One of the most tired rhetorical tropes in Washington starts with, “We must . . . ” In the age of Obama, this is now usually followed by “Get the cost of our health care under control,” or “Invest in the education of our youth,” or “Spend wisely.” Such promises usually devolve into pleas for more money. They rarely explore how we ended up in the first place with such severe crises in health care and education — and with trillions in borrowing to spend trillions more that we do not have.
The cost of health care is spiraling out of control, and not just because the proverbial evil “they” (fill in the blank: pharmaceutical companies, insurance companies, medical corporations, trial lawyers, etc.) charge too much. Such profit-mongering entities may well gouge us, owing to a lack of competition, fear of lawsuits, or government mandates and interference. Yet the larger culprit is, of course, we the people. The cost of our health care is soaring because, to be frank, that health care is usually very good, and it does things routinely that almost no one else in the world contemplates — such as providing 83-year-olds with heart-valve replacements, 78-year-olds with hip and knee replacements, and those who drink, smoke, and are chronically obese with drugs and weekly doctor visits.
When I grew up in rural California in the 1960s, an obese uncle in his early 70s had “heart trouble.” That translated into some nitroglycerin tablets, and otherwise about the same regimen offered President Eisenhower after his in-office heart attack: Try to quit smoking, eat less, more bed rest — and good luck!
Forty years later, that same patient would have a bypass, and an expensive battery of medications and weekly follow-up doctor visits — and would make it not to 73 years old (as my uncle was when he died), but to 78 or 80, or even 90.
If we wish to get health-care costs under control, then we should at least be honest with the American people and admit that we are all paying a collective fortune largely for three reasons: (1) to keep functioning into their 60s those who drank, smoked, and ate too much and in a past era would have passed on at 60; (2) to give us all an extra three to five years of mobility and functionality after we reach 75; (3) to fit us up with IVs, feeding tubes, and respirators so that in our last six months of life we can die in a rest home or among machines and specialists in a hospital rather than in our own home with a few morphine tablets for pain and a bowl of soup with a straw on the nightstand.
My dentist warned me in 1962 to brush three times a day, since he could predict a depressing train of events to come for most of the more fortunate rural patients who could pay for his care: surely fillings in your 20s and 30s, hopefully caps in your 40s, maybe root canals and crowns in your 50s, and, unfortunately, false teeth after that. And now? We confidently expect all sorts of restorative dentistry and tooth implants to such a degree that the old common sight of a normal American middle-class fellow with a couple of missing teeth or even a shiny, crass glistening gold incisor is now the exception.
Again, health care is expensive because Americans, with some good reason, have decided that the ancient tragic view — we all age and break down, and pay for the sins of our 20s and 30s in our 50s and 60s — can at last be replaced by the therapeutic promise of vigor and health into our 80s.
What could be done? President Obama could try some honesty. Thus he might say, “We are spending hundreds of billions to keep us healthy, vital, and alive in ways unimaginable a few years ago. To keep our part of the bargain, we must then encourage the aging to remain active and working — and delay retirement. If we are living to 80 rather than 65, then surely we can start receiving Social Security benefits at 67 rather than at 62. What we save in postponed payouts can go to the greater cost of keeping us alive to 80.”
President Obama also promises historic new rates of high-school and college graduation. Again, he seems to think the present problem is the absence of money — as if brilliant, gifted, and motivated young people are ending up at McDonald’s rather than doing quantum physics because the bogeymen “they” raised the bar and didn’t give them enough college scholarship support.
More banality. The truth is quite different. First, too many of contemporary minority youth — the growing Hispanic and African-American underclass that may well soon make up 40 percent of our nation’s student body — for a variety of reasons beyond the government’s control (e.g., from inordinate patterns of illegitimacy; greater absence of two-parent families; above-average parental drug use, incarceration rates, and felony convictions; and a pervasive ethic of machismo that disdains “acting white” with your nose in a book), simply are not as competitive as other students in grade and high schools. In reaction, the good-hearted state, at the 11th hour of college entry, seeks to ensure an equality of result through affirmative action, set-asides, de facto quotas, and government subsidies. When poorly prepped minority students subsequently do not graduate from college at rates commensurate with other groups, the Left cries “racism” — and we are again back to asking for more money rather than a radical change of heart.