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We are a nation of uninsurables. By and large, that is—at least when it comes to healthcare and true market costs. We’ll do anything to dismiss this unpleasant truth. The only thing that varies is how we dismiss it. Is there a division into liberal and conservative on this issue? Yes, but only in a superficial sense. Liberals and conservatives eat roughly the same way and die roughly the same way. 

An American’s fresh vegetables are Papa John’s Pizza toppings. His fresh fruit is prepackaged in a bowl of Lucky Charms. Daily exercise consists of walking down the office steps to grab Danish and coffee and taking the elevator back up. When he quits drinking he starts smoking again, and when he quits smoking he starts drinking again. He pops OxyContin like PEZ.

The results of this lifestyle—and this reality is not a climate change type proposition that can be banished with sophistry and denial—are obesity, diabetes, cardiovascular disease, liver disease, and a wide range of cancers. An American may be young and relatively healthy today, much the same way jumping off a bridge doesn’t kill you until you hit the water. Unfortunately, most American deaths are several orders of magnitude more expensive.

Young Americans can convince themselves they are exempt, but with few exceptions young Americans are old Americans in training. Bellies distend, arteries clog, and expenses balloon, regardless of who is paying. The lifetime expense curve, in fact, is something like a positive parabola approaching a vertical incline near the end. Year 29 might cost $175 for a trip to a walk-in clinic and a prescription for amoxicillin. Year 59 might cost $55K for twelve months of kidney dialysis. The very last day on earth might cost $120K for an array of life support machines providing an extra hour-and-a-half of vegetative existence. Walk through the palliative care wing of a county hospital and see if you can pick out who voted for Mondale in ’84 or Goldwater in ’64.

So-called liberals tend to argue for unlimited medical care entitlement for all people under all circumstances. But no matter how politically incorrect it may sound, it’s hard for healthcare to be a right while eating and drinking everything, shooting up and doing anything you please at all times are also rights. By the time you’re all done on this earth, the area under that positive parabola might be a million dollars. Divided by perhaps thirty productive work years, the average yearly cost in constant dollars could well exceed $30K. This is simply unaffordable to the vast majority of Americans. So how, then, does the difference get made up? The so-called liberal will tell you the cost should be shared. Sounds great. Exactly how and by whom?

Not to be outdone in delusion, the so-called conservative believes he is Davy Crockett. He claims to pine for the day when medical treatment consisted of a bottle of whiskey, a hacksaw, and a tourniquet. When he looks in the mirror he sees an alpha male who has conquered the frontier with an axe and a rifle, not a portly midlevel manager freebasing Lipitor. He demands his insurance options read like a Denny’s menu of ailments. 

I’ll have the lung cancer, liver cancer, emphysema, cirrhosis, throat cancer, tongue cancer, colon cancer, prostate cancer, triple bypass surgery, Viagra, Levitra, and Cialis, please. Hold the hep C, Pap smear, and cleft palate surgery, thank you. And you know something, I’m going to skip the anorexia, migraine headaches, anxiety disorder, clinical depression, postpartum depression, and autism. Could you leave a menu with me? I might order the gastric band surgery in a few years, but I'll see what kind of appetite I have.

Hey, Davy, there’s a catch. What you’ve ordered isn’t actually insurance. You can go ahead and order whatever you want on the menu, but you will have to pay for it on the spot in cash. May we suggest visiting the establishment across the street? See the sign—it says “health savings account.” Put aside a little money (Tax-free, praise the Lord!) every year, and just make sure that 17 years from now you have $200K banked for stem cell therapy.

Things would be bad enough if typical liberal and conservative inmates ran the asylum. The asylum, however, is run by politicians with topnotch healthcare paid for by sucker liberal and conservative taxpayers. Co-managing the asylum are a handful of major health insurers whose only true function is to act as a conduit for the trillions of dollars sent back and forth between taxpayers, the government, and healthcare providers—while of course siphoning off a hundred billion here, a hundred billion there. This is not simply an asylum. It is an asylum with a gas leak and a four-alarm fire built directly over a Superfund site.

Is there any hope of transforming the burning asylum into a tranquil hospice or maybe even transforming the hospice into a well-run emergency room? Yes. But first we must be brutally honest with ourselves and admit this is not football or baseball or basketball. It is not rap music. It is not the creation of computerized special effects, space travel, or a dramatic series on Netflix. In those endeavors, we are the best. Or number two. Or number three. 

In developing a rational, humane yet cost-effective healthcare system, however, we are not as a nation number one or two or three. We are not even in the top ten, twenty or thirty. We are the cellar dwellers of the western industrialized world yet believe we are headed for the World Series and the Golden Globe Awards. We waste our time arguing whether healthcare should be driven by the free market or by compassion when reality insists it be driven by a combination of both. But we are obstinate in shouting whatever it is we shout. As Americans, that is something we share along with a declining life expectancy.