Victor Davis Hanson wrote a good article on how our changing views of what constitutes a good life has effectively bankrupted the country. His first example comes from modern ideas on health.
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.
One solution to this problem is easy to implement but nearly impossible to envision, at least as a voluntary choice on the part of the people:
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. […]
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.”
Hanson, who teaches college, then goes on to explain why higher education became a lucrative growth industry over the past forty years:
From some 20 years’ experience in higher public education in California, I have come to know a familiar student profile:
Units enrolled: 6–9
Residence: Still at home
Job: 20 hours a week at minimum wage to pay for car, insurance, video games, entertainment incidentals (but not rent, food, laundry, etc.)
Major: Either undeclared or changing
Goal: Return to school every other semester, work part-time, party, and put off becoming autonomous
Such students, in today’s grade-inflated university, are able to get Cs and Bs for F and D work, to cobble together state and federal loans, student work assistance, and grants — and to delay growing up while they sleepwalk through a largely therapeutic curriculum.
And his proposed solution, again easy to implement but impossible to imagine:
If President Obama is serious about education, then he might also remonstrate with universities to bare their books, keep their costs below the rate of inflation, mandate a cutoff of student support after four years, insist that the BA or BS degree be contingent on some sort of final exit examination, re-examine tenure — and invest in vocational and trade schools rather than continue subsidizing community-studies, sociology, education, and physical-education degrees. One brilliant plumber, gifted carpenter, or adept auto mechanic does more for the American economy (and our collective values) than a dozen 20-something sociology majors in progress.
My only quibble with Hanson’s proposals is that, like most people, he leaves off asking the hard questions far too early in the process. He mentions his obese uncle as someone who society left to suffer the consequences of his condition, but doesn’t seem interested in whether that condition was the result of a bad choice that should be punished or was somehow inflicted on him unknowingly. Similarly, I think he misses the bigger point in this anecdote:
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.
To me the more interesting question is this: When did it become necessary to brush your teeth three times a day in order to preserve them, and why? People did not do anything like this in 1800 to care for their teeth, and yet life back then was not the agony of rotting teeth that their approach back then would lead to today.