they are authors of a new guided tour to the federal budget crisis.
It's called "Where Does the Money Go?"

Well, let's talk a little bit about federal spending. One of the things that
you do in this book is to break down federal spending by category, and you
find that certain things surprise people about how their federal dollars are
allocated. What is most surprising about where our federal checks go to
people?

Ms. JOHNSON: I think what's most surprising when we talk to focus groups
about this is how little of the federal budget really goes to the things that
a lot of people will pick as their targets for cuts. So many people will talk
about the space program or the endowments for the humanities and the arts or
they'll talk about welfare, and, you know, the kind of--farm subsidies is
another one that comes up. And you know, the problem, if you sort of add
these programs all together, you're really getting less than 5 percent of the
budget. The big expenses are on Social Security, on Medicare, on defense and
on interest on the debt.

DAVIES: And you point out that a lot of the things that really tick people
off, things like farm subsidies--I mean, in fact, you have wonderful--one case
in the book of a guy who gets--who has an asphalt lot behind him, his house,
that he's paid not to grow rice on there, which he never intended to do, and
various other outrages, don't add up to a lot of money but you say they're
important nonetheless? Why?

Mr. BITTLE: The importance of waste and fraud and pork barrel spending and
earmarks and all these kind of extremely frustrating things about the federal
budget isn't that they add up to a lot, as you said. The most aggressive
definition of earmarks I have seen is about $1.6 billion in the total budget.
The budget for the coming year will probably be $400 billion in deficit, so
you don't balance the budget by getting rid of that.

The real problem with that is trust. This is what makes people cynical about
the federal government and how federal spending is allocated. When we've done
focus groups on the federal budget at Public Agenda, what what we found is
once people understand the problem, they're willing to consider making
sacrifices. They're willing to consider changes in benefits, changes in taxes
to solve the problems. But they won't make those sacrifices if they think the
money's going to be wasted.

DAVIES: We're speaking with Scott Bittle and Jean Johnson. Their new book is
"Where Does the Money Go? Your Guided Tour to the Federal Budget Crisis."
We'll talk more after a break. This is FRESH AIR.

(Announcements)

DAVIES: If you're just joining us, our guests are our guests are Scott Bittle
and Jean Johnson. They're both affiliated with the nonpartisan Web site
Public Agenda Online, and they've written a book. It's a new guided tour to
the federal budget crisis called "Where Does the Money Go?"

Well, let's talk about Social Security and Medicare, which is the really,
really big looming problem for the federal deficit, and in a snapshot, how big
is the problem, how quickly does it descend upon us? And what do we do about
it?

Ms. JOHNSON: Well, you know, it's interesting, because we often talk about
Social Security and Medicare as if they are the same, and in fact they are
quite different, and Medicare is already in trouble financially, and it's in
trouble financially because it's set up a little differently, but the major
problem is that health care costs are going up so rapidly. So already that
program is facing enormous strain.

Mr. BITTLE: Medicare really brings these two problems together. One is the
78 million baby boomers, and the other is health care costs, which are
skyrocketing in any case just throughout the national health care system. So
when you bring these together in Medicare, you end up with something that is
actually much, much worse than Social Security in terms of its impact on the
budget. If you project out the obligations, as the government auditors have
done, over the next, you know, 75 years or, you're talking about $32 trillion
in Medicare obligations compared to six and a half trillion for Social
Security.

Or, to put it another way, if you wanted to fix this and you could raise taxes
or cut benefits any way you wanted, to put Social Security in balance for
another 75 years, you could raise taxes by 16 percent or you could cut
benefits by 13 percent or some combination in between. Again, politically
could you do that? That's another question. To fix Medicare for 75 years,
you'd have to raise taxes 122 percent or cut benefits in half. I think that
gives you an idea of how much larger the Medicare problem is.

DAVIES: As somebody who considers myself a pretty informed citizen and I've
actually, as a reporter, covered budgets in state and local governments, I
have to say that I find the federal budget process utterly bewildering. I
mean, you know, continuing resolutions and 13 different budget bills that are
introduced and debated separately. Am I wrong, or is it the mess that it
appears to be to me?

Mr. BITTLE: Oh, you're not wrong. It is an extremely complicated process.
The president submits a budget request, Congress then passes its own budget
resolution. Neither of those necessarily are reflected in the 13 different
spending bills. The 13 different spending bills do not necessarily factor in
Social Security and Medicare, which are running on autopilot. We actually in
the book looked at a few other countries and different ways they go about
this. New Zealand works with a system of budget targets that are set. So
does the Netherlands. New Zealand actually has a remarkable system where
government auditors put out estimates of the financial impact of campaign
promises made by the various parties during the election....

DAVIES: Wow, that would be...

Mr. BITTLE: ...which I'm not sure how that would actually work in practice
here. But there are different structural ways of going about this that could
make the system a little more rational.

Ms. JOHNSON: I think the other part of it--you know, there are all these
kind of structural ideas--but on the other hand, not so long ago, you know,
within memory of most of us, our political memories, there were bipartisan
deals on the budget and there were agreements that parties got together with
the administration, the Congress got together and decided to try to get a more
fiscally responsible plan for the future. And there's no reason that if the
American people want that and start asking tough questions, we can't get back
to that kind of state of mind.

DAVIES: Well, Scott Bittle and Jean Johnson, thanks so much for speaking with
us.

Mr. BITTLE: Thank you. It's a pleasure.

Ms. JOHNSON: Thank you.

GROSS: Scott Bittle and Jean Johnson are the authors of "Were Did the Money
Go? Your Guided Tour to the Federal Budget Crisis." And they're executive
vice presidents of the think tank Public Agenda. They spoke with FRESH AIR
contributor Dave Davies, a senior writer for the Philadelphia Daily News.

You can download podcasts of our show on our Web site, freshair.npr.org.

(Credits)

GROSS: I'm Terry Gross.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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