Saturday, September 8, 2007

A Generation At Risk

Rounding the bend into midlife, Gen X is finding that, as usual, we've got it all.

As kids, we got the aftermath of the 60s -- broken homes, drugged-out older siblings, schools that started to come apart, a culture scarred by Vietnam and Watergate and the beginning of the end of the American Dream.

As young adults, we got to watch it all unravel as Reagan and his successors gutted the New Deal social structures that had made our Silent parents and Boomer elders so wealthy. They got rising real estate markets; we got rental housing. They got pensions; we got 401Ks (if we were lucky). They got interstate highways and the Internet; we got New Orleans and 9/11. They got fast cars and two-week vacations; we got global warming and an extra day off now and then as long as we were willing to take it without pay.

And where they got what really once was the best medical care in the world, we got industrial food; 60-hour workweeks and double shifts that kept us estranged from our beds, let alone the gym; and HMOs that refused to pay up when the load of work and stress and bad food and a sedentary lifestyle and environmental garbage finally built up in our systems and made us old before our time.

And we are old before our time. I look around at American 40-somethings, and I'm frankly astonished at how fast we're aging. Fifteen years ago, our Boomer brothers and sisters didn't look like this: at 45, they were fit and fabulous and well on their way to doing what they'd always expected to do -- which is to say, live forever. A lot of them look better now than we do. Our parents, now hitting their 70s, are doing better than any generation before them. So why is it that we, still only halfway down the road ourselves, are showing so much more mileage?

We are not doing well. My beloveds, we are fat -- obese like nobody before us. Our hair and skin are both a little on the grey side. That wheeze -- I don't remember hearing that last time I saw you. We've got bad eyes, bad ears, bad teeth, bad knees. We've got reflux, ED, diabetes, hypertension -- conditions that used to belong to people 20 years older than we are. Too many of us are struggling with depression or some other mental glitch. In the absence of actual doctors, some of us are quietly medicating away our various aches and pains with booze and dope.

Because doing it ourselves is the way we've always done it. Somewhere in our early adulthood, that great insurance our parents raised us on evaporated, and we found ourselves on our own. Not that we minded that -- hell, we were the original latchkey kids, doing it all for ourselves since we were babies -- but there are some things in this life that nobody should have to deal with alone, and health care is absolutely one of them. It was one thing going without insurance when we were 25, on our own and starting out in robust health -- but quite another when we were 35 and trying to raise two kids with nothing more than a catastrophic care policy that cost more than our car payment. And now we're 45, most of us with at least one condition that renders us completely uninsurable at any price south of our entire monthly take-home. Turns out that working hard was no guarantee. Going to college was no guarantee. A six-figure income (should you be so lucky)...still not a guarantee that you'll get access to health care when you need it.

Health care has been a fraught issue all those years now --- years we've spent hanging on the phone with insurance companies and doctors, doggedly waiting on hold, sipping Maalox and popping Xanax while negotiating to get the bills paid. After a while, though, we learned. I think a lot of us just stopped going to the doctor unless and until it couldn't be ignored anymore. (My Canadian friends go see the doctor the minute their kids walk in with a splinter or a cough; but I've still got that old American habit that says, "Let's deal with it ourselves. If it's still bothering you in three days, then we'll go see the doctor.") You have to be damned sick for it to be worth the long wait to see an overworked and distracted doctor, the inevitable insurance fight, the astronomical bill, or the look on the face of the receptionist when you inform her you're paying your own tab. By this point in our lives, whether we've been blessed with insurance or not, the system has left both psychic and physical scars we'll carry to our graves.

Lower Manhattanite's stern warning below is a personal message; but I am here to tell you that the personal in this case is deeply, directly, outrageously political. Our prematurely aging bodies are walking (limping, aching) monuments to the planned demise of America's agricultural and medical infrastructure. We are the living, breathing (coughing, wheezing) results of that better life that corporate medicine and industrial food promised us 25 years ago. The free market was going to give us a healthier diet, better jobs, more time to rest, a sweet lifestyle, and "wellness care" at a much lower cost. We were promised that. A lot of us voted for that. And now the effects of all that are staring us in the mirror every morning, in faces that are not improving with age.

I know this is so, because y'all don't look like the people I hang with here in Canada. My Canadian girlfriends have had access to doctors all their lives. In their late 40s, they're healthy and rosy and active. The usual stuff's beginning to catch up with them; but they just go get the tests and drugs and surgeries required to put things back to right. The very fact that there's no strain or worry -- that they don't spend hours every week beating their heads bloody against a healthcare system designed from the ground up to deny them and their families needed care -- seems to have added years to their lives. It's time they get to spend hiking the Coast Range, kayaking in Deep Cove, or surfing in Tofino instead.

And I see it in the doctors' faces, too. My doctor in California worked 70 hours a week. She spent half that time actually seeing patients -- and the rest of it on the phone or writing letters to insurance companies to get her patients the care they needed. That was time she wasn't treating a single person, reading journals, learning new skills, or getting the rest she needed to do her job well. And beyond that, she had two people in the office whose only task was to coordinate with insurers.

On the other hand, my doctor here works 35 hours a week -- and goes home at the end of the day. She goes to conferences and keeps up on her reading. She gets a full night's sleep and frequent vacations. (Last spring she climbed Kilimanjaro.) Her one office assistant answers the phone, handles appointments, keeps the examining rooms turning over, and does the billing -- and also works 35 hours a week. The difference in care -- in attention, in the quality of thought, in her knowledge base, in sheer compassion -- has to be seen to be believed. And that's been true of every doctor I've seen here. Their only job is treating people. And they love their jobs.

We're in bad shape, and it is our own damned fault. Not only because we didn't take enough responsibility for our own health, as LM argues; but because we allowed truly evil people shred the system that was supposed to look after us, the way it looked after our parents. And now we're looking into the abyss of middle age without any support at all.

This blog exists because of one of Gen X's brighter, feistier lights -- a man who left us at the age of 42. Some of that was, undeniably, due to his own choices. But, as Jen has hinted, a lot of it had to do with the system he was caught in, too. Racism no doubt played its part. So did class and money and genetics. But let's not kid ourselves: almost nobody our age, no matter how white or how rich, is getting anything like the care we need or deserve as move on toward middle age. When you think of Steve, remember: There, but for the grace of Aetna and Humana, go any of us.

We're spending what fraying physical resources remain to us in a fight to take back control of our country from the gang of idiots, criminals, liars, and True Believers who did this to us. It's ironic, but probably true, that more of us will follow Steve in sacrificing our lives in this battle. But if we win, our children will, truly and finally, have decent, fresh, local food to eat, health care that's a right and not a luxury -- and, because of these, the expectation of much longer and more productive lives than most of us can expect to see. These things are very near the heart of everything we're fighting for. Like every generation before us, we fight on because we want our kids to have it better.

The fight may well kill us. But in the meantime, it's also our best shot at staying alive.