I.O.U.S.A. ought to be a knockout. A discussion of the national debt (both public and private) could hardly be more timely, as many assets held by Americans simply vanished in the wake of massive banking failure this past week (following massive abdication of common sense over the past several years) and mega-insurer A.I.G. tried to fix the problem by borrowing from itself. (Even after that ingenious move, taxpayers had to hand them the credit card.) And after Jennifer Abbot and Mark Achbar’s The Corporation, there’s no reason we shouldn’t expect a clear, useful documentary about complicated economic and legal issues, even one that might offer a vision of practical steps towards change. But I.O.U.S.A. largely drops the ball.
It starts off with great energy and vigor as it introduces its two heroes — the Concord Coalition‘s Robert Bixby, a reedy nerd archetype with bushy eyebrows and a sweater vest, and bull-necked former Comptroller-General of the United States David Walker. These two make a great team because they seem to bring together two great strains of American political personality — the feisty policy wonk, still blinking in the bright light of the day after having been dragged out of the library, but clearly ready for a fight; and the conservative (in the best sense) public servant whose oxlike stubbornness in the face of governmental corruption and irresponsibility gives the lie to the macho posturing of other supposed “conservatives.” (Here’s a video of them appearing on Iowa public TV in July 2007.)
They’re both bright, thoughtful men with a passion for their subject — Walker, in particular, gets some props from the filmmakers for quitting his government job in order to be able to speak freely on this subject. But Walker’s standard “stump speech” underlines part of the problem with his presentation. Everywhere he goes, he presents “four deficits” that are bloating our overall national debt: The federal budget deficit. Check. The personal savings deficit. Gotcha. The trade deficit. Roger. And the leadership deficit. Ok– what?
It turns out Walker has worked up a fairly clever metaphor involving leaders being fiscally irresponsible in order to “profit” in elections. Okay. I get it. But when you start mixing metaphorical “deficits” in with actual ones, you run the risk of undermining the seriousness of your own argument. Three real deficits would have been fine.
The film is consistently entertaining, mixing in SNL‘s great “Don’t Buy Stuff You Can’t Afford” self-help parody sketch and a cartoon demonstrating Warren Buffett’s Squanderville and Thriftville parable to keep things lively. It also creates a strong visual symbol, the rolling penny, which puts a friendly Lincolnian face on the potentially intimidating line graphs the film requires its viewers to follow and understand. (Why “up” and “down” should be intimidating concepts I’m not sure, but I suppose for many the line graph brings back unpleasant memories of eighth grade math.) And even when that penny is used as a spurious pie chart to demonstrate Walker’s less-than-helpful “four deficits,” I’m okay with it.
But after a while, the entertaining aspects of the film seem like they start to get in the way. It’s fun to watch an energized college club go out and pester people on the streets about the national debt, and there’s an undeniable chill to watching the National Debt Clock being switched on again after it had been mothballed at the end of the Clinton administration. But I’m still trying to figure out why it’s bad that China owns so many T-bills. And what was that thing about the interest from the debt?
In the end, all the answers are there in the film — though too often they’re obscured or rushed past. It’s the kind of movie that is good only to the extent that it gets at least wonks and worriers like me to go out and read more. And if it ended there, that might be enough.
But this film isn’t just concerned about today’s debts. As becomes clear towards the end, the real killer isn’t what we owe now; that’s salt peanuts compared to what we will owe in the next forty years or so as the population ages and we’re forced to spend more and more on pensions, medical care, and prescription drugs. Here’s where I sat up in the theater, gooseflesh all over. Because today’s total national debt is already more than half our GDP, and this film’s projections, if they’re in any way remotely accurate, predict a national debt in the coming decades that will actually completely dwarf our GDP, many times over. Remember when you were a kid, and they had those diagrams — “How many Earths could fit in side the Sun?” This is like that. And when that happens, we will literally have no more money left for anything but paying Social Security and the national debt. No national defense. The fucking Canadians will just come across the border and make us all wear flannel and replace our table sugar with maple syrup. Jesus.
The one graph in the film that projects into the future (taking into account all the unfunded entitlements currently mandated under law, including Social Security, Medicare, Medicaid, and the new prescription drug benefit) simply shows the penny going up and up, until the peaks of previous decades simply disappear from sight, off the bottom of the screen. The penny eventually stops, but only because no one can project out any further (or because they didn’t want an R rating for “terror”).
This is really horrifically bad news. It makes everything that’s happening now — out-of-control war spending, collapsing banks — seem like the good old days, something we’ll all be wishing for again when we’re 80 and still working fifteen hours a day in the rice fields of New Szechuan (formerly Mississippi). Is this really even possible? How can such a gigantic meteor of financial doom be hurtling down upon our country? Where the hell is Bruce Willis?
And the film offers no positive suggestions whatsoever. If the problem were unbridled government spending, we could do something about it. If the problem were too much cheap credit, we could regulate it. But this film, although it encourages action, gives very little in the way of real policy options. The problem, it seems, is that people are getting old, and when they get old, they get sick, and they don’t contribute to the economy. Really, it’s as simple as that.
Of course, there are plenty of actual solutions to the problem. But I suspect that these are so politically unpalatable that Walker and Bixby simply don’t want to bring them up. They talk sternly about politicians of both parties needing to come together to make the “hard choices,” but they’re rather vague about what those hard choices might be.
My father, a nurse, worked for nearly thirty years supplying end-of-life care to the elderly. He hated it. My father is a sensitive, compassionate man, but he hated spending his time and tens of thousands of insurance dollars (or private dollars, or Medicare dollars) extending the “life” of a bed-ridden husk by three or six months. (He did it to send us to school — there was far more money in that kind of care than other types of nursing.) He was very clear with us, starting in his mid-forties, about how little care he wanted at the end of his life — at the first sign of trouble, probably up to and including a stubbed toe, we were to enact a strict “Do Not Resuscitate” policy, and furthermore we were to instruct the hospital to forego any and all “heroic” measures. If it couldn’t be fixed with a splint and a bottle of anti-biotics, he didn’t want it. My dad said, not really joking, that he wanted to be put on an ice floe.
Dad’s a radical, but he’s also a man of faith. He later told me that he always felt that he felt he could do some good for the families of the patients by helping them reconcile to death, and by re-assuring them that physical death is hardly the worst thing in the world. It’s the exact opposite of the view espoused in the pilot of House, M.D. (“You can live with dignity; you can’t die with it!”), for example, but House is a fantasy, one in which patients almost always get better. In old age, patients almost always get worse.
My dad’s solution — put them on ice floes — is not as extreme as it sounds. As John Kenneth Galbraith and others have pointed out, universal retirement isn’t natural or necessary. It was invented by our government — first as a means of getting the elderly out of the workforce to provide unemployment for younger generations during the Depression, and later as an accepted entitlement for members of the “affluent society.” There’s no reason for perfectly healthy 65-year-olds to stop contributing to society and to the GDP. (Dad, true to form, is not only still working but actually considering, at 67, traveling to the Gambia for five weeks to teach health at a school for young women.) In every society in human history, the vast majority of people “worked” in some capacity or another until they died. Even if, as Natalie Angier has argued convincingly, the primary purpose of old people is to take care of children while their parents do the brunt of the economic production, this is hardly a function we can do without today. Instead, though, we’ve infantilized old people and decided to pay for both child care and retirement for the elderly.
There are other solutions to the growing costs of health care, too. While I was in Iraq, I worked with a guy who was absolutely, 100% against government intervention in anything at all. He didn’t give much of a damn about the environment (“if it’s down to gas for my car or a moose — sorry, moose’s gotta go!”), thought the minimum wage should be abolished, and was firmly against any sort of government assistance for people too stupid to see through predatory lending — even when such lending verged on fraud. But even this guy could see that national health care was coming. And even he didn’t really seem to mind it.
Mostly this is because health care costs for everyone have continued to skyrocket since 1994, when the “socialized medicine” bugaboo and Harry and Louise scared us enough to let private insurers keeping running things for a while longer. But that’s also, especially according to this movie, true of Medicare. If everyone, essentially, is on Medicare, won’t the costs become even more astronomical?
Paradoxically, no. Senator Obama is partly on the right path when he says he wants everybody to be covered and for employers who don’t provide health care to have to pay into a national system. What he’s getting at, although he hasn’t explained it very well so far, is the idea that in order for group coverage — whether in the form of a government plan or private insurance — to be effective, the young and the healthy have to pay in. Unfortunately, it’s not clear that his plan will fix the problem. Any system which requires that everyone be covered while simultaneously offering several different choices will naturally lead healthy people to choose the cheapest plan available to them, while the unhealthy will be forced to rely on whatever plan will accept them — almost certainly one funded by taxpayers.
Basically, no one who gets catastrophically ill can afford to pay for his own care. That care will always be funded by someone else: someone healthy enough to go to work and make money. There are two ways of accomplishing this. We can either all belong to one vast pool, where everyone pays in and those unfortunate enough to get cancer will be covered by other people’s payments, or the healthy can buy private insurance on the market and then end up paying taxes to subsidize treatment of the sick anyway. The difference is that if we do it the second way, we’ll have to establish some sort of means test for the sick — which essentially encourages people to bankrupt themselves to get medical care. Hardly a solution that’s good for the economy.
On the other hand, if we choose the first way, we can save on overhead, simplify the health care system enormously, provide incentives to entrepreneurship (if your family can still go to the doctor, you’ll be more willing to quit your job and start that dream business), and finally have the orthodontic care the British have long enjoyed.
So why do people resist it? Why has “socialized medicine” been such political poison for so long? In part, of course, it’s because insurance lobbyists have a lot of money to buy ads. (By the way, that’s part of what your premiums go for.) But corporate greed is only half the story. The other half is that there are many honest politicians (ha-ha, I know, right?) who are genuinely trying to do the right thing but who don’t believe the American people are ready to make the hard choices. Put it this way — if the insurance company tells you Granny can’t have a fifth kidney after a life of alcoholism and heroin addiction, that’s a very sad story, one you can tell Michael Moore as he strains to make vaguely sympathetic noises. But if the federal government tells you Granny’s through, you can do much more — you can write to your congressman. You can organize behind the candidate who promises fifth kidneys for everyone — whether they need them or not! You can donate to the MoreKidneys.org political action committee. You can, in short, exert all manner of political pressure to ensure that health care spending spins wildly, frivolously out of control, ensuring, as I.O.U.S.A warns, the end of America, and possibly the world.
Maybe I cracked wise too soon about David Walker’s “leadership deficit” idea. Surely only a great leader could call on Americans to accept death, curtail spending on fruitless end-of-life care, and essentially pack Granny a sandwich and some prayer beads before putting her on the ice. We need someone with the moral authority of an FDR or a Lincoln to call us to that kind of sacrifice, right?
Not necessarily. According to a USAToday poll fielded two years ago (before the current political campaign):
When asked if it is better to keep a terminally ill person alive as long as possible, regardless of the expense, or to make a judgment as to whether it’s worth the expense, 48% said it’s better to weigh the costs, compared with 40% who said to keep the person alive as long as possible, regardless of the cost.
Among those 65 and older, 60% said expense should be considered, compared with 28% who said cost should not enter the decision.
Sounds like Granny’s on board. Let’s start making some serious choices.