The bioethicist on education and health care.

Question: What are the challenges confronting the U.S.?

Ezekiel Emanuel: Well we’re in for a perfect storm. Medicare bankrupting the federal government because we have an increasing number of retirees. And not only an increasing number of retirees, but they’re also living longer. I think the average lifespan now, if you get to 65, is 17 and plus more years. That’s going to be a huge cost on a shrinking number of people who are going to be able to fund that; who are in the working population. So the increase of costs of Medicare, which is going to dwarf the Social Security problem. An increasing number of retirees. And tremendous problems with how to fund that.

Secondly, I worry tremendously about the primary and secondary school educational system. I don’t think we’re investing enough. And one of the reasons we’re not investing enough because so much money is going to Medicare and Medicaid that we have not been spending enough on primary and secondary education.

Educated populous is critical for economic growth. It’s also critical for a functioning democracy. And I think we need a lot more focus on education in this country [USA]. Not only primary and secondary school, but even before nursery school and probably early childhood development. That would be a major place of investment in my opinion.

Ezekiel Emanuel: Look. I think we have more than any culture society has ever had. We seem not to be satisfied by it, and I think that’s a terrible travesty.

Somehow people who are, you know, millionaires and billionaires need “more”. And we need to be able to redistribute it to everyone. I think it’s a shocking number for most people when they realize that the medium income – that means 50% of America’s families – live on less than $50,000. It’s actually lower than that. It’s probably $48,000. Now if you’re having difficulty living on a couple of hundred thousand dollars, or a million dollars a year, the fact that half of Americans live on less than $50,000; that is horrible in this rich country.

And I think we need to give more and to spend more for our collective good. The education of children is not something that is something that we all have an investment in. Having educated children is going to be important for us when we retire because they’re going to be the workforce. And we need a strong economy. It’s going to be important for our democracy and wise political decision. And I think we need to be more generous to the commons in that. And I think the fact that we have all this prosperity, and yet we’re willing to tolerate all this inequality, and some people are willing to; Hedge fund managers think that somehow they’re paying their fair share of taxes instead of paying their taxes at the capital gains right is somehow highway robbery and strikes me as ridiculous, and selfish, and self-indulgent.

Ezekiel Emanuel: Domestically we have to address four problems, and we have to address them relatively soon.

We have to address the global warming/energy problem. As I said, I do think we have the technologies. I do think we need to put in the infrastructure incentives just to let our best inventors and our manufacturing go wild.

Second, we need to reform the tax system to make it more fair, and to bring down income inequality. And I do think that’s going to be very important for funding initiative.

Third, we need to change our healthcare system to get a sustainable healthcare system that does guarantee everyone high quality care, and keeps the cost constrained.

And the last is we need to invest in education. I think those are our four big domestic issues. And I think they’re all within our grasp, and I think we need to do it for posterity.

Topic: Conspicuous consumption.

Ezekiel Emanuel: I would say five years ago, I was doing some work in Uganda, and I took my kids to Uganda. The family went to Uganda for three weeks. Nothing cures your kids like consumption. And the conspicuous consumption of having the latest “this,” the latest fashion of “that” is going to Africa to see how other people live. And then being a shopper at second-hand clothing stores is grilled into you. Wanting to do good for people around the world is something that is very, very powerfully motivating to youth.

I certainly think that something that I see a lot of kids in this generation of college students being very interested globally and wanting to get involved that way. I think it’s going to be much, much more positively influenced, and much more widely available to kids.

Recorded: July 5, 2007