Age does indeed bring perspective, and a changed view of everything. Nonetheless, I find myself gripping the ideals of my early life more tightly and becoming in many ways less conservative. This peculiar reversal of normal aging makes me more sympathetic to, and interested in, the views of young people, while at the same time out of sorts with their impractical impatience. The old folks I know think something's wrong with me, because I don't just lay back and accept whatever.

People under 40 don't get it. I run into it a lot in on-line encounters. I run  into it the few times I have a personal encounter with anyone under 40.

Aside: Has anyone bothered to notice the extreme segregation of our society? We are sorted by race, ethnicity & religion, gender, age, etc. Where I live, a University town, you have to look hard to find any old folks. We have less than the usual quota of hospices, nursing homes and the like. I do run into a few old acquaintances at the grocery store, when, by accident, we have similar "schedules."

Most young people have no idea that there are nursing homes in Davis. Medical practice is something you attend when you or your young children have a cold or infected ear, or someone needs shots. Young people go to annual checkups, and shuck them off. They are just rituals people do, like midterm exams. Once in a while, there is a major doctor production: pregnancy and birth.

Perhaps young people visit an ill grandparent for a few minutes or hours.  But, by and large, they are not involved in serious, chronic illness, dying and, ultimately, death. Their experience of human termination is most often visiting Grandma in the Nursing Home well before the bitter end. I may be wrong, but there is very little to prepare today's young people for what happens to people after the 50th or 55th birthday.

One reason I have these beliefs is my attempts to bring up Medicare with young people. I almost always draw a blank. They don't know what to think about medical care for the ill, the aging and the disabled. They don't understand the issues; for example, how much care is required in chronic and terminal cases. Young people "know" there are fatal diseases, just like they know how to spell "bee."  It's in the book.

The vast majority of our lawmakers and administrators and their staffs, excepting US Senators, are between 30-55 years old. They make the Medicare, Medicaid and other laws which regulate the lives of Senior Citizens intensively. This creates Medicare's biggest problem: the laws don't solve the problems doctors and patients actually have.

The laws do solve the problems those lawmakers, etc, think patients have. There is a vast difference between "think" and "is." This difference seems greatest among conservatives, who tend to be wealthier than liberals, so usually receive better medical care than liberals. Conservatives imagine the care they
receive is what everyone else can get, somehow failing to appreciate the difference money buys.

Life-Time Costs

It is a well known fact that 1/2 of all medical costs are run up in the last 6 months of life. If we were somehow able to predict dates of death, and divide the terminal from the yet living, we could cut the medical care premium in half for the non-dying.

The difference is even greater than that. Excluding pregnancy and childdbirth, almost all other medical care is delivered to children under 5 and the elderly over 55.

The cost of medical care from 5 to 55 is minimal. Moreover, the medical costs of those 5-55 are radically reduced by systematic preventive care programs.  In addition, programs to reduce accidents, epidemics and other catastrophic events further lower those costs.

Unless a baby has an unusual conditon, such as being premature or having a genetic defect, the cost of medical care to age 5 is not overly burdersome.  The fact is, taken together, there is no reason why every resident of the NAFTA countries should not have thorough, low cost, life time medical care between birth and age 55. The Canadians already do it. It is so cheap, that it is affordable even by Mexicans.

Intensive Care & Old Folks

The problem is the catastrophic cases in the 0-55 age group, and elder care in general.

It is almost always surprising to Americans that countries like Taiwan or Finland have 100% health insurance coverage and medical care. Taiwanese people live much longer than Americans. How can they afford nationalized medicine for everyone? For that matter, how do the Japanese, British, French, Germans (and on and on) afford it?

Conservatives have been attacking Medicare and any National Health Service (NHS) that comes to mind for over 50 years. Their complaint is the supposedly low quality of care people get from Medicare or NHS. In fact, it is true: you do not get treated as well at a publically funded clinic as in very private doctors' offices.  The difference is MONEY. Doctors catering to the wealthy charge truly hefty fees.

MONEY is at the bottom of the problems we have in America providing medical care to everyone. Almost everyone agrees with that statement. What people don't agree about is the solution.

Warning: Now comes the socialist part.

What I believe is the American problem is the wealthy bid up the price of medical care. The top X% of our population can demand service by offering to pay outrageous fees. At some price, there are always doctors who will jump ship (abandon the Hippocratic Oath) to serve the rich. Example: one factor in awarding organ transplants is the monetary ability of the patient to pay for and sustain the procedure. Medical need or likely benefit to the patient is usually a lower rated factor than ability to pay.

I have no moral difficulty with the rich calling away the doctors, provided everyone else is also served. In other words, the system should be set up to meet everyone's needs. The rich can attract any overflow or excess capacity. This simple idea is the reason the British and Canadian systems treat people at much lower costs.

Note: Conservatives spread the story that Canadians come to the US for treatment they cannot get in Canada. This is true:  rich Canadians come to the US for those services. However, it is also true that the Canadians who stay in Canada get as good medical service as Americans. Example: A recent study showed no difference in outcomes between the US and Canada for major treatments (heart disease, cancer). [So much for the lousy NHS lie.]

The fact is, adopting a universal health care system in the United States is likely to lower health care costs by at least 25%. The probability is that treatment outcomes will not get worse, but might even improve - especially for those now unable to get any medical care.