Our Unsolvable Problem

I grew up in Southern California. I remember backyard incinerators for household trash. I also remember smog. Use of the incinerators was the first thing they banned when the anti-smog regulations were established. Every couple of years there would be a new anti-smog regulation, and every time they would sell the new regs by claiming there would be far fewer deaths and hospitalizations from asthma, pneumonia, and emphysema.

I am not complaining. Smog has been massively reduced in Southern California, and I am happy about it. But, I have always wondered when I would read about the happy statistics. We were never given the opportunity to celebrate all those prevented deaths and hospitalizations, plus all the money we saved on healthcare.

I also remember newsreels about polio, iron lungs, magic sugar cubes, and the success of the March of Dimes. My childhood included a society where everyone smoked, everywhere, all the time. And then they didn’t because of all the lives we could save by quitting.

It appears we are entering a golden age of reducing obesity through medication. Sounds great. The reduction in the number of diabetes cases alone should be fantastic. I doubt, however, that we will ever celebrate that reduction. I doubt we, the general public, will even notice.

We won’t notice because the reduction of any one disease never seems to reduce the cost of healthcare. Every medical advance is not a victory over death. It is a postponement. Sometime, somehow, we will all need medical care.

Which leads us to the problem we can’t solve.

America can be described as a "Compassionate Capitalist" state. We are free to choose how we make our money, and we agree to part with some of it to help others. We help the poor, but we reject equality of outcomes. We celebrate unequal success.

The middle class lives better than the poor, and the rich live better than the middle class. Americans are okay with these disparities.

In the bad old days, paying for healthcare for the poor was not a problem because there was none. There was also no healthcare for the rich. Doctors were not well paid, and they were, frankly, fairly worthless. Healthcare sucked, but it sucked equally.

Great news! We are living longer, healthier lives in part because doctors are now miracle workers. But, like ending smog or reducing obesity, these new miracles only provide temporary relief. The need for healthcare does nothing but grow.

Part one of the problem is that medical miracles are expensive. We can’t afford to give them to everyone, even though everyone needs them. Part two is that we Americans are not okay with unequal outcomes when it comes to health.

Most of the civilized world solves this problem with socialized medicine. Healthcare is equal, but it is mediocre. Besides being mediocre, socialized medicine doesn’t innovate. All the new miracles come from America. All the innovative cost reduction comes from America. Even non-American innovators rely on the American health marketplace to support their businesses.

I repeat, this is all good news. More of us are living longer. More of us are receiving good healthcare. Healthcare itself keeps getting better and better. The problem is that it is more good news than we can afford. But, who is ever going to choose to have less good news?

Almost a hundred years ago, we created Social Security. The actuaries assured us we could afford it. After all, the retiree who retired at age 65 would likely be dead within five years. No one thought to create Medicare at the time because healthcare wasn’t worth paying for.

A hundred years ago, the only thing that could drive the national debt through the roof would be paying for a worldwide war. Today, our skyrocketing debt is caused by providing medical miracles to all.

As a problem we can’t solve, we will muddle through for as long as we can, as best we can.

G-Pub

P.S.: The particular medical miracle that permits me to be around to mutter about problems we can’t solve is called “a stent.” Taxpayers paid for it. Thank you. Yes, I am part of the problem.