Monday, February 6, 2012

in health

“The retirement of seventy-eight million baby boomers - Americans born between 1946 and 1964 - will cause the costs of Social Security and Medicare to skyrocket.  Between 2010 and 2020 those costs are expected to rise by 70 and 79 percent, respectively.  By 2050, according to Michael Tanner of the Cato Institute, a libertarian think tank, these two programs plus Medicaid will take 18.4 percent of everything the United States produces.”

this warning comes from the most recent book co-authored by thomas friedman and michael mandelbaum titled that used to be us: how america fell behind in the world it invented and how we can come back.  and while i take issue with the authors using any pronouncement issued by the cato institute as unbiased and factual, truth be told, america is not healthy.

friedman and mandelbaum point of in this book of theirs the slew of problems america now faces: congressional polarization, under education, the economic stress caused by the technology revolution of the late century, and the lack of concern so far shown toward the potential environmental disaster of global warming.  basically americans are lazy and aren’t doing anything.  friedman and mandelbaum write calmly, declaring that if we set certain goals, enact positive and exact legislature now we can catch up, we can set the environment right, we can stay on top, and my generation won’t end up slinging burgers in beijing when we should be retiring.  they’re saying act now before this offer ends!

but reading their forecast, all i can conceive of is how monumental this task is.  not just innovating new technology to create cleaner energy and save the environment.  not just figuring out how to lure the brightest minds into teaching in america’s public schools.  not just completely restructuring medicaid, medicare, and social security.  in my mind, one of the biggest problems is the american public in general.  mandelbaum and friedman believe that the american public is not as divided politically as their representatives in congress, and they write from a pretty moderate (moderately-liberal) viewpoint.  but i do not think they realize that they’re writers for the new york times, a paper that is viewed as both over liberal and over intellectual and overly wordy and pompous and stuffy and yes i pay to read the paper daily and i love reading friedman’s articles but the majority of americans wouldn’t recognize his name let alone read his book and they surely would never believe that he’s anything but rabidly liberal!  and reading this book is almost on par with reading revelations.

bill clinton wrote out more dooming statistics in his recent book back to work:

According to the Simpson-Bowles Commission, total costs for Medicare, Medicaid, and the Children's Health Insurance Program equaled 6 percent of GDP, or about 35 percent of total health-care spending, which is 17.6 percent of GDP.   That's a lot, but it's still cheaper than the same coverage would be under private plans.  For one thing, administrative costs are far lower - less than half of what private plans cost.  Overall health-care spending is $35 to $40 billion lower than it would be if the government's administrative costs were equal to those of private insurance companies.  Even more important, the inflation rate in the government programs, though high, has been lower than the rate of increase in private coverage.  As the New York Times economics columnist Paul Krugman has pointed out, Medicare spending per person has increased 400 percent since 1970, while private insurance has skyrocketed 700 percent.”

what are we to though?  what exactly can my generation and the american public do about these skyrocketing costs and our tumescent deficit.  i guess i’m absolutely a liberal in that i believe that more than simply raising taxes and maintaining healthcare benefits, we must come together as a community and a nation to discuss what exactly we need as such.  a liberal outlook favors greater equality over individual liberty.  thus to understand and work toward a greater community of fulfillment and happiness, we must come together and discuss the needs of this community.  we must make sacrifices.  we must think more about our community.  i pay taxes and can comprehend the need at times of higher taxes because i support our common good and not just my own self interest.

how then does a dialogue about healthcare needs begin?  certainly we need a better understanding of health.  we cannot allow pressure from the food industry to allow the tomato paste on pizza to count as a vegetable serving at school lunches.  we must come to grips with the effect of sugar in the diet.  and we must be frank about what exactly it is fair that we pay for as a community.

According to CBS's 60 Minutes (August 8, 2010), in 2009 'Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients' lives.  That's more than the budget for the Department of Homeland Security, or the Department of Education.  And it has been estimated that 20 to 30 percent of these medical expenses may have no meaningful impact.  Most of the bills are paid for by the federal government with few or no questions asked.' Indeed, Medicare is barred by law from rejecting any treatment based on cost.”

this was reported by friedman and mandelbaum and it brings up a tough question.  certainly we respect and love our elders.  these are our family members.  and they must be care for, just as our nation must have healthcare at any age.  yet we cannot allow our love for our families cloud our judgement.  doctors should not be allow to prescribe any treatment at any cost without proven efficacy.  and the cost to keep a person alive slightly longer unconscious and on a respirator may not be a cost the public should bear.  perhaps some costs should be private burdens.

where is the line between public and private?  recently, cities such as san francisco and certain companies have started paying and supporting the medical transition between sexes.  transgendered people should have our support, but should their transitions be the burden of the public when we cannot even pave our roads and feed our children and bring basic healthcare to the public at large.  when i think of this though, i believe that the need to transition could bring a psychic pain that i cannot begin to understand, and thus perhaps we should be able to make a sacrifice for our fellow citizens.  and in cities such as san francisco, the consent and encouragement for this support does come from the public, blessing the use of public funds.

but these are the hard questions i find myself thinking of, and of which we must all think.  what sacrifices will each of us be willing to make and what do we expect from our society?

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