To my surprise, I’ve become something of a connoisseur of surgery lately.
When the nurse came into my room after recent back surgery, her question was, “On a scale of one to ten, how would you rate your pain?” Still half groggy from anesthesia and mildly irritated that instead of wearing a starched white uniform required of nurses in the days when I trained to be a physician—she wore a faded plum colored scrub suit. I answered, “Well, compared to my eye surgery six weeks ago, this pain is worse. But, compared to my knee surgery six years ago, I’m in nirvana.”
“But on a scale of one to ten?” she persisted.
“Give it a four” I mumbled. Then, as she left the room I realized that I, who consider myself a basically healthy eighty-three year old male, have become a surgical connoisseur. In the past decade I’ve had both knees replaced. My right hip’s been replaced. I’ve had quintuple coronary bypass surgery. Last July a screw was placed in my broken neck to hold the pieces together. My lower eyelids were tucked up to correct ectropian (it’s on Google. What isn’t?)—and now I’ve had a mini-lumbar-laminectomy on vertebrae 2, 3, 4, and 5. The latest venture is intended to relieve pressure on my spinal cord caused by spinal stenosis. You should hear the bells toll and whistles blow when I go through TSA screening.
I tell family and friends that I’m like an old Volvo with 400,000 miles on it. I’ve still got some good miles ahead but every so often I need to go in to the shop for some body work. The question I ask my partner (and myself) is, “When do I get traded in on a newer model? or When am I considered a junker and ready for the scrap heap?”
In the process of all this I’ve learned a few valuable lessons. Take a list of the medications you regularly take with you to the hospital—it saves time. Wear something warm. Hospitals are dedicated to global cooling and you’ll have at least an hour or two of paper work before you’re able to don your stylish split skirt drag outfit. You know, the one with the slit in the back. And most important, if given a choice, schedule any elective surgical procedure for early in the week so you have the regular crew caring for you, as opposed to the weekend warriors.
Perhaps, I’ve been sensitized by the focus placed on Medicare in the 2012 fiscal cliff fiasco, but the most distressing part of my recent surgery was the recognition that I’m part of the problem. In fact, I, as a Medicare user, am a major contributor to the fiscal cliff. Medicare costs are a huge and an increasing segment of the national debt. The data has been around for years indicating that something like a third, maybe a half, of Medicare costs go to pay for keeping our oldest citizens, our 400,000 mile Volvos, on the road. That’s me. And I also realize that not being in the 1% financially, without Medicare I’d probably be dead by now. I’d be rusting on the scrap heap or providing lunch for some hungry worms.
From a Medicare cost perspective, that would be a good thing. If more seniors died sooner, costs would go down, the fiscal cliff would be more of a crag, and politicians could find something else to deadlock over—like how many angels can dance on the head of a pin.
I don’t know who invented the supply vs. demand idea. It might have been Adam Smith, or possibly his wife Eve. Actually, Wikipedia gives credit for supply and demand to Muslim scholars in the 14th century. It could have been Plato, for all I know. But supply and demand is basically what drives cost. The Medicare dilemma is that too many people in our aging population need medical services and not enough services are available. Therefore, health costs keep escalating. Even I can understand that.
But what the planners and prognosticators don’t understand is that the solution is obvious and in your face. Decrease the demand. Decrease the number of people needing medical care. Get rid of seat belts. End the no smoking nonsense. Instead of rewarding The Biggest Loser reward The Heftiest Heifer. If we could return to the increased death rates of yore related to smoking, trauma, diabetes, and obesity, more people would die earlier and Medicare costs might be contained. Furthermore, there would be increased employment for morticians. Then the fiscal cliff would simply be a viewpoint rather than a national suicide platform.
There’s really nothing novel to this approach. Jonathan Swift, author of Gulliver’s Travels, proposed something similar in A Modest Proposal in 1729. Actually, the full title of his essay was A Modest Proposal for Preventing the Children of Poor People From Becoming a Burden to Their Parents or Country, and for Making Them Beneficial to the Publick.
In the midst of their economic troubles, Swift suggested that the impoverished Irish might ease their economic woes by selling their children as food to the wealthy nobility. He states, “A young healthy child well nursed, is, at a year old a most delicious nourishing and wholesome food, whether stewed, roasted, baked or boiled; and I have no doubt that it will equally serve in a fricassee, or a ragout.” His satire even included recipes for preparation.
It’s classic supply and demand. The impoverished Irish could always produce more babies and the wealthy had an insatiable appetite for tempting gastronomic delicacies. Bake the babies. There are fewer mouths to feed and more money in circulation.
So, fast forward a few centuries. Get rid of the elderly— the smokers, the obese, the unhealthy. The number of citizens needing care would decrease and Medicare costs would tumble. Hurrah!
Would that really solve our national fiscal crisis? Hardly.
But it would mean the Pentagon budget could be restored. There’d be enough money to continue our overseas military misadventures and maybe start another war or two.
John Siegfried, a former Rehoboth resident, lives in Ft. Lauderdale. Email John Siegfried