Intensely Focused

This is a really interesting book. I was caught up in it enough that I was willing to overlook some things when I was reading it, but once I finished and started to think about it was harder to ignore important points.

The book is set in America in the year 2030. The annual deficit outstrips the GDP and the debt, mostly held by China, is already an astronomical figure that no one really thinks the US will ever be able to pay off. Most of the money goes for caring for the "olds" (those 60+). Thanks to advances in medical technology, people are living longer than ever before. There is some sort of universal healthcare but it's not explained that well. Everyone is required to pay premiums but the sense is that nearly all the money goes for the "olds." I have no idea what the co-pays are or what it covers.

The situation is dire. Infrastructure has disintegrated but there is no money for repairs. When "the big one" strikes L.A. there's literally no money to rebuild. There is also a deep generational divide and the young have a nearly universal resentment of the olds, who they see taking all the money, jobs, and opportunity. They're also driving up the cost of housing. The animosity is such that the olds are afraid to go out alone and so they stick to themselves in gated communities and only travel in groups.

But here's one of those pesky problems. There's only one "old" who starts out poor and he dies in the quake. There's another that loses his worldly goods in the quake but he started off being financially comfortable. Meanwhile, the young are portrayed as almost always poor unless they manage to inherit money.

While Brooks certainly taps into anxiety about what may lie ahead as increasing number of baby boomers retire and go on Medicare and Social Security the real problem is going to be income inequality between classes. It's not just retiring baby boomers who have money, better access to jobs and opportunity. And there's no way Medicare will cover everything. They're already talking about cutting benefits to providers in the near future (which of course, effectively cuts benefits even though they're saying they aren't). That means that fewer providers will agree to see Medicare clients. The future of Medicare is looking a lot like Medicaid. Reimbursement rates are so low that many doctors refuse to take Medicaid patients (plus, there's a stigma attached to it in the medical community).

Without massive reform I think the saying will remain true: if you're wealthy, America is the best place in the world to be sick. If you're not wealthy or at least rich you could get better, faster care in many other countries.

When Kathy's father ends up in the hospital after letting his premium payments lapse, his surgery ends up costing $350,000.00 which is money he doesn't have. The hospital person in charge of his case tells Kathy she can take out a medical loan and anyone can pay it off. It's unclear why Kathy would incur the cost for her father's hospitalization. As the patient, it should be his burden. I can understand her wanting to help pay it off, but I don't understand how legally, it becomes her responsibility. It's ambiguous who actually takes out the loan. It's true that anyone can pay off a loan regardless of who owns the loan. That's true of any loan.

Her debt increases another $150,000.00 after her father's death. Again, I fail to see how this ever becomes Kathy's loan. That debt should belong to her father's estate. The fact that he doesn't have the money to pay it off doesn't matter.

It's true she could be homeless if there's still a mortgage on the house, but again, that's not her responsibility unless her name is actually on the mortgage and deed.

So I get that Brooks is trying to show the younger generation crushed by debt as exemplified by Kathy, the problem is that none of the debt seems to actually be hers.

I do think some of the medical ideas imported from China make sense. It would be nice to have some help when waiting in line. I wouldn't be surprised if remote surgery is the way of the future. But I'm less comfortable with the idea of having an RN doing the regular medical work. For wellness visits okay, but what about for things that are currently taken care of specialists?

Another problem with the olds have all the jobs postulation is that it flies in the face of reality. Even if medical advances physically allow older workers to work longer, one need only look at the unemployment statistics to see the problem. While those over 55 have a lower unemployment rate compared to those 25 and under, when they are unemployed it takes them longer to find employment.

I find his portrayal of what might happen if the deficit really does outstrip GDP more persuasive. What happens if we really can't afford to rebuild a city after disaster? Although speaking of that, I was astonished that there was absolutely no mention of New Orleans, a city that was also heavily damaged by nature, though LA was even worse. I will say though that broken or not, I don't see Americans ever sitting still for the idea of a foreign country having a large presence and very public ownership of an American city.

The book does raise some interesting points. How does increasing longevity affect the following generations? At some point does it become unsustainable? (And everyone should have a DNR!) It's definitely a book worth reading, just keep in mind that it's also a fairly skewed look at the generational and economic divide.