Friday, August 21, 2009

No free lunches, except for me

Despite the fact that I'm overseas, I've continued to follow politics at home, and the ongoing healthcare debate has convinced me moreso than ever before that a large number of Americans have a thoroughly infantile view of their government. They want comprehensive, high-quality services, but don't want to have to pay for them. They do seem dimly aware that someone has to pay, as widespread concern with the federal deficit shows - they just don't want it to be them. Ideally it would be some other segment of the tax-paying population (the rich, corporations, etc.), but if that's not an option, future generations of Americans or Chinese bankers will do. All the while, the government grows and grows, waste and inefficiency continues to proliferate, and the country's fiscal future grows ever dimmer.

Healthcare policy is an extremely complicated subject, and the various proposals being debated right now all have their plusses and minuses. What is undoubtedly true, however, is that any meaningful reform to the current system is going to entail either A.)higher taxes, B.)curtailed services, or C.)some combination of the two. It's elementary economics. An ever-growing population of sickly and elderly people demanding an ever-growing variety of ever-more-expensive cutting edge medical treatment means costs will inevitably continue to go up. A relatively stagnant working-age population, an economy in recession, and increasing federal deficits means that revenues will not rise fast enough to pay them. The system as currently constituted is a fiscal train wreck in the making, and whatever solutions may be available to avert that, they are going to entail pain all around. I know that most people are happy with their current healthcare, and are worried they might lose options as to doctors or treatments under the reform proposals being considered. That's not an excuse. One way or another, people are going to lose options eventually anyway, because if we keep spending on healthcare the way we are now, rather soon there won't be enough money available to pay for those options. That means either significantly higher taxes, or a healthcare regimen that doesn't outlay extravagant amounts of money on marginally effective but expensive treatments. Sarah Palin's hyperventilating about "death panels" aside, I don't have a problem with the latter.

A major part of the problem, I think, is America's childish fear of death and dying. I've lived in Japan and Korea, both countries with national healthcare systems. In both countries, doctors and hospitals provide a standard of care comparable to what's available in the U.S. to patients, at significantly lower costs. What they won't do is spend absurd amounts of money to briefly prolong the life of a moribund patient. The grandfather of a Japanese friend of mine is currently dying of terminal cancer. The hospital took good care of him for months, but when it was determined that his case was hopeless, he was sent home to receive palliative care and live out his last days in relative comfort. My friend's family has no problem with this. They are doing everything they can to make the most of the time they have left with him. There is no whining or complaining about how the doctors aren't doing enough to save him - he's old, he's lived a long life, and his time to go is coming, and people accept that. This seems to me an infinitely more sane and humane approach to the final days of life than spending enormous amounts of money on painful, difficult, and ultimately futile treatments intended to give a person a few more days or weeks of poor quality life. The fact that it saves hundreds of thousands of dollars that can be used to provide cheaper and more effective healthcare to other people, younger and healthier people, people with a lot of good life yet to live - that's almost besides the point. People grow old and die. American culture, perhaps as a result of its relative youth and obsession therewith, does not accept this fact gracefully or with dignity, but it should.

It's becoming increasingly apparent that that's not how it's going to be, though - Americans are determined to keep reaching into the piggy bank for handfuls of change, irrespective of the fact that it's not being refilled fast enough to replace what they take out, and it's going to be the young who are stuck trying to fix things when there's no money left to pay for repairs.

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