The Forthcoming Troubles

Medicine is a great thing. Western medical science is one of the truly amazing success stories of the human race, improving and extending lives that would otherwise have been short and miserable. But with these benefits come distinct problems that society has not made much of an effort to deal with. To wit: people are getting old.

It’s a fair point that (from a certain point of view) people today do not necessarily live much longer than they did centuries ago. Someone making it to 84 today is doing pretty good. And yet when Ben Franklin died in 1790, he was 84 years old, and hardly the oldest man on Earth. Thomas Jefferson made it to 83. John  Adams made it to 91. What we have managed to change does not seem to be the uppermost age a person can reach, but instead we’ve improved the chances of any random person making it to that maximum age bracket.

On the one hand, that’s a good thing. Who can argue against extended lifespans? On the other hand… well, it’s perhaps not such a good thing on the whole. If people were living to be hale and hearty up until their 90th brithdays, economically productive that whole time and drawing minimally from the common welfare, and then simply keel over peacefully, things would be just fine. But what’s actually happening is that people are living for decades past their productive years… and decades past their savings. To put it bluntly, they then become burdens on the rest of society.

Not so long ago, the medical problems of the elderly could not be handled by medical science. You got old, you died. It was just that simple, and people accepted it. Of course, there was also a time not that long ago when Granny’s body was put in a simple pine box, displayed for a day or so in the family home, then buried out back. Now, we bury the dead in hermetically sealed bronze time capsules complete with lace and pillows, out in community cemetaries. And it’s probably *illegal* to have the viewing of the body in the home. Might traumatize the kiddies, who we try to shield from even the concept of death lest their tiny little minds snap under the strain.

Now, there is no medical problem that cannot be extended via the application of terribly expensive medical technology. And the problem is… now that the technology exists, people seem to univerally think that they are owed the complete and unfettered use of that technology, and generally at the financial expense of others.

Britains National Health Service may well be the canary in the coal mine here. Britain has a lower birth rate compared to the US, and more extensive “universal health care.” The result is a graying population that is demanding more and more for longer and longer, being funded by a proportionally smaller and smaller workforce. A recent article on the subject says this:

With the baby boomers reaching retirement, one in five of the population will be over 65 by 2026. This means that over the next 20 years, there will be another 1.7 million citizens that need care, and that spending could soar to £26 billion.

Many people are obviously unhappy about the prospect of being landed with such a bill. They claim – often quite aggressively – that they have worked hard all their lives, they have saved and paid their taxes. Surely they can expect the state to provide for their old age?

The fact is that, no, they can’t.

In the United States, one of the last remaining remnants of FDR’s disastrous “New Deal” programs is Social Security. When it was passed in 1935, Social Security’s job for the elderly was basically to help keep them from *dying* of poverty, and only covered the primary worker in the family (the man, in other words, not the presumably unemployed wife). Today it is seen as a retirement plan. When it was passed, the age at which you could start drawing from it was 65… while the life expectancy for a man born in 1930 was estimated to be 58 years. Today the life expectancy is pushing 80 years. In other words… statistically most people wouldn’t draw from Social Security when it was originally passed; today people can expect to draw from it for a decade and a half.

And of course the birth rate in the US has also dropped substantially, with much of our population increase being due to immigration. As our economy continues to tank and America slips from first-world status, you can expect immigration to slack off noticably. But people will keep getting old, and will keep demanding to be taken care of.

The hell of it is, everyone who has worked honest jobs since FDR is getting screwed. If some miracle happened and Social Security was declared unConstitutional and ended tomorrow, this would be fantastic news for people younger than myself… an instant 15% raise. The non-existence of Social Security decades down the line would not bother them, as nobody really expects it to be there anyway. But it would be bad news for people older than myself… they spent their whole working lives with Uncle Sam’s hand in their wallet, drawing out 15% from every paycheck. If Social Security were to end, this would be simply money pissed away.

Of course, simple math shows that it would be best to end it now. Yes, the current oldsters would get robbed and screwed over. But that would be a one-time issue. If Social Security and similar programs continue to exist in perpetuity, their economic impact lasts forever. Simple math… screw over a finite and countable number of people now, or an uncountably large number of people for the foreseeable future. Basic ethics also demands the immediate end: just because Person B got robbed to pay Person A does not give Person B the right to rob Person C.

However it goes, there’s the problem that no government program can support a growing population of old folks in the way in which they want to be supported. The economics simply does not support it, as the ratio of recipient to taxpayer continues to grow. So, some form of health care rationing will have to be instituted. If you have X dollars, and ten people each want 0.5X dollars worth of care…. they can’t all get it. So, how to ration it?

1) Get government out of the health care business entirely. It is now no longer the governments job to ration a damn thing. Health care can now be purchased by the individual… or rationed by private charities and institutions. What, you think they’d do *worse* than government bureaucrats? As it is, you’ve got the government, and that’s pretty much it. Get governmetn out of the picutre and private charities will bloom. Now there will be a whole raft of organizatiosn to appeal to. Hell, the Catholic Church could start selling off their bling, and could make one hell of a positive impact.

2) A lifetime government expendature of, say, $1 million dollars per person, adjusted for inflation. If someone is a serious mess at a young age, they could easily blow through that million bucks in a hurry. At which point… it’s time to find some other option. Bake sales, mortgages, charities, whatever.

3) Standardize the *level* of care at “state of the art, 25 years ago.” Rather than the latest and greatest meds and scanners and surgeries and whatnot, if you go to the government for care, you get the equivalent of the latest and greatest that was on the market a quarter century ago. This puts them well past the patent expirations; generic versions of drugs should not be available. Instead of the machinery being advanced, expensive prototypes, it’ll be time tested and mass produced. If you’ve got your own money, go ahead and buy into the more advanced stuff. As with all good, new technologies, the rich get there first, and that’s just fine. You won;t see too many people driving Tesla Roadsters… but if enough rich folk decide to buy ’em, you’ll soon enough see mioddle class folk driving Tesla minivans based on the same – but developed – technology, and then sometime after that, perhaps the “Tesla Yugo” will come along for the poor folk. 

4) This’ll be popular: “You suck, you don’t get anything.” Use a series of standardized criteria to determine who is actually worthy. Spent time in prison for rape and murder, and now you’re old and decrepit? Screw you, there’s the gutter, go die in it. You spent a life of invention, productivity and advancing America/mankind via science, hard work, economic innovation, art, whatever and now you’re old and decrepit? Here, have a seat, we’ll be right with you. You spent a good life and are a great guy, but your body is a total wreck, your mind is essentially burned out, and all we can do is keep you a drooling vegetable for the next two or three decades? Here, watch this film of deer in green meadows while Beethoven’s Symphony #6 plays in the background.

 None of these may seem too thrilling. But what option do we have? Medical science will continue to advance, people will continue to live longer, and will continue to demand to retire at 65 and be taken care of. The birthrate will continue to slide, and the number of younger workers will decrease. Thus the ratio of unproductive to productive will increase, which means an increased burden on the productive. At some point it collapses. One good strike could bring down the whole system. A true war between the age groups could result… if some 25 year old worker was told that 95% of his paycheck is going to the government, and 80% of that to take care of old people… how long before he gets the idea “fewer old people means less expense… how do I go about making fewer old people?”

Time is not on our side here. Difficult choices must be made.