Sunday, February 13, 2011

When We Are Not Entitled Part 2

Sometimes an idea gets lodged in your head and try as you might you can't dislodge it. For the last day or two I've been toying with the thought that the Republicans in Congress are like the Romans at Masada, marching ever forward with certitude, unaware of the tragedy that awaits them, one of their own making. Cutting all the good government in the belief we can't afford it only to find the budget is still way out of wack, forcing the baby boomers who are certainly not known for their noble deeds to take the only desperate action available, a mass suicide that obliterates an enormous chunk of health care spending and in one fell swoop restores fiscal balance.

Isn't there a less dramatic way out of this mess?

Economists know that GDP is a very imperfect measure of welfare. It only measures market transactions and has nothing to say about work done where no money changes hands. Hire somebody to mow your lawn and (in theory at least) that activity becomes part of GDP. Mow your lawn yourself and it does not. And the same goes for childcare, housekeeping, and a host of other activities. There is also the issue that some market transactions are there not to improve welfare but rather to make sure bad things don't happen. If there was no such thing as a computer virus, we wouldn't need anti-virus software. GDP would be lower then, but we would be no worse off.

Where does health care spending on the elderly fit in?

If only that question had a ready answer. Atul Gawande is thoughtful on these issues. This piece about when the end is near serves as an example. But what about before that? Thinking that through is much harder.

Last night I watched Harry and Tonto, a movie from 1974 where Art Carney won the Academy Award for Best Actor. I had started watching it a couple of weeks earlier, but I realized it would get to me so I shut it off before getting too far into the story. Last night I was ready for the rest of the film. Carney was my age when he made that movie, but he is very convincing as somebody 20 years older, a widower who has lost his apartment because they tore down the building. He is having a second coming of age doing a drive trip cross country, rediscovering his memories, visiting his adult children whom he loves but can't tolerate for too long a period of time, unsure what's in store afterward. He has his marbles and is in reasonably good health. But he is outliving his friends and in a poignant scene dances with a girlfriend from before he was married, who is now in an old age home. She is on the way out with signs of dementia. He will not see her again. Tonto is his pet cat and constant companion. Near the end of the film Tonto dies. Can Harry start a new life a this point? The film doesn't tell us.

You feel the system should be for Harry. Several times in the film he asks about his checks, which must refer to his pension as a NYC teacher and Social Security. So that part works. But what of when his health starts to fail? On an emotional level, it is much harder to understand that obligation.

No comments: