walkitout (walkitout) wrote,

_Never Say Die_, Susan Jacoby

Subtitled: The Myth and Marketing of The New Old Age

Just beneath the author's name in big red letters is "Author of The Age of American Unreason" in all caps, a sin I refuse to recapitulate. So to speak. Har de har har. That's probably the last laugh you'll get out of reading this post.

I bought this Pantheon (Random House/Bertelsmann) hardcover fully aware of many of its numerous, serious problems. It is debunkery. It is written by a boomer. It is about the "false" ideas and feelings and attitudes that people have about an ill-defined idea, with very little in the way of alternative "true" ideas and feelings and attitudes suggested to replace those railed against.

Think this might have useful, insightful policy ideas? Go elsewhere.

I knew this before I bought this book, and I bought it anyway.

What did I hope to get from this exercise? Well, I know that my ideas about managing health care issues in general (whether it's a cold or a baby or old age or whatever) are not representative of any readily identifiable segment of the population. I'm not so foolish or blind as to be unaware of that. I did not read this book thinking this author would share my ideas (quite the opposite) and expose everyone else as an idiot and us as the Chosen Few Who Know All. What I was hoping was that in the course of exposing what she thought were the errors of others, it would become clearer to me what everyone involved was thinking when they do the things they do that confuse me so thoroughly.

Did this work? Sort of.

Jacoby belongs to a cohort that included a lot of women who decided they weren't going to have babies and stay home, and instead went out into the Big World and Had Careers. Jacoby did not have children, which she mentions so it is not speculative or a violation on my part of her privacy, and she talks a little about women of her generation who were surprised to discover they had trouble having babies in the expected way when they decided to try to have a baby sometime after age 40. She does not develop this theme in particular, but rather glances off it as part of a more nebulous rant about being-in-denial-about-biological-realities.

Jacoby's husband predeceased (again, not me violating her privacy), and this experience shaped her perspective.

If Jacoby had written a book that went something like this, I would have very little to complain about:

(a) We're all going to die, and before that, most of us will require quite a lot of care. In fact, we're not going to be in a great position to be making decisions then (whether due to Alzheimer's or other), and neither will the people who love us, assuming there are any of them still around. Also, it will expensive and very unpleasant.

(b) We should probably be talking about this ahead of time, communicating what we want done to and for us, and figuring out how it will be paid for and overseen/advocated for. Since most of us aren't realistically going to be able to prepare for this financial and fiduciary burden, we should use political structures to come up with a group solution for those of us "lucky" enough to live for decades relying upon the assistance of paid non-kin.

(c) It would be wrong to expand all our society's resources on the demented aging, so we should also make sure we make collective provision for the health care of all ages in our society.

(d) Some of the better-off among us may have to give up disproportionately more in order to pay for all this. We'll probably all have to make some sacrifices, but that's better than really sticking it to a few people who are unlucky enough to be ill.

(e) But that's okay, because we've been spending a lot of our money in dumb ways. If we just got a lot less stupid, it would all work out pretty well.

I suspect, in fact, that's the book she was trying to write. Unfortunately, while the first third of the books shows a lot of evidence of very careful editing, it is mostly of the form of, hmmm, that generalization is obviously untrue; what adjectival phrases can make it technically true long enough to send the careful reader looking elsewhere for something to complain about while the less careful reader is led deeper into the rhetorical labyrinth.

The problems with this book do not lie in ridiculous generalities hedged about with careful qualifiers. They don't even lie in examples that elide not-enough-money-for-food-and-fuel-in-winter with not-enough-money-for-fashionable-clothing, or a story that asks us to sympathize with the 90 year old whose wife predeceased two years prior of Alzheimers and would now like to move back out of assisted living but his kids are in no hurry to help him. Oh, woe, the old ladies hit on him and the social director won't leave him alone.

Yes, I'm sure that's all true, but I'm just going to put worrying about that guy much, much lower on my priority list. Much, much lower.

The problems with this book lie in the nearly-300 pages that seem unaware that hospice can exist in a hospital (and barely mention hospice at all). That seem gleefully and enthusiastically unaware that our horrifying end-of-life bill and experience is a direct result of failing to see the consequences of "do everything if there's a reasonable hope".

I spent a long time reading this book (and I did, indeed, read the whole thing and I even refrained from detailing any, really, of the truly shocking errors that started showing up after the halfway point. I'm not sure if the careful editor got fired, reassigned, or they figured that anyone whose brain wasn't completely swiss cheesed had already given up and it was safe to let the party get well and truly started), and even longer thinking about it. This is an important topic, and there will be consequences if we don't, as a country, consider it carefully and make good decisions.

A moment of silence for that levenloos kind.

Okay, so what's really going to happen? Jacoby pretty much nailed it entirely inadvertently and in passing. We aren't going to do shit about this, because in order for anything to happen, boomers would need to lead. And they won't. If the parallel to the problem of infertility holds, we could reasonably expect the boomers to start taking the problems associated with being old in about 2025. Here's the calculation: boomers start in 1945. A boomer born in 1945 will turn 80 in 2025. Boomers don't believe that anything that happens to non-boomers will happen to them, so it will take other boomers being 80+ to convince them that this could happen to them. Boomers end in 1965. Those boomers will be 60 in 2025. Some of them will persist in the it-can't-happen-to-me, but it'll be an uphill battle. Also, a much more reality-based portion of the population will constitute a more significant component of the voting population (since by then, most if not all of the Greatest Generation will have stopped voting by then). I can't predict what -- if anything -- anyone will do at that point, but they'll probably at least be talking by then. Let's just say that's a lot of electoral cycles away.

Jacoby points out that the cohort in advance of the boomers is pretty chary about their own entitlements, much less extending benefits to anyone else. She does not (IIRC) note that that cohort votes reliably; that's a factor that shouldn't be ignored, but it's a classic boomer error to fail to do the math.

I would like to point out a couple of the benefits of Doing Nothing. Not because I think this is a good choice, but because it is going to be our choice for a long while yet and we'd better find some benefits there or we'll be so exhausted and sick of our own whining about it that we'll just off ourselves before we're eligible for Medicare. (1) When there is no collective solution, the territory of possibilities is often more thoroughly explored. Sometimes, this finds a better solution that can then be adopted. Sometimes. A lot of the time, even a bad solution implemented early would have been better. This is our hopeful moment. Dammit. (2) If we don't figure out a way to pay for all this care, some of this care will not happen, and people will die earlier than they might have with the kind of care currently being experienced by those in skilled nursing facilities right now. Your call as to whether this is a good or bad thing, but it definitely makes one view longevity statistics with even more skepticism. (3) People might start to take DNRs a lot more seriously. I think that's a good thing.

Don't waste your time reading this book. I don't have an alternative suggestion. Perhaps the next decade will present us with an entire genre on the topic. Whether that's a good thing or not remains to be seen.
Tags: book review, economics, health, hospital, our future economy today, politics
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