Part II: A Modest Proposal

Money, money, money – it’s all you hear about in the news. A billion here, a trillion there. Before you know it, we’re

In honor of Tax Day
Image by swanksalot via Flickr

talking serious bonus. The Huffington Post published an article about how smokers are good for the economy. Since they die so conveniently young, smokers save taxpayers a lot of unused Medicare and Social Security dollars. Talk about altruism! That kind of news is such a ray of light in these grim times – we’ve got out of control spending, an imploding healthcare crisis, a raging war in Iraq, and more and more troops needed for Afghanistan. And possibly North Korea.

The shining self-sacrifice of smokers (just to reduce the nation’s deficits) got me to thinking – why not use the same cost-analysis approach to solve all our national problems at once? Because what we’re all clearly after these days is less spending. No preferences. Rational fairness. In a word, efficiency. Simply put, cost effectiveness (the type of analysis used in the cost-of-smokers-to-society-article) is the idea that we should approach costs, health, and survival in a logical, fair way, because, really, can everybody have everything? No. Of course not. That would drain all our resources away. So somebody’s going to get the short end of the cigarette, and squawk. Our national goal is to figure out how much impact there is on how many people, make some rational decisions, and then go forward from there.

How do we do this? Well you have to measure everything. And I mean everything. I once went to a cost-effectiveness conference where people in bow ties and polyester shirts earnestly discussed how to quantify fates-worse-than-death while standing at a plastic podium in a cheap, pine-paneled Days End conference room.

That’s when I had a life-changing revelation that I think we should use here: no one should be limited by matters of taste, either in clothes or subject matter. So I propose we use tried and true cost-effectiveness tools to create what will be the first sane, mathematical approach to the nation’s problems – war, health, and entitlement benefits.

In healthcare, we’d start with Years Of Life Saved. That’s the easiest, clearest number to come up with. But we’ve got a few wars to deal with too. So we’ll call it Years of Life Lost. It’s a number for something I think most everybody agrees we should avoid – in other words, our goal is to minimize Years of Life Lost. Not so long ago, Congressman Rangel (D- N.Y.) again discussed implementing a draft, one for both men and women, with the only exemption being pregnancy. The issue is that, now that the military is so technological, boys and girls both go to war. War isn’t really about hand-to-hand combat anymore. Congress showed us that clearly war has changed completely, and all our assumptions about who should be drafted ought to be re-analyzed for fairness.

First, we can see if a pregnancy exemption makes sense. After all, it might not. Logically, if we’re sending young people off to die, why exempt a fetus? Well, looking at the numbers, we have an answer nobody can argue with. Years of life lost for a fetus nowadays can be as high as 91 years. You multiply that times a few fetuses and that’s unacceptable. Next we can compare drafting men to women. For drafting men, if you take the life expectancy of a man today, you kill off a twenty year old and you got 56 years of life lost for each one. Not good. If you take a twenty year old woman, we got an even worse scenario with 61 years lost. Women live longer.

What we need is a better, fairer solution. I looked at the model and one of the issues is that people are living longer and are healthier and more active as they get older. Now, if you kill a healthy 70 year old, you only get 15 years of life lost. That’s an improvement. We could slot in the smokers’ data and get even better results with a dead 70-year-old smoker. Which means, age for age, smokers hit the battlefield first. The model selects for elderly grannies too (knock off a feisty 80-year-old and you’ve only got about 10 years of life lost). And next we look at that other measure of cost-effectiveness  – years of work lost. We also want that number to be as low as possible. People who work are productive. They are giving back to the community. Heck, these geezers are retired. You get a double benefit from using them — less years of life lost, no lost work years. Think of what we’d save in combined Medicare and Social Security costs. If we go deep enough into the aged population, we may not ever need pension reform. There are other benefits to this approach too, even though I’m not quite sure we have the data yet to quantify them. What kind of intangible benefits am I talking about? For one, I just can’t see a bunch of 85 year old retired accountants stacking naked Afghani prisoners in a pyramid, now, can you?

The only sane, fair, rational solution to our nation’s problems is an army of dentured, frail, elderly people.

And if we start killing off too many geriatric citizens, we can even come up with guidelines for which population should go to war next. If you look at years of work lost, you can find an exact numerical break point where sending a 55 year old chronically unemployed waitress to Kabul is better than sending a 62 year old marginally employed bricklayer. I mean, there are lots of people who believe that if these people really wanted to work, they would be working. We could solve the homeless problem, the housing crisis, spiraling unemployment, the healthcare crisis and Social Security depletion all in one step. What could be more rational? Or fair?

One last point – I’ve looked at the model and I think we obviously also must create an elite platoon. Even with using  more resources, there is no justifiable reason, numerically, to ignore the inescapable fact that the best approach for minimizing years of life lost (and maximizing cost effectiveness!) is to create the Honored 83rd Battalion of the Terminally Ill. Think of the way these soldiers–young/old, male/female—just think of the way they would strike fear in the heart of the enemy. Talk about altruism AND making history at the end of life. Being an honorary Terminally Ill battalion member is really the ultimate organ donation. Get your biopsy results, go to the front lines, and save the lives of young healthy Americans who would otherwise,  instead of you, be patrolling the Green Zone. Think of what we’d save in hospital costs alone.

These satirical views are solely those of Doc Gurley, a physician who works in a homeless clinic in San Francisco–where almost nothing is cost-effective, and almost everything is worthwhile.

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