Envy And Medical Care

Inspired by a comment over at Chicago Boyz, which in turn set me off on one of my favorite rants there...

The crisis in medical insurance is set off by the increase in the costs of medical care.  While many of these costs are indeed artificial and in some possible world unnecessary - CYA lab tests and tort reform, overuse of services, expensive ER care versus prevention, pick your culprit, really - the overwhelming driver of the cost increase is medical care used to be dangerous, stupid, and valueless, where it is now at least somewhat accurate and can extend, improve, or rescue your life. The break-even point for doctors saving you versus killing you was not the Renaissance, but 1950. In the 19th C, the finest hospitals in the world were in Paris.  Yet any modern reader can see in the descriptions of the behavior of French doctors an amazing stupidity compounded by arrogance.  (On this score, I recommend The Greater Journey by David McCullough.) Better to stay home and wait for a snake-oil salesman.

We spent lavishly on snake-oil salesmen, cranks, and quacks, because we wanted to live, and wanted our feet to stop hurting enough that we could get out to the barn and milk the cows, to stay alive another season, or wanted to have babies (or not have them), wanted to finally get a night's rest, wanted your child to be able to see again.



I read a futuristic short story in the early 1970's, I think in "Playboy,*" of a world in which time literally was money, and your bank account reflected how much longer you had to live. I imagine the premise was that we could be kept alive indefinitely, so the rich would live forever, and the poor die soon. Health was irrelevant. Your account expired, and support for your life was withdrawn. The frantic behavior of the protagonist is about all I remember. This seems rather prophetic now, as we move to a world in which extending life becomes more plausible.

At a cost.  And the cost will rise as the magic becomes more amazing.  We will increasingly consider it an outrage that the rich could afford to live longer on the basis of mere money, a final inequality not brought under societal control. Yet as the magic increases and the cost increases, we won't be able to give that gift to everyone, no matter how much we try to paper that over by spreading the cost around.

I am 60, and I have some advantage over those younger, I think.  I grew up in a world in which we expected that nearly everyone died before age 90, starting about now.  Before 80.  Hell, getting to 70 was considered a pretty good innings.  Plus, I have been thinking about death as long as I can remember.  It still might become chillingly difficult to face at the end.  Yet I have had some preparation that may not be so general anymore.  Particularly among those who did not grow up in the Christian faith, death must seem a terrible intrusion to the young now - an insult and unfairness that government should move heaven and earth to keep away from its citizens. The worst of evils.  The idea of finding a good death, since you were guaranteed some sort of death anyway, was common to our ancestors.  To trade some years of life for a good death was considered a reasonable exchange, at least in theory.  But increasingly, there will be a scramble for every minute.

Perhaps not.  Humans and cultures adapt and change.  We may find some new accommodation with death as we go.

* I always said I read it for the articles.  This proves it.