A little sincerity is a dangerous thing, and a great deal of it is absolutely fatal. -Oscar Wilde

Sunday, January 24, 2010

The scary, scary future, or why my generation is screwed

This has been such a freaking bizarre week.

First, decompression: Hell really is other people. Some people are hellbent on being such assholes that calling them assholes is an insult to assholes everywhere. I console myself with the firm belief that in whatever kind of afterlife exists, they'll have their own room with one another for company.

Second, I was called cool by merit of my docs by a little high schooler wannabe punk type. I suspect the kid was in diapers when I got my first pair of docs, which I have worn through coolness into uncoolness and apparently back into coolness. I also suspect the kid wasn't even in school yet when I first played with Manic Panic, which I think was the dye in their hair. I am so very, very old.

Third, let's not talk about work.

Fourth, politics are sadly progressing exactly the way I expected them to: bitter and divisive.

Can we talk politics for a bit? It's my blog, so I'm going to anyway.

I'm a proud independent. Apparently I've been ahead of the curve for twelve years, because I just saw that almost a third of voters are calling themselves independents regardless of their registration nowadays. I'm usually a fan of practical, pragmatic actions, and not affiliating with a political party pretty much means that nobody really gives a damn about my vote. But I'm quixotic in the extreme when it comes to my personal politics, and not aligning myself within the two-party system gives me the moral high ground while the politicians and parties make a mess of everything.

Which they've done an extraordinary job of doing with health care reform.

Many of my acquaintances, professional and academic, spent the summer with bated breath in anticipation over what the Obama administration might do with health care. One of my favorite professors was taken aback when I said (over a poorly-made and overpriced old-fashioned) that I was skeptical about whether it would pass. From a policy analyst's perspective, they were going to the extreme to avoid a Clinton-esque debacle-- surely it would succeed? And the proposals were so similar to a Nixon-proposed plan (that was all but forgotten in the wake of Watergate) that Republicans just had to find it acceptable.

No. I expected the Republican party to pretty much do everything in its power to stall and delay any attempts at reform, including seeding doubt and capitalizing on the American public's utter lack of faith in its government. Sadly, that's been exactly the case. I expect that a lot of my acquaintances thought that the '08 elections were a sign that the public was shifting back toward the center. I saw it as more of a referendum on the Bush administration-- no Republican candidate had a prayer, which is probably why the powers that be in the party finally allowed McCain the nomination-- and then completely destroyed his bipartisan "maverick" appeal by positioning him farther to the right. (Yeah, as if they really needed to worry about him losing those votes-- were the Southern Baptists going to vote for a Democrat, let alone a black Democrat from the north?) I believed that delay on health care would allow other issues to steal the thunder, and distract from the core issues. Because health care is tricky. It's a problem that has been sneaking up on us for decades, going bad but not supercritical-- yet. And sadly, that's what been happening. Not that I particularly agree with this version of reform-- I've discussed that here before. But I think that acting like an ostrich, hiding our heads in the sand and trying to convince one another that our current system is just fine is about the most destructive thing that can be done.

But sadly, I think that health care is going to have to go supercritical-- no, supernova-- before it finally gets the attention that it needs. Aside from the debates about whether care is a right or a privilege and the government's role, it's quietly become such a huge sector of our economy-- 17% of our GDP is spent on health care, double the rate of the next biggest spender. Instead of questioning why this is, and whether it should be so, we have those who are too terrified at destabilizing almost 1/5th of our economy. And that is a reasonable concern-- but it's become an excuse for inaction while it continues to grow like a malignant brain tumor. And I have a strong feeling about what is going to bring this issue to a head.

Medicaid.

Those who've never had to rely on it disparage the program as welfare when not outright forgetting its existence. But almost one-tenth of all women in the US rely on Medicaid, and it pays for over one-third of all births in the US (over half in certain states-- AK, NM, WV and MS, which are ironically very red states). Of course, such statistics demonstrate its importance to some while reinforcing the "welfare mom" strawman for others. But Medicaid is also an essential payer for long term care-- there wouldn't be nursing homes and similar facilities dotting the landscape if Medicaid weren't available to pay over 40% of all long term care costs in the US. There is a significant amount of misunderstanding about who pays for long term care. Most people believe that Medicare or their health insurance will. Well, no. Neither will pay for a long-term resident nursing home. And almost everyone loses their health insurance when they stop working, assuming that they even had it in the first place. That leaves your own pockets, charity, and Medicaid to pay for the care of the elderly and disabled, at a time when the average nursing facility in this state costs well over $7,000 per month. And climbing.

What chills my blood is the tidal wave of baby boomers inadequately prepared for not just retirement, but their long term care. Sure, there's long term care insurance, but the policies are so limited and the customer base is so small that their effect is negligible-- perhaps even detrimental for the false confidence they imbue in buyers. Of course, this means that the ranks of Medicaid recipients are going to swell beyond belief (and will probably include a lot of those who look askance at recipients now). We'll be awash in boomers unprepared to retire, unable to work, and dependent upon us to take care of them and pay for it all. Not to mention that they're going to be flooding a system that is simply unprepared, without the infrastructure or information technology, to adequately meet their needs. That sounds supercritical to me. In fact, I think that then we'll officially hit supernova.

The question is, will it be too late to take any sort of meaningful action?

2 comments:

Anonymous said...

The issue that I have with healthcare bill really is that the power in the Legislative branch are truly so corrupt that I can't fathom a version of that bill that isn't truly ineffective, overpriced, and catering to special interests. I've never heard of a single person educated in legalese who has read the whole thing.

So, yeah, healthcare is going bad and has been for a long time, but the engineer in me can not support a solution that hasn't at least been partially verified by test or data.

-klari

The Constant Gardener said...

We had to read a big piece of the thing for Health Law last semester. Good times. I think that only two of us actually did.

What kind of verification would suffice? The states act as laboratories for some types of reform, but they're hamstrung by trying to perform reform within the context of the same old health care system. Which is to say, you'll never see a state actually try a single-payer to see if our American attitudes could handle it. You'll see half-measures like in Massachusetts that are doomed to failure because they're crippled by other interests (both private sector and federal). Can we look abroad? The Netherlands have a system that manages to increase access while preserving (to a certain extent) the private insurance and provider markets. There's always that old chestnut of Canada. Almost every other first world and a large number of second world nation has a better system, but those examples are rejected out of hand as not being American.