Wednesday, August 5, 2009

Another modest proposal


Thirty years ago I put together a book on heart attacks. I flew around the country and interviewed physicians who had done seminal studies in cardiology. Although the company paying me folded before the book was published, the interviews made me understand the close connection between diet and exercise and health. Again and again I was told that having a heart attack was a matter of choice.

Of course, a heart attack is less likely for anyone who has a low-stress job, doesn't have parents with heart disease, and who is younger than 40. But when I go to Costco these days I think I'm stuck in the ballet scene of Disney's "Fantasia." There may be some abnormal pituitaries out there, but there are far more people who eat big and exercise small, and they're blowing off solid medical advice that's been around for three decades.

So I've become a hawk on insurance reform. I don't think that people who abuse their health should be eligible for health insurance. That includes people who overeat, people who won't exercise, people who smoke, people who drive and cell phone, people who have more than two drinks a day, people who won't move away from contaminated air, water, or soil, speeders, jaywalkers, helmetless bicyclists, people who eat fugu fish, and people who go into the woods without a map. And anyone who has ever said, "Hold my beer. Watch this."

Expulsion from the insurance system should be on a zero-tolerance basis.

It's the only way that Americans will be able to pay for rising health-care costs. It's the only way insurance companies can make a profit without bankrupting the rest of us with increased premiums. It's the only way those of us who take care of our health won't have to pay for the foolishness of those who don't.

Repealing laws mandating emergency-room admittance for the uninsured will be a first step toward educating the public to an improved health-care regime. The bodies pushed off to either side of emergency-room entrances will provide useful object lessons for those prone to magical thinking.

Lest you think I'm being heartless, consider that my plan makes you a partner in your own health, rather than infantilizing you. You won't lose control of your mind and body when you enter into the myriad procedures and paperwork of a hospital stay. You can take your place in the culture as a responsible adult who's adjusted your behavior to the latest common-sense medical information on the Internet.

By doing what you can to stay healthy, you will be healthier. Leaner. Smarter. More resistant to fast-food advertising. Less filled with high-fructose corn syrup. In addition to having cleaner coronary arteries, you'll have less chance of having a stroke or getting diabetes or cancer.

A healthier population will restore the free market to our medical industry. With empty hospital rooms, darkened labs, silent MRI machines, unpurchased drugs, and unemployed physicians all over the country, the price of health care will plummet. An emergency-room visit that used to cost the taxpayers thousands of dollars can be bartered down to the sack of the fresh vegetables your physician needs to maintain his own health. Medicare fraudsters will seek greener pastures in the financial and real estate markets. Surgeons will crack two chests for the price of one, and maybe throw in a kidney. Malpractice suits will dwindle in proportion to physicians' assets.

All told, eliminating people who won't take care of themselves from the insurance system will result in a far better America than the one we've got now. Big insurance companies will be able to invest their excess capital in fusion research, gyms, restoration of wetlands, the development of solar-electric siding for houses, and fossil DNA reconstruction of extinct species. Dams will be breached. Interplanetary probes will be launched. Foreign oil exploration and stealth fighters will be subsidized.

Best of all, computer technology can proceed to the point where we can all upload our brains into hard-drives and live forever. Freed from the pain and mess of the flesh, safely encased in titanium-and-steel bodies, powered by long-lasting fusion reactors the size of a beer can, we'll tune into the wavelengths of a world-spanning Wi-Fi. We'll dance to its delicate interweaving patterns, talk among ourselves in ones and zeroes, and thank our lucky stars we're no longer stuck in a system whose entire resources were devoted to fighting off the quaint idea of mortality.

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