A work of fiction for the health policy wonk

Albert Brooks’ 2030 was enjoyably depressing, funny in spots, and simultaneously plausible and not. For the plausible portion, it’s worth a read, especially if you prefer to consume your  health policy implications in fictional form.

The Plausible

  • Health care spending has not been brought under control by 2030.
  • Cancer has been cured, leading to a dramatic increase in life expectancy, putting additional pressure on the federal budget through increased Social Security and Medicare spending.
  • With the exception of the wealthy, the non-elderly in the US feel like they have no future. They feel as if too much of the economy is absorbed by funding social programs for the elderly. For this, some are angry enough to take to the streets and commit acts of terrorism.
  • The national debt is at historic highs.
  • Because of that debt, the nation cannot afford to rebuild Los Angeles after it is leveled by “the big one,” a 9.1 magnitude earthquake. Insurers lack capital to do so either.
  • China will not lend the US $3 trillion to start to rebuild LA, let alone the full $20 trillion it will cost to complete the job. No other nation or collection of nations are in a position to do so.

If not in detail at least in broad stroke, all of that is reasonably plausible by 2030. Thinking about these issues as Brooks’ characters navigate the consequences is not terribly different from thinking about the policy questions of today.

The Implausible

  • The US easily accepts a deal for China to rebuild LA in exchange for half the income from the city’s future economy. Not only does it seem crazy that such a deal would fly politically, it doesn’t even make sense. An economy doesn’t generate income one can use to pay off China unless we’re talking about increased taxes. But if China were willing to accept future tax revenue as payment, why would it not lend to the US in the first place?
  • The president is unaware what the terrorists who hijack a retirement cruise ship want. That makes no sense given the FBI interviewed the leader’s girlfriend and she plainly told them what his issues were.
  • Congress unanimously passes and all but a few states ratify a constitutional amendment to permit foreign born citizens to become president. It’s clear who the amendment is for, a Chinese born hero who helped reshape the US health system, beginning in LA. Again, who believes it would be so easy to amend the constitution in this way?

I was willing to let these implausible plot developments slide by so I could continue enjoying being generally depressed about the mess the US got itself into. Besides, these crutches were employed by Brooks so he could extricate himself from a novel that otherwise would have left the reader with no hope. That only illustrates how much trouble we could get into. Even the very creative Brooks couldn’t find a plausible way out.

It’s a funny book, for a horror story.

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