Barb B

This is a really interesting book. I was caught up in it enough that I was willing to overlook some things when I was reading it, but once I finished and started to think about it was harder to ignore important points.

The book is set in America in the year 2030. The annual deficit outstrips the GDP and the debt, mostly held by China, is already an astronomical figure that no one really thinks the US will ever be able to pay off. Most of the money goes for caring for the "olds" (those 60+). Thanks to advances in medical technology, people are living longer than ever before. There is some sort of universal healthcare but it's not explained that well. Everyone is required to pay premiums but the sense is that nearly all the money goes for the "olds". I have no idea what the co-pays are or what it covers.

The situation is dire. Infrastructure has disintegrated but there is no money for repairs. When "the big one" strikes L.A. there's literally no money to rebuild. There is also a deep generational divide and the young have a nearly universal resentment of the olds, who they see taking all the money, jobs, and opportunity. They're also driving up the cost of housing. The animosity is such that the olds are afraid to go out alone and so they stick to themselves in gated communities and only travel in groups.

But here's one of those pesky problems. There's only one "old"; who starts out poor and he dies in the quake. There's another that loses his worldly goods in the quake but he started off being financially comfortable. Meanwhile, the young are portrayed as almost always poor unless they manage to inherit money.

While Brooks certainly taps into anxiety about what may lie ahead as increasing number of baby boomers retire and go on Medicare and Social Security the real problem is going to be income inequality between classes. It's not just retiring baby boomers who have money, better access to jobs and opportunity. And there's no way Medicare will cover everything. They're already talking about cutting benefits to providers in the near future (which of course, effectively cuts benefits even though they're saying they aren't). That means that fewer providers will agree to see Medicare clients. The future of Medicare is looking a lot like Medicaid. Reimbursement rates are so low that many doctors refuse to take Medicaid patients (plus, there's a stigma attached to it in the medical community).

Without massive reform I think the saying will remain true: if you're wealthy, America is the best place in the world to be sick. If you're not wealthy or at least rich you could get better, faster care in many other countries.