The Speculist: Possibilities, Tough Choices, and the Other

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Possibilities, Tough Choices, and the Other

Here's John Stossel going all transgressive on us with one of his subjects you're not even allowed to talk about:

America Needs to Do Less for Its Senior Citizens: Stossel reports when Medicare was created, senior citizens did not live as long, and medicine offered fewer wonderful but expensive treatments. Now Medicare is headed towards bankruptcy. Government has promised seniors $34 trillion dollars more than it has funded. It amounts to generational theft, says Andrew Biggs of the American Enterprise Institute. "The government spends around $6 on seniors for every dollar it spends on children, and yet the poverty rate among children is far higher than it is among seniors," he says. Stossel confronts seniors about it. Some say, "we've paid our dues" and "every paycheck, money was deducted." But in fact, today the average Medicare beneficiary collects two to three times more than they paid in. Why do even wealthy seniors feel entitled to have taxpayer-subsidized access to state of the art medical care?

I'm sure that my standard disclaimer that I don't want to get into a discussion about the merits of Medicare, that I'm really going somewhere else with this, will be ignored. Please consider the disclaimer nonetheless issued.

There are some pretty startling ideas asserted in the paragraph I quoted, and I'd like to deal with a few of the supporting arguments by way of getting to the real problem. Let's begin with that final question:

Why do even wealthy seniors feel entitled to have taxpayer-subsidized access to state of the art medical care?

Well, gosh. That is a stumper, now isn't it? But maybe it's because under the system as it currently exists they are entitled to that care? (Isn't that why they call them "entitlements?") If one believes that strict means-testing should be applied to Medicare payouts and that there should be severe caps on how much gets spent, then one really ought to say that. Painting people as villains because they take advantage of coverage that they've paid into and that -- hey, at least in the technical sense -- they are entitled to seems an odd choice.

But there's a reason for putting these folks in the position of the bad guy, as we'll see.

Working our way back, we come to this:

The government spends around $6 on seniors for every dollar it spends on children, and yet the poverty rate among children is far higher than it is among seniors...

There's a simple explanation for why government spends so much more on seniors than on children, and no, I don't think it has anything to do with the fact that seniors have a powerful political lobby and that "no one will speak for the children." I'll get to that explanation in a minute. But first, please don't misunderstand me. I'm not arguing in favor of this 6:1 ratio, nor am I saying there should be a different ratio. I offer no opinion on how much or how little the government should spend on either seniors or children. I merely note that we get a somewhat broader vilification here than in the previous quote. It isn't just mean old rich people helping themselves to government services they shouldn't feel "entitled" to, its old people in general greedily taking dibs on big piles of money that probably otherwise would have gone to buying shiny red bicycles for neglected poor kids.

Okay, so the reason that we spend so much on seniors is that seniors are the people who do most of the dying in our population, and dying is an expensive proposition when you're (pardon the expression) dead-set against it.

The U.S. statistics are based on aging Medicare patients who account for about 70 percent of all deaths each year. Five percent of all Medicare patients die per year and spend almost 30 percent ($143 billion in 2009) of the Medicare budget. Medicare patients who die spend about six times more in their last year of life than those who do not, which comes to about $25,000 for each person who dies, compared with the almost $4,000 spent per year for those Medicare patients who do not die.

Sadly, even those Medicare patients who don't spend the last six months of their lives in a given year are queuing up to do so eventually. There is apparently no getting around it. The long, slow, painful decline of the human body costs a bundle. Kids just aren't that expensive by comparison. And once again, I take no position on whether more money should be spent on children and less on seniors. I simply point at that the educational, nutritional, and housing expenses of poor kids are a bargain compared to what it costs to keep dying people alive a little while longer. So comparing the number of dollars spent on one versus the other is apples and oranges.

In any case, this long process of death need not be so expensive. We could just accept death rather than trying to fend it off. That's what Stossel is apparently arguing for. Just find people who are in the most expensive phase -- that last six months, say -- and tell them that if they can afford treatment by some other means, okay. But otherwise they're on their own. Medicare can't afford to cover them. It sounds harsh, but look: they're in their last six months anyway. We're really doing them a favor by not prolonging their agony, right?

To be fair, Stossel doesn't come right out and say that. He just says this:

America Needs to Do Less for Its Senior Citizens

So, per my comments above, we might put in strict means tests and caps on coverage. But ultimately, whether you call it "means testing" or "caps on coverage" or just "doing less," somebody doesn't get covered for something. And the logical place to start making cuts would be where the expenses are greatest and the ability to do any good would be the least, right? So that puts us right back in the last six months.

Well, here's the problem with "the last six months."

My father, now age 76, went through series of long and difficult cancer treatments last year. Right now he's doing quite well, but there was a time when things were looking pretty bleak. Around this time last year he might well have been pegged as someone in the final six months of his life. And then, with treatments cut off, he actually would have been.

But he is alive today. He met his new granddaughter last month and, for all we know, he'll be at her high school graduation.

With that in mind, I think it's important to restate Stossel's argument as follows:

America Needs to Let More of Its Senior Citizens Die

That's the ultimate meaning of "do less for our senior citizens." Of course, I doubt ABC would have allowed him to run his 20/20 segment if he had come out and sad that.

Does Stossel have a point? Should we be letting more of our senior citizens die? After all, there is the issue of that 34 trillion dollars mentioned above. (Some recent math I've done -- see comments -- informs me that that's enough money to give a million dollars to each of 34 million people. It's a lot of money, in other words.) Am I suggesting that all other considerations need to be put aside so that we can pay for every possible heroic medical intervention on behalf of terminal seniors?

I am not.

One of my favorite ideas about the future, and one of the most controversial ideas that we talk about here at The Speculist, is the notion that humanity might actually be improving morally. There is some evidence to suggest this might be the case, while (obviously) evidence that people are no damn good remains all too readily available. Putting the latter aside for a moment, it's been observed that people living today are much less likely to die at the hands of their fellow human beings than they were in earlier stages of human history. Horrifying atrocities of the past century notwithstanding, most of humanity has taken a sharp turn away from cruelty towards and mistreatment of our fellow humans.

Why is this happening? The turning point in making humanity better occurs each time we find it possible to stop regarding some segment of humanity as the Other. And it is technology that opens up these new possibilities.

50,000 years ago, when we were 10 or 20 times more likely to die by way of homicide than we are today, human beings lived in small highly self-sufficient family clans. There could be friendly interactions with the clan a couple miles up the river, or the one that showed up on a nearby hilltop one morning, but ultimately they were all the Other. The Other was a threat and needed to be treated as such in order for "humanity" -- that is, the clan -- to survive. Each group of a couple dozen or so people was essentially at war with the entire rest of the human race.

Then agriculture came along, opening up new possibilities. Human beings could now begin to see themselves as part of communities and eventually nations. The scope of the group with which we identified increased massively, from less than 30 to tens of thousands. The Other was still out there, in other communities and other nations, but interactions with these others were not as frequent. Life became more peaceful than it had been in the pre-agrarian past.

Let's jump ahead several thousand years.

In England, the end of the slave trade coincided with the dawn of the industrial revolution. The story of the Abolition movement that we're most familiar with tells us that public consciousness was raised by Enlightenment philosophy and Quaker activism. And that's true. But what set the stage for this awakening of the conscience? What made it all but inevitable? When machines began to provide a level of productivity that would never have been achieved via slave labor, England could afford to do the right thing. (That same basic conflict played out in a much more costly and tragic way 60 years later in the US Civil War fought between the industrialized Union and the agrarian slave-holding Confederacy.)

A pre-industrial society had fewer choices available to it than an industrial society. It saw fewer possibilities. It treated Africans as Others who were not truly human, but property to be used as needed, because there was no viable economic alternative. Industrialization presented the alternative and allowed English and then American society to hear the voices of conscience.

slavetrade.jpg

This tension between a world of possibility in which we can do the right thing and a world filled with Others in which we are constrained in terms of how good we can be has been with us all along, and is with us today. Let me be clear that I generally like John Stossel and I don't mean to pick on him. On the one hand, I don't want to be misunderstood as putting him in the same league as our murderous or slave-holding ancestors. On the other hand, I do want to point out that he is making use of a somewhat milder version of the their thought processes in order to make his argument more palatable.

Stossel doesn't like the idea of arguing that we should let old people die, so he finds another way to phrase it. And then to help make his case, he talks about greedy rich old people "feeling entitled" to things, and greedy old people in general taking six times as much government money as poor children. He talks about generational theft. What he's doing is casting seniors as the bad guys, which of course is one of our most familiar varieties of Other.

In fairness to Stossel, let's note that making someone out to be the Other in order to reduce empathy for that person (or group) does not originate with him, and is in fact a widespread practice. P J Manney points out that many of the technologies designed to bring people together which have skyrocketed in popularity over the past couple of years do little or nothing to increase empathy between the known and the Other, and in fact may work to make us less empathetic. One of the reasons I personally have become disenchanted with politics is that so much discourse related to it -- particularly on the web, but in other media as well -- has to do with caricaturing the opposing side, making them out to be as offensive and undeserving of empathy as possible. (This is hardly a new trend in American politics, but it seems that in the past there was a more clearly defined limit to the extent to which we would regard the opposition as the Other. At some point, we would fall back to we're all Americans, or we all want many of the same things, or we have many of the same values in common, or some other final acknowledgment of commonality. That seems to have been lost, and very much to our detriment.)

But Stossel is wrong to cast seniors as the Other. Seniors are our parents, our grandparents, and our friends. And all too soon, for those for whom it is not already true, they will be us. The answer to the problems he cites is not to start calculating how many seniors we should let die and steeling our resolve to do so by making them out to the bad guys.

The answer is to look for new possibilities enabled by new technologies. Aubrey de Grey tells us that there are seven basic biochemical problems -- engineering problems, as he likes to frame the situation -- which, if solved, would eliminate human aging as we know it. Eliminate aging and we do away with the pain and devastation that it causes directly, as well as the pain and devastation that it enables via accompanying diseases such as cancer, diabetes, and heart disease.

Eliminate aging and we do away with that long treacherous death march of people lining up for their last six months of life and all the expensive medical care that goes with it.

Eliminate aging and we slash that 34 trillion dollars mentioned above to a tiny fraction of that amount.

In fact -- and now I will go ahead and throw out an idea as to how money might be spent on caring for seniors -- that 34 trillion which would otherwise be spent ushering the Baby Boomers (and their elders) through their painful final six months might be put to better use. Let's add just one more trillion and make it 35: that would give us 5 trillion dollars in research money for each of Aubrey's seven engineering problems.

Call me a cockeyed optimist, but I think that would get us there, or at least get us pretty close.

But where do we get the money to pay for that, especially if while the research is being done we still have millions of seniors using Medicare for expensive, final-six-month treatments?

I don't know.

But I do know that if we're looking to have to come up with 34 trillion as it is, we might as well double down and truly solve the problem once and for all. We'll save about 40 million lives (that's the population of Americans aged 50 and up) in the short term, and well over 300 million lives in the long term -- and that's just in this country.

Even if we have to borrow or print the money to do it, down the road we could always put some kind of special tax on wage earners aged 100 and up to pay off the debt. After all, they promise to be some of the most highly skilled, productive, and best paid members of the future work force.

So rather than arguing to let people die, maybe John Stossel needs to do a truly transgressive segment on an upcoming 20/20:

America Needs to Cure Aging.

I think we'd all tune in to that one.

UPDATE: Instalanche! Plus, some related thoughts over at Fight Aging!

UPDATE II: Okay, gang, seriously. Some people think big government programs are a swell idea and should be better funded. Good for them. Others believe that taxation for social programs -- as well as most other things -- is a basic violation of our rights and needs to be eliminated. I'm very happy for them, too.

I do not take a position on that question. It is irrelevant to what I'm talking about.

I merely point out that changing payouts to the system as it currently exists will result in some people dying who otherwise would have lived. When I personalize the story, it's not to argue for one policy or another -- maybe Medicare should be made bigger; maybe it should be eliminated altogether; maybe having lots more people die is the only way to keep the program and our government solvent. I use it to point out the fallacy of trying to catch people in their final six months and and to back up the idea that seniors are anything but the Other.

Apparently, to some, Medicare is so intrinsically evil that it's wrong even to note that its dismantling may result in human suffering. One commenter turns me into a Medicare advocate simply because I noted that I'm glad my father is still alive! Guess what: I'd be equally glad had he been treated through private funds in a world where Medicare doesn't exist. And even if I were a pure libertarian 100% opposed to all federal programs, I'd still be glad to have my father alive even if his life was saved by Medicare.

Call me a freaking hypocrite.

A quick scan of this piece will show that I didn't come up with the 34 trillion figure. And my one and only certain statement as to how we could ever come up with that kind of money runs three words long: I don't know. But I know this: if the choice the current system presents us is "come up with 34 trillion bucks or let a bunch of old people die," then I would call that the quintessential "tough choice." In fact, I believe it would take a lot less money than that to make significant progress in extending human lifespan -- and, yes, that could come from private rather than public sources. Per Dave Gobel's comments, this isn't really a financial issue at all.

I do find it disheartening that so many are so eager to leap to a political debate that's getting plenty of airtime elsewhere, or fret that words are being put into poor John Stossel's mouth -- for crying out loud, the guy's whole shtick is to be this outspoken and somewhat obnoxious source of rough-edged, you-can't-handle-the-truth; stating the undeniable implications of one his arguments ought to at least be in line with the kind of stuff he does -- rather than be part of a discussion about how new possibilities might radically alter the situation for the better.

Comments

Good article but have you thought of the impact to society of having cured aging?

You are spot on with the fact that defining that "6 months" is not clear. My grandmother went through at least 3 "she's a goner" situations between her 85th and 95th birthdays from which she came back in pretty darn good shape before passing just before 99. the Docs really have no idea when that last 6 months is.

The whole issue is GOVERNMENT (ie enslaving others) to pay for this stuff. If you have the cash or can persuade others to pony up - go ahead and spend all you want to the last day. Expecting others to pay (and we all know the "i paid in" is a big lie as it has been and always will be pay as you go) just means you are continuing the slavery you say we have moved beyond so that others have to labor for the bulk of each year in order to pay for someone else' health care. And yes, the government taking money from one person and giving it to another is slavery. The reality is that if you pay taxes for money that goes to others and not to the basic role of government that supports us all, then the government owns you and enforces it through threats of violence if you don't turn over what you produce through your labor.

American's are a lot less likely to die at the hands of their fellow men than ages past?

Seems from my reading of history books that in no era but the present have 20% of children in the womb been murdered by their fellow humans.

You are certainly correct. Living human beings in their middle years are much less likely to see each other as different.

But at the margins, for the very young and the very old, we still find it quite easy to dehumanize people and recommend their death by abortion, suicide, euthanasia or somesuch other atrocity

I beleive Ben Stein once said that Liberalism is a perfectionist view of the life while Conservatism is a tragic view of life.

$34 trillion spent on conventional healthcare isn't going to save every life. In the long run, it wouldn't even save one life. Every conservative knows this, admits this, and has some religious/philosophical/ideological views that makes them go through life accepting this without going crazy or committing suicide.

Liberals, on the other hand, are in denial about this (as with many things). Tell them that $34 trillion spent on entitlements will bankrupt the country, and they respond with puerile accusations of the other side being coldhearted, greedy and cynical--all while heading themselves and everyone else in this country full retard off a cliff.

Conservatives know though that tradegy can't be avoided or averted. It must be confronted and experienced. To quote Frank Herbert's Dune, it must pass over you, around you and through you, and when it passes you will remain.

Immortality through a exponentially increasing technology might work, but I have doubts about the efficacy of giving all 6 billion of us godlike powers over heaven and nature. There may be tragedy worse than death facing us after the singularity.

Socialistic micromanagement of health and life decisions will not work. A better idea is this: let people opt for a buy-out of their Medicare benefits. If you agree to go to private insurance instead, we'll pay you a lump-sum. You can compute the actuarial cost at age 65, offer 80 cents on the dollar, and get lots of takers. You can also put in an age cut-off -- if you live one standard deviation above the expected year of death, counted from age 65, you're cut off. That will induce taking the buy-out at an early date, so you can invest the money in an alternative health insurance program.

Curing aging is a pipedream (I don't think it's possible, but even if it is, it's a very long way out.)

As someone approaching the status of senior, I get quite annoyed at people suddenly wanting to yank my benefits away. As a compromise, I'm willing to move early retirement to 65 and reduce the Social Security benefit to half and make normal retirement 70.

As for medicare; I think a big part of the problem is the fear of death drives people, often the children not the senior, to resort to heroic measures. At some point, you need to let nature take it's course.

Tort reform wouldn't completely fix the problem, but it would make each medical dollar go a lot further.


Oh come on, your putting words in Stossel's mouth and your laboring pretty hard to do it. Stossel isn't saying "America Needs to Let More of Its Senior Citizens Die," he's saying America needs to let seniors, the wealthiest demographic in the country, pay for more of their own health care. And when he questions seniors' feelings of entitlement, he's questioning their feelings of entitlement in general, not their opinions concerning their legal entitlement to Medicare benefits.

I like the post, and I generally find your point of view quite interesting, but I think you're doing a number on Stossel.

How about rephrasing the issue from a Health Care Crisis to an Immortality Crisis? A number of the Pharaohs of Eygpt thought they could spend the nation's GDP in pursuit of it. Now in a democracy, we all believe we're 'entitled' to immortality, only if we hang on for a couple more weeks or months. Somewhere in the 20th Century the very natural aspect of death become unnatural. Our forefathers and mothers died in and among family at home. Now its removed from the every day environment and compartmentalized away from our presence. It becomes scary and we want to make it go away. Death is a zero sum game. Decrease the causal factor in one part of the pie chart and the border increases in another creating a call for ever more studies and resource expenditures.

Re. my earlier post. Personal injury attorneys are "the Other." I don't advocate shooting them. Worse. Jigger the rules to make most of them find something else to do or starve.

A basic assumption is being ignored here. That government should interfere at ALL in how long seniors live. That question was answered in the affemative in the 1960's and we are seeing the bill now. It only takes one (politically incorrect) law now to wipe out the entire 34 trillion dollars entitlement.

Just another example of the federal government's faithful stewarship of the peoples money.

Since the Democrats have made it clear that they won't accept any form of privatization of health care, there are only two choices: 1) destroy the Democratic Party; or 2) try to modify their approach. It's not at all clear to me why we should provide limited (and expensive) coverage for minor problems, while ignoring catastrophic problems. In any case, it seems wrong to me for the Republicans to fight to their last breath against any form of national health care. They should instead try to turn it into coverage of catastrophic problems. Something along these lines might work: establish a policy whereby no one should have to spend more than x% of his income (or wealth) per year on health care, and have the government provide 100% coverage of the rest. If nothing else, it could be a bargaining chip against the notion of abolishing private health care altogether.

I agree that eliminating aging is a good idea, but I disagree that this is a good thing for the government to throw our money at -- based on the track record, that would just ensure that no progress is ever made. The argument should be that eliminating aging won't prevent death, but it will make it much less painful (and expensive). I'm quite content to have the private sector work on this -- I just hope that the government doesn't make medical research the exclusive province of government.

Very good article! Well written and thought out.

There are a few points that I would disagree with however. Stossel's comparision between the money spent on the young and old was very well ripped up, but Stossel shouldn't have made this point in the first place. The real question is whether the government should be doing any of this. The federal government was created to do a very few things that that the States couldn't do for themselves, providing health care or other benefits is not the proper role of federal government. Mistakes made long ago.

The idea that aging can be defeated is surreal. Sure, all we have to do eliminate this reality or that and everything is cool. They are just engineering issues, very solveable, it's just engineering. Has it occurred to you that while letting people die is cheaper than spending ineffective money as the end of life closes in, trying to postpone the inevitable fact that everyone dies is the most expensive of all?

I don't believe that it's about "the other" it's about "the self", we can only be concerned about others, when we have the luxury of not being concerned about self. Luckily we are in that situation, for now. As government tries to take over more and more, we will lose that luxury. It's the fallacy of government.

Mark --

But at the margins, for the very young and the very old, we still find it quite easy to dehumanize people and recommend their death by abortion, suicide, euthanasia or somesuch other atrocity.

You're right. But the broad historic trend is to make the definition of "human" more inclusive, not less. Currently abortion is a tough one to analyze by this measure because the argument for unrestricted abortions is grounded in the recognition of women as full human beings. Both sides claim to be arguing for broadening the definition of "humanity."

Technology can solve this with more advanced contraception methods and perhaps the eventual ability to transfer a fetus to an external gestation environment in a painless and low-risk way. Eventually we will have a situation in which abortion is truly "legal, safe, and rare" -- as well as non-lethal to either party involved.

Euthanasia and assisted suicide are also from humanitarian grounds. I'm not interested in arguing about whether they should be legal when requested by the patient, but I think that advanced in medical technology can eliminate most of the instances where these options are suggested or forced on a patient externally.

Peter --

I'm trying not to be unfair to Stossel, but I think he does a number on himself. There are other (and probably better) ways to frame the argument besides trying to get us riled up about those smug wealthy seniors and their "sense of entitlement."

If the argument is to put in means tests and benefit caps -- and, again, I take no position on that issue -- then the consequences are that some seniors won't get treatment and some will die sooner than they would have. I'm not interested in arguing the merits of that policy -- maybe it's right; maybe it's the only thing that could possibly work; I don't know -- I just want to point out that those are the implications.

If anyone is laboring here it's John Stossel in avoiding the implications of what he's arguing for.

You are completely missing Stossel's point.

Medicare was sold to the public as an insurance plan, under which each worker would "contribute" a small percentage of his income, "matched" by his employer (or doubled to reflect the actual "contribution" in the case of self-employed workers), which would pay for his health care after retirement.

It, and its twin Social Security, were supposed to not be "welfare" programs under which poor people are subsidized by society at large. The retired workers have been told all their lives that they're getting back their own money plus interest.

And that has been a lie since day one. Neither program has been actuarially sound; they have depended upon the Ponzi mathematics of having far more workers paying into the programs than retirees benefitting from them. As life expectancies have grown, the shortfalls have worsened.

Social Security and Medicare have promised more benefits than FICA "contributions" can provide. If a private insurance company tried to market these programs to the public, its executives would be in Leavenworth for such blatant fraud. A state insurance regulator would force a private company offering these plans to either increase the premiums, delay the age at which benefits are paid, or reduce the levels of benefits promised. But whenever anyone proposes doing any of these things to SS/M, they are politically vaporized by the high-voltage Third Rail. When President Bush proposed allowing workers to set aside a small portion of their SS "contributions" to go into private retirement plans, the idea was summarily executed without trial.

And all you can say is "John Stossel just wants old people to die Die DIE!"

Well, here's the thing we're *really* *really* not supposed to talk about:

The fact that the authority for the government to be collecting the taxes to pay for any of these entitlements in the first place is entirely suspect.

We're simply supposed to accept it and move along with everyone else, ignoring the mockery the whole thing makes of the rule of law.

Rather than get into an argument over the uses and abuses of the general welfare clause, a debate with well known contours, I'll take another tack instead.

How is it that society can be said to "morally improve" when the foundation of that alleged "moral improvement" is theft that simultaneously deprives us of the immediate use of our property, and places use into a posture of enfeebled dependency? The very act of taking the funds today that are used tomorrow to pay for the care of all make it impossible to either prepare for our own eventual care needs, or the immediate needs of those for whom we are responsible.

Our society will not make moral progress when its basis is mass scale deception and theft.


You had me right up until the point where you started putting words in Stossel's mouth and knocking down strawmen.

You keep saying how you don't have a position in any of this, then go on to cite personal, anecdotal stories about your father's cancer.

So, like Stossel (according to you), you really DO have a position, you just won't come out and say it. You support generational theft so long as it benefits your family.

In any event, you are free to ignore Stossel right up until Medicare goes belly-up, when there will then be *tens of thousands* of people's fathers with cancer who will receive NO treatment because the preceding generations stole their wealth through deficit spending.

Many good points, however, it seems you have built a strawman. I do not believe the only two choices are:

Commit to spending 34 Trillion we don't have

or

Letting old people die

The Methuselah Foundation has been taking the lead on Phil's positive sum proposal. In addition to our $5 million Mprize focused on reversing the damage of aging, our donors got Aubrey's theories into actual research at serious universities. We recently made a founding investment in Organovo which is well along in commercializing their 3D tissue/organ "printer" which uses a patient's own cells to create a new organ/vessels.

We have many more strategies that we will be prosecuting over the coming months that have as their aim the short/medium and long term reversal and gradual elimination of the damage caused by the disease called "aging".

The problem is not financial. It is one of will. Each of us *will* face this problem if it is not solved. One does not face aging as a population - we each face it utterly alone. Methuselah Foundation encourages united action to defeat the real enemy causing catastrophic costs and of healthy life, liberty (not nursing homes!) and the pursuit of happiness

"But maybe it's because under the system as it currently exists they are entitled to that care?"

A politician tells me I'm entitled to your money. Hand over your wallet. I'm entitled. No, you're not allowed to complain; now hand it over and shut up. Oh, and I'm entitled to your kids' money too, fork over the piggy banks.

In other words, stop being such an incredibly amoral moron.

"Seniors are our parents, our grandparents, and our friends. And all too soon, for those for whom it is not already true, they will be us."

This is not true.

The social security and medicare problem is tied to a historically unique situation: the baby boomers and the demographic transition. The ratio of seniors to working-age people is going higher than it ever has before. That is the crux of the problem. The current generation of senior citizens expects the same level of support as earlier generations received when there simply are not enough able-bodied human beings to provide that support, regardless of technology. So they sell their children and their grandchildren into debt slavery to get what they want anyway.

These people are NOT our friends.

I do have parents, and aunts and uncles, and grandparents. Most of them have been financially provident and have sufficient resources that they can take care of themselves. If they can not, I have sworn that I will not - with the sole exception of my parents; that is a part of the parent/child debt that must morally be repaid. The others are on their own, even if that means starving in the streets. I WILL NOT impoverish myself to give them six more months of life. I defy anyone to tell me I should.

If one of them dies six months before a grandchild is born, that will be sad, but hardly unprecedented or unacceptably tragic. It is certainly not a principle on which to build a justification for generational debt slavery.

We can expect that over the course of subsequent generations the ratio between seniors needing medical care and those who can support them will return to supportable levels. Possibly simply by redefining the age at which we differentiate between seniors and working age. The current situation, however, cannot continue, and therefore will not.

"The answer is to look for new possibilities enabled by new technologies"

In other words, magical thinking. "Let's pretend and maybe the problem will go away!"

These new possibilities DO NOT currently exist. Until and unless you have proven methods that WORK, that can be applied to the situation RIGHT NOW, there is absolutely no point in planning on this as a means of dealing with the entitlement program funding shortfall. Yes, SOME DAY it may be possible to resolve these issues through life extension. Right now it is not. Pretending that plans can be made on that basis is foolishness of the highest order.

"Even if we have to borrow or print the money to do it"

Please, please, please, stop paying attention to futuristic whizbang for about three months and go do some intensive financial self-education.

In the first place that suggestion is massively nonsensical, naive, ignorant, and self-destructive, particularly given the current state of economic affairs and how we got here. In the second place, THERE IS NOT ENOUGH WEALTH ON THE ENTIRE PLANET TO DO WHAT YOU ARE TALKING ABOUT.

Super idea. But why stop there? Let's spend even more money and cure all disease, injury and dementia, and dispense with this whole "health care" thing once and for all!

Regarding "Why do even wealthy seniors feel entitled to have taxpayer-subsidized access to state of the art medical care?":

It was, and is, arranged this way on purpose. Here is the quote on the subject from Luther Gulik's 1941 memo, attributed to FDR (link below)

In the course of this discussion I raised the question of the ultimate abandonment the pay roll taxes in connection with old age security and unemployment relief in the event of another period of depression. I suggested that it had been a mistake to levy these taxes in the 1930's when the social security program was orgiginally [sic] adopted. FDR said, "I guess you're right on the economics. They are politics all the way through. We put those pay roll contributions there so as to give the contributors a legal, moral, and political right to collect their pensions and their unemployment benefits. With those taxes in there, no damn politician can ever scrap my social security program. Those taxes aren't a matter of economics, they're straight politics."

FDR also mentioned the psychological effect of contributions in destroying the "relief attitude."

http://www.socialsecurity.gov/history/Gulick.html

The solution to recognizing the last six months is easy. Reimburse any medical expense in full -- but only to the patient, and only six months later.

That way everybody pays for their own last six months.

It has been my understanding that the greatest factor in extending human life is public sanitation. The deaths that used to happen due to typhus, cholera and other diseases of poor public sanitation went by the wayside when sewers were invented. For all that Rome used lead for piping, thus having a slight decrease to life expectancy, average life expectancy increased due to better public sanitation and actually allowed people to reach what we moderns would consider 'middle age' and beyond.

London pre-public sanitation had regular epidemics of cholera, and afterwards those outbreaks went down to nil. By performing that great good more people survived infancy and childhood, and by increasing that starting cohort and having better sanitation to reduce the risk of disease outbreaks, life expectancy climbed steadily. The Black Death and 30 Years War were the last times humanity saw a marked decrease in overall numbers, since then the rise has been steady with a relatively steep slope coming with the advent of the underground sewer system.

Neither WWI or WWII decreased the slope of increasing life expectancy or the absolute number of people on the planet, and yet they were two of the most horrific conflicts of the modern age. Looking at that slope, save for the flu epidemic of 1919 which decreased life expectancy (although not the increasing number of people on the planet) points to something else going on outside of the standard four horsemen as none of those have dented the numbers. As that is a global phenomena it is more than just civility... it is civilization itself. And the greatest of all boons is getting the sewage out of the streets and rapidly moving underground and away from city water supplies and public shorelines. After that is potable water... but that is part of the entire sanitation system...

This walks past the point. We aren't going to cure aging quickly enough for Medicare to not bankrupt us.

Personally, I think the cap should be at the bottom, and not the top, and Medicare should be a catastrophic-care coverage only policy, with the bottom waived only for seniors with a very low net worth. It'll shell out megabucks for end-of-life care, but it'll pay out far less when major interventions aren't happening.

What this guy said:

Posted by: John | May 14, 2009 10:54 AM

When politicians call it an entitlement, and people believe it and count on it, they are believing a lie and counting on the proceeds from theft.

Yours, TDP, ml, msl, & pfpp

Several years ago I had a very minimal heart attack, which as a surgeon, I hardly felt it worthwhile to do anything about, but I did. I was in my late 70's then. Just to prove to my self how insignificant it was I ran for the 500 yards to the emergency room. My Dx was confirmed and they wanted to fly me to Phx (250 miles) to remove the clot. I laughed and went for my clothes to leave, go home and start my aspirin Rx because up to that time I didn't feel old enuf that I should be on it. You should have heard the objections. On and on they went. Finally I tried once more to get up and leave. NO! I was told. I would ruin the reputations of the hospital and all the ER staff should anything more adverse occur. They finally wore me down after another half hour with that gambit and I did it for them. The plane ride was 55,000 bucks and the work in hospital a bit less. They retrieved no clot. Still running. And on ASA. You want to blame SENIORS for that crappy Rx?
Whoa!! Next time I'll ask for the paper and sign it. HR Matern, MD, FACS

If a person wants to spend their own money on heroic healthcare, who's to stop them?

The problem here is that people want heroic healthcare and they want someone else to pay for it.

That and the fact that "insurance" has turned into a benefit that pays for everything. It used to be that insurance was for a catastrophy...you were on your own for the minor incidentals. Pay for everything and the costs skyrocket.

Let people pay the cost for their own healthcare. Anything else is just stealing other people's money.

Tally the last 6 months of medical costs before death. Make that amount the primary creditor to the estate, get back as much money as possible from the life insurance and other assets. The poor will be spared, because they have no assets. Tax the death of a person, instead of having their death tax the living.

Mandate living wills and in lieu of a living will for the disinterested, establish minimum care protocols. Protect the current mentally infirm from themselves and family.

How sad you must conclude that any sense of fairness is demonization. How convenient it is to simply rule all other issues outside the scope of discussion. So you've proven that when all conclusions except yours are ruled out of the discussion, your conclusion seems like the best one available. Who knew?

PS: You fantasize that we can simply decide to spend any amount of money and of course desired solution is within our grasp.

I agree with you that it's wrong to blame old folks for taking advantage of the Medicare benefits they were promised. The real villains here are the pundits who say that seniors have a moral right to these benefits (at others' expense) and the politicians who enact them.

The solution is not to have government give less to the old folks and more to some other group (e.g., "the children"). The solution is to get government out of medicine and out of the business of seizing one person's wealth to give it to another. E.g., see afcm.org.

$34 trillion is $113,333 for every man, woman, and child in the US (give or take a few hundred). I don't have that kind of money. None of my acquaintances do either. You propose spending this gargantuan sum rather casually. Since collecting (or spending) that much cash at once is impossible, that leads to...

This year's federal debt is estimated at $1.8-2 trillion. Your proposal dwarfs that. Even if such spending were spread out over 20 years, your proposal would either double the national debt or consume 2/3 of my annual savings. Wiping out the middle class is political suicide. The money would thus more likely be borrowed than immediately taxed. Therefore...

I am aware that neo-Keynesianism is all the rage in DC at the moment; nonetheless, I do not see how this trend can end in anything but bankruptcy. Spending trillions of dollars that do not actually exist can only lead to two outcomes: public credit default or hyperinflation. Either would wreck the economy for a generaton.

Your critique of Mr. Stossel's reasoning is cogent, and your points are taken; but your alternative is fiscally impossible. Runaway spending in a sharp recession is insanity. Regardless of what false promises were made to older generations, the Welfare State is doomed. Let it die. Even if spending $34-35 trillion now would save money in the long run, the funding is not available.

"A democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves largesse from the public treasury. From that moment on, the majority always votes for the candidates promising the most benefits from the public treasury with the result that a democracy always collapses over loose fiscal policy, always followed by a dictatorship."

As long as we are spending over our means and allocating that sort of money ($34 TRILLION!), we are -never- going to have money to do the sort of research you desire.

Investment is what you get when you consume less than you produce.

I think you underestimate the complexity of biological systems. "In The Pipeline" (http://pipeline.corante.com/)is a marvelous blog by a medical chemist, mostly about the enormous difficulties of actually producing a useful new drug. Much of this difficulty is in our extremely limited understanding of how biological systems work.

Things that appear obviously true have been shown to be completely wrong. Processes thought to be completely unrelated turn out to use the same compounds. And so on. Genes turn out to have dozens or even hundreds of unsuspected connections.

We could quite possibly spend $34 trillion or $340 trillion, and still not have a "cure for aging".



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