Gen Wars

Which one deserves healthcare?

There’s nothing like scarce resources to bring out the survival instinct in any species. Who gets that fish? That clump of green grass? That puddle of water?

The biggest threats to young organisms are the old ones of their own species – because older individuals are bigger, stronger, more experienced and downright craftier.

Here’s a simple arithmetic problem:

Long life expectancies + rising health care usage + rising healthcare costs + municipal retirees’ entitlement to healthcare = ?

What they equal is disaster.

As a recent newspaper article reported, many cities are experiencing enormous stresses because their retirees – often not elderly enough to be covered under Medicare [see my past blogs discussing this program] – are using doctors and hospitals at a greater rate than ever before. Medical care also costs more than before, and in the US is mismanaged so that consumers receive less care per dollar. What this means is that cities are now paying as much for their retirees’ medical consumption as they are for their current employees as medical consumers.

It’s a given that retirees are older, current employees are younger . . . young enough to give birth to and raise children.

If cities must, by contracts written years ago, honor retirees’ healthcare costs, in the next few years they will not be able to afford to cover current employees and their families. That’s a scenario the US has never faced, and it means that unless the federal government moves to a healthcare system à la the rest of the First World, American children will suffer while their grandparents and great-grandparents live it up. Literally.

If contracts could be rewritten – that is, if retirees agreed to share healthcare dollars – there are ways to postpone the inevitable. Retirees could eliminate from reimbursement particularly expensive procedures (transplants, for example), or restrict hospital usage to a certain number of days per year. They could also agree not to use heroic measures when death is likely. Current employees could do the same, electing to give up pricey items such as fertility therapies (Australian research shows that when a woman brings her weight up or down to a healthy level for her, conception is much more frequent – demonstrating that costlier treatments may not be necessary). They could agree that risky behavior ought to carry its own medical price tag: a city employee who snowboards without a helmet should pay her own expenses for concussion.

But contracts are unlikely to be addressed, because both retirees and employees want the most services for the smallest contribution. Who will suffer? The ones who don’t get to vote, who are smaller, weaker, and guileless.

The next generation.

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