Sunday, August 9, 2009

Gold for Geezers

ABOVE the oracular cave at Delphi, we are told, was inscribed the fundamental atom, or perhaps even quark, of all wisdom: NOSCE TEIPSUM, “Know thyself!” For some reason the Greeks thought it cool to write their mottoes in Latin, just as the Romans often opted for Greek. But whether in Latin or Greek (γνῶθι σεαυτόν, if I am provoked to a display of pedantry) the injunction to self-knowledge has a long and venerable history in the western philosophical tradition.

Self-knowledge is of course the hardest of all knowledge to obtain. “O wad some Power the giftie gie us,” wrote the immortal Robbie Burns, “to see oursels as ithers see us!'” Most of us are pretty good at some things, and not so good at others. But what a rare ability it is to have a clear and accurate view of which is which. In fact the more things we are good at, the more lively is the danger that we will think we are also good at vaguely related things. For example, I am pretty good at eating. Indeed modesty alone keeps me from saying “very good”. Eating is logically connected with cooking, but it would be most rash of me, and even rasher of you, to suppose that my prowess at eating implies an equal prowess at cooking.

National political developments of the last month have encouraged me to think about the Delphic injunction with regard to our much-admired president. Barak Obama is a very able politician. In fact he is a superb politician. But even though he is very good at most things political, he is not, alas, very good at all such things. Contrast, for example, the lavish praise that has greeted the “Cash for Clunkers” program with the controversy and dramatized divisions ignited by his Medical, well, Whatever. I speak thus irreverently only because the Democrats seem to have abandoned what was formerly called their “Health Care Plan” in favor of their “Medical Insurance Reform”. I am not sure I like the switch, because I am a man with a prostate; and if I have to be in the hospital I’d prefer being treated by a doctor rather than an insurance agent. I can hang out with any number of insurance agents at the Rotary Club.

Still, there does still seem to be, camouflaged amidst the Delphic obscurity, an actual medical dimension to Health Care/Insurance Reform. The trick is figuring out what it is. There is light-hearted Saturday program on NPR (“Wait, Wait—Don’t Tell Me!”) in which one of the segments tries a contestant’s ability to pick from three preposterous stories the one that (in addition to being preposterous) is an actual news item. President Obama has assured me of three things: (1) he will give health care insurance to about fifty million currently uninsured people; (2) this change will have no effect on my own personal medical arrangements unless I want it to, and (3) nobody making less than a quarter of a million dollars per annum will be asked to pay a penny more in income taxes to pay for the program.

The problem is to figure out which one of the three highly popular possibilities could conceivably be true. I have no intention of going to a Town Hall Meeting, and I certainly will not foam at the mouth if I stumble into one by accident; but as an Obama voter I do have to inquire whether lobotomy will be a precondition for my support of the president’s good intentions?

The question Mr. Obama should be discussing with Messrs. Rahm and Alexrod, not excluding of course Speaker Pelosi, is how to make the Health Whatever as attractive as “Cash for Clunkers”. The popularity of “Cash for Clunkers” has nothing to do with the free lunch aspect. It is the intellectual elegance of the concept. Toward the beginning of the last century one of the European governments, concerned with the frequency of fatal railway accidents, established a commission to look into the matter. The commissioners soon discovered that by significant proportion most people killed in railway accidents had been sitting in the last car of the train. In a flash the elegant, cost-free solution to the problem flashed through the mind of the chief investigator. The commission would recommend that in future the last car be removed from all trains. Voilà!
A clunker: $4500 max

That’s the kind of thinking that has made “Cash for Clunkers” such a success. The beauty of it is that the model can be applied to the Medical Whatever at the slight cost of a few modest adjustments of vocabulary. Everyone agrees that the killer cost in health care is geriatric medicine. But “geriatric medicine” is merely a euphemism that may disguise rather than identify the problem. Let’s call a spade a spade. The real problem here is geezers. First they get old. Then they get sick. Then they expect to see a doctor. Give them an inch, they take a mile. The suggested plan to create a special group of thanatological shrinks (commonly called the Kevorkian Corps), while undoubtedly well intentioned, is actually an inadequate response. The health care crisis demands something more fundamental. The solution is obvious, though it may at first seem a little startling. Eliminate the last car on the train. Get the geezers off the road in the same way you are getting the clunkers off the road. Give the program a snappy title: “Grants for Gramps,” perhaps, or better yet “Gold for Geezers”.
A geezer: $450 max