Dr. Peter J. Weiss

I enjoy read­ing news­pa­pers, either phys­i­cally in-hand or online.  Each week­day morn­ing I read Florida Today, the Wall Street Jour­nal and the New York Times, and catch up on local, national and world events.

Two major themes of the cur­rent news sea­son are the drive for fis­cal account­abil­ity by state gov­ern­ments, and the unrest in the Mid­dle East.

Across the coun­try, state gov­ern­ments are deal­ing with bud­get short­falls of hun­dreds of mil­lions to bil­lions of dol­lars.  The states arrived in these sad finan­cial con­di­tions from years of ignor­ing the impli­ca­tions of their “finan­cial lifestyles.”

Too much spend­ing; too many pen­sion promises; too lit­tle straight talk about the prob­lems; avoid­ing hard choices — it all added up to fis­cal crises across the coun­try.  The time for bud­get account­abil­ity has arrived.

Our tra­jec­tory of health­care spend­ing and the rapid dete­ri­o­ra­tion of Amer­i­cans’ per­sonal health are both unsus­tain­able.

In the Mid­dle East, we see crises of gov­ern­ments’ legit­i­macy.  Auto­crats and dic­ta­tors are under pres­sure from their peo­ple, or have been over­thrown, as pop­u­la­tions have risen up to demand reform.

These kings are being held account­able for their mis­rule — decades of per­sonal greed, vio­lent repres­sion of dis­si­dents, and will­ful neglect of the legit­i­mate needs of their masses.  It’s not going well for most of these rulers who have been liv­ing large at oth­ers’ expense.

The core issues aren’t lim­ited to money and power. We will have our turn in health and health­care — both indi­vid­u­ally and col­lec­tively.  Like the state gov­ern­ments and the dic­ta­tors we have been liv­ing unsus­tain­able lifestyles, in will­ful igno­rance of the health con­se­quences.

We have cre­ated an Amer­i­can lifestyle that is killing us, and, while we ignore our own pri­mary role, we ask the health­care sys­tem to save us — shov­el­ing in the money.

Health­care spend­ing is cur­rently at 17 per­cent of GNP and ris­ing.  How high can it go?  It isn’t work­ing any­way.  We’re sim­ply not get­ting well, no mat­ter how much more we increase health­care.

How sick can we get?  How much can we spend on treat­ment that isn’t help­ing?  A magic pill is not com­ing.  Sooner or later we will have account­abil­ity, as indi­vid­u­als and as a nation.

Health­care is in a bub­ble, and bub­bles end.  Maybe not this year or next year, but they do end.  Our tra­jec­tory of health­care spend­ing and the rapid dete­ri­o­ra­tion of Amer­i­cans’ per­sonal health are both unsus­tain­able.  Bub­bles pop.  Peo­ple die.

Now bub­bles usu­ally end badly for most par­tic­i­pants, but not for every­one.  Those who wake up and take hard action early fare the best.  States with vision­ary and coura­geous lead­ers will weather the cur­rent and future finan­cial chal­lenges bet­ter than oth­ers.

Some mon­archs will remain in power by respond­ing to the legit­i­mate needs of the peo­ple.  Sim­i­larly, some Amer­i­cans will take account­abil­ity for their health before it is thrust upon them by a cri­sis.

How about you?