Doctor my eyes…

While you’all were doing whatever day-job you do between tweets, I was stimulating the economy and reducing health disparities: almost effortlessly. With two vitreous detachments, one of which took a morsel of retina with it, a budding cataract, macular changes, and astigmatism, I’m doing my part for Obama 2012 by supporting the ophthalmological economy. I’ve accomplished most of this using only the inside of my left eyeball. For the life of me I don’t understand why the Obama administration and Ben Bernanke can’t finish the job.

This ongoing experience leaves me with some mundane thoughts…

First, one has to applaud the routine excellence of the medical care enterprise. I have a laundry list of vision worries. Yet it’s corrected to near normal and will probably remain so for years. I can see fine to drive. So far the only real issues arise with reading my iPhone and making many more annoying typos in emails. I’ve been fortunate to work near major academic medical centers with good eye care. The retinal hole was fixed two hours after the injury in a blaze of purple light through (apparently beautifully-executed) laser surgery at Michigan’s Kellogg eye center. The hole is outside the visual field. So that issue is done.  My cataract will eventually be resolved through lens replacement, after which I will probably see better than I have since I was nine years old.

Second, my direct medical care costs have been modest because I have good insurance. Blue Cross Blue Shield has always covered everything, with occasional manageable copayment. On the other hand, my eyeglasses are absurdly expensive. For precisely this reason I dallied about getting expensive sunglasses, which apparently has accelerated my difficulties.

Of course low-income people face greater issues, and are thus more likely to put important things off. Vision care was one of the major services with appreciable demand elasticities in the RAND Health Insurance Experiment. Ninety percent of people in the free care arm with self-described vision issues received eye care. Only 76 percent of the people in the cost-sharing arm did so.  Among low-income respondents, 78 percent of people in the free plan, but only 59 percent of people in the cost-sharing plans had eye exams. Low-income people in the free plan were markedly more likely to get corrective glasses, and were therefore, on average, able to see better.  

I’ve said and written critical things about Amazon and Walmart. I don’t disown these comments. Yet there is a real need for people of modest means to get decent commodity eyeglasses at a reasonable price through an efficient distribution channel.

Third, this modest health challenge leads me to appreciate from a distance the tenacity of people who have more to worry about. I periodically get my pupils dilated, and have someone shine a bright light in my eyes for several minutes examining my optical innards. No one cuts, pokes, or prods. The bright lights are deployed for only a few minutes. Yet I’m embarrassed to admit that I find the experience quite aversive. Aside from my eyes, I have been fortunate in my physical infrastructure. I’ve had the occasional ER visit as a kid. Aside from one broken bone I have never been really sick. I have never experienced a painful illness or traumatic surgery. I’ve never been pregnant. I’m surrounded by millions of brave and tenacious people all around me. 

Finally, my eye issues produce some discomfiting thoughts about life planning. Like many academics on this list, my implicit retirement plan is to drag myself into the classroom well into my ‘70’s, sometime close to 2040. I’ve always figured that the usual age-related physical infirmity and mild slowdown in CPU speed shouldn’t stop me from walking into the classroom and droning on about Charles Murray and welfare policy. 

As the crush of email becomes more burdensome to process, I realize that my eye difficulties might eventually change that personal calculation. Many of us evaluate policy issues such as Social Security retirement age through a lens of relative youth and vitality as we work our physically undemanding jobs. Of course you never really know.