My Modest Proposal

On Decreasing Health Care Costs: A Big Olde Nicotine-Stained Proposal

(With many apologies to Jonathan Swift)

It has come to our attention that writers of better repute than myself have divined that the health care system in our blessed land…England, of course, for by the Grace of Our Lord no other land can be called as such with any sense of the honor imposed by the term…may someday cost our kingdom more than it does today. This hard to believe, for even the best life is worth no more than a pig and a farthing in the eyes of the physic, and is but half a thought in the mind of the Lord. Yet there are those, flushed with the bawdy proclivities and foolishness philosophies of the The French…natural rights, indeed… who predict a time when our colonies might dare to someday be independent and prosperous without the sheltering wings of our generous King, and who say that by the year 2006, should mankind still be upon this earth awaiting the rapture promised to us in the Gospels, that goodly band of rabble across the ocean may spend up to two trillion of their monies on health care each year.

Yet it is easy to recognize why this is so, as we walk about our homes and lands to see that followers of the Way of the Camel put Promethean fire to the tobacco leaves in our mouths; and that the hurly-burly of life, the hiss of the steam engine and the clatter of the coach traffic on the cobblestones streets, has caused many of us to worship at the altar not of the Almighty Jehovah, but at the King of Burger and his consort Wendy. And if we are to consider for a moment what may be next, just as the rebel Franklin talks about sparks from the sky as though they may be useful some day and the scornful idea of independence from their Mother Land…we might only expect these habits to worsen in our midst, until we eat foodstuffs on the advice of white suited colonels, makers of pommes frittes from Alba, and small canines of the new world speaking the Castilian tongue. We will chew leaves on the advice of Red Men and Bears of the North, and smoke products to remind us of fortunate moments at ninepins. Our machines will do our labor for us, and we will have no need for walking or exercise; we will become as a confined boar, growing larger yet losing our ferocity, until we are led meekly to the slaughter. We will develop disease such as the gout, which will make us immobile; we will develop dropsy, and our limbs will swell; we will find Hippocrates’ oncos and carcinos in our lungs, in our voices, in our mouths and noses; we will develop the disease of the honey urine, and lose the feelings in our limbs before the darkness envelops our eyes; our hearts will rise in defiant aggression and slay the body that bore it. The battle will be waged over many long and difficult years, and will cost us. Our purse will be poorer, and the costs will not be borne not only by the sufferer, but truly in every holt and heath.

But as we together lament the state of our wellness, and of our debts in this world and in the world to come, let us note the work of our Dutch colleagues (if such a continental can be called a colleague; still, Our Lord asks us to recognize good in all, even those who are not Loyal Subjects of Our Beloved King) who have used the bones of sheep and the motions of the stars to calculate the costs of living the life we seem destined to lead. They tell us that those who use the leaf of Raleigh and who revel in the kettled fat live less than those whose lives are a smokeless Spratt, but cost less, too. Those who live a more healthy life live longer, and cost more over their years than those who die sooner and quicker.

And so, my friends let us solve our problem in the most pleasant way. Let us smoke and drink, feast and sup, tell tales of humor, sagas of heroes, and legends of woe amidst the leafy haze of aromatic combustion; let us make merry. And let us die, quickly, painlessly, if the Lord grants us favor; but more likely hacking, coughing, suffocating as the malignant masses encases our lungs, or with the tense burden of Atlas falling onto our breasts, manifesting the weight f the world upon our arms and shoulders, giving off the sweat of honest labor as our heart takes that last…beat…beat…

And let us say Amen.

(Van Baal HM, et al. Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure. PLoS Med 2008; 5(2):e29.)