Could we have expected any other result, than these slightly unsettling new public arguments to live and enjoy life while we can? Some baby boomers now try to hold out for what might be expensive healthcare needs while they wait for the eventual (?) Medicare coverage. Meanwhile, social security gets pushed to an "optimal" (?) age where some lower income levels can't expect to live long enough for late life "repairs". How did anyone expect to extend longevity in aggregate much further, while strict limitations on physician quantities - let alone knowledge use constraints on drugs of all kinds - continue to exist?
Plenty of folk shifted their priors somewhat, after reading Emmanuel's article. As for myself, there were lingering questions whether I was strong enough to engage in certain workplace environments were I to take the plunge and seek a city with low unemployment statistics (I know, only useful to a point). Of course the possibility of early social security exists since I just turned sixty. But...argh. Like many, I always imagined living a long and full life, which included the idea of delaying social security as long as possible.
Sure "live for now" is the kind of philosophy that can help anyone. Even so, I remain uncomfortable about experts making longevity decisions for everybody. Yes, my mother's last year was quite rough, after an extensive surgery and the ever hopeful prognosis which had gone with it. But I would not have questioned any of the decisions she made, to extend her life to the best degree she was able.
How to slowly back out of an intense end of life support paradigm without leaving a void? That's the problem, because little really exists in any organized capacity which could provide what so many of these older patients seek. Hence we'll probably get more rationale for further cutting back, with too little thought how new doors can open as old ones close. Indeed, healthcare decline "inevitability" is closely linked to today's "limits on growth" mindset . Some arguments include studies showing that while longevity gains have occurred, not necessarily so quality of life. So it's surprising - given our lousy physicians to population ratio - that decades of dialogue assumed populations would have "ever growing" longevity statistics.
What about the missing healthcare marketplace which once tended not only to the needs of the poor, but others as well? Don Boudreaux highlighted a quote by William Easterly which seems apt:
The rich have markets, the poor have bureaucrats.For healthcare in the U.S., fortunately this has not always been the case. Before the bureaucrats became heavily involved in the 20th century, there were small town healers and other health advocates who were sought out not just by the poor, but also people from all walks of life if they believed those individuals could help them. When lines became long for these healers, it was because of the degree to which they were able to directly prove their worth to a public which responded in kind. Sure, a few charlatans were out there. But the same is true today.
A rich and diverse marketplace in health options once assisted the poor - along with everyone else - for as long as anyone could remember. Finally representatives of this marketplace were driven underground or out of business, only to have many of their knowledge and skills sets resurface in altered form - often decades later - in "exclusive" clinics and equally exclusive remedies. Lower income levels are today expected to rely on whatever the physician decides - or not - to provide for them instead. So treatment options tend to be all or nothing. All too often, earlier methods of less invasive healing are no longer available to them. As it turned out, when "real" healthcare came to town in the 20th century, that often erased the memories how locals gained good results through knowledge and resources in their own midst.
Bureaucrats not only defined what healthcare is supposed to be, they have limited the available marketplace by doing so. Think of a giant supermarket of health options which - in aggregate - has purposely turned itself into a small grocery store. Maybe it does not seem so yet, but insurance offerings see little choice. Bureaucratic healthcare was able to win the day because special interests convinced the public that entire shelves of goods are worthless, then get to decide among themselves afterward whether that is really the case. They handily won the game of "What do you know??" This Cato article about a squeezed marketplace was difficult to excerpt, as it is worth reading in its entirety:
Medicine is simply no longer the profession it one was. In 1970, the average income of general practitioners was $185,000 (in 2014 dollars) Today, even though doctors now see nearly twice as many patients as they did back then, the average physician income has fallen to just $161,000. At the same time, the average medical-school graduate now begins his career with more than $170,000 in debt...Existing government programs already reimburse physicians at rates that are often less than the actual costs of treating a patient. Estimates suggest that on average physicians are reimbursed at roughly 78 percent of costs in Medicare, and just 70 percent of costs in Medicaid.Few aspects of life are more politically correct than what people still expect of healthcare. Politicians of all stripes have not really sought to change the basic structure, which now makes the art of healing something that can only be practiced by the few and the privileged. No one can expect populations to maintain healthcare markets for the long run, under such circumstances.
It's perfectly understandable that we gained medical schools which expected their graduates to go above and beyond, who were capable of meeting exceedingly high standards. Who would not want the work of these graduates when they are waiting on the operating table for an important surgery? There's just one problem. The United States built and continues to back an exclusive system, yet still expects every citizen to be able to take advantage of it when the time comes...
I respect the thought processes that went into this logic. However now it is time to move beyond them, and allow education for healthcare of all kinds to once again flower, for all income levels, for all places that people desire to live. It's time to quit insisting that all populations depend on extremely limited markets. These are environments which mostly burn out the ones who still attempt to provide services as if they were superhuman. Let people practice healthcare in the ways that make sense to them and to those who seek their help. If some desire to live to 100 or beyond, by all means allow them to do so.
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