Now that the season of love and giving is coming to a close, I can once again revert to type and foray into the world of what will be as opposed to what we all wish it would be.

The Affordable Care Act, more colloquially known as Obamacare, has promised us more coverage for more people, both highly laudable offerings that may have contributed to his return to the Oval Office. In an era of shrinking revenues and ballooning debt, how is this possible? I’m going to prognosticate.

The healthcare world of the not-to-distant future will, by necessity, implement the following changes:

  1. Comorbidity, i.e., the number of severe, chronic medical conditions, will determine whether or not a procedure or treatment will be a covered benefit. Age will be one of these comorbidities, but not the sole one, unless things become pre-cataclysmic. No percutaneous valve replacements for a 91-year-old grandfather with diabetes and kidney disease.
  2. Medical care for prisoners will be titrated to the offence. Rapists, child molesters and serial killers with no longer be escorted by two highly paid guards for diagnostic testing and expensive surgery so that they can be housed for a few more decades at great taxpayer expense. When things get bad enough, single murderers will find themselves in the same boat. When things get even worse, attempted murderers may succumb to the same fate.
  3. Drug addicts will be denied care for ongoing abuse. When things get worse, tobacco abusers better watch their backs.

Of course, before any of this occurs we will have to bring the economy to its knees. Our dysmorphic view of how a compassionate society is defined (and the powerful trial lawyers lobby) will fight these kinds of changes to the very end. All of the above, to some extent, should have been implemented years ago, but we tend to be a much more reactive than proactive culture. Perhaps it’s human nature, wanting to put off the suffering for as long as possible, even if it means an even worse fate down the line. Maybe it will take an intervention, like falling off the fiscal cliff or banging our skulls against the debt ceiling.

Tough love hurts.


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