Setting aside partisan policy issues, the point about this epic encounter is the manner in which the interest of a single person—albeit an archetype and icon—exploded into a metaphor of society. Joe the Plumber wanted to know what was good for him, not what was good for plumbers, his compadres in the building trades, the good citizens of Ohio, or anyone else in America, for that matter. In the case of Joe, the issue was taxes and, to Joe and many others, the optimal outcome in a world of personalized economics is to pay as few taxes as possible.
In the ebb and flow of dollars, personalized economics is at variance with personalized medicine and, because of dwindling money in the nation’s coffers, they are on a collision course. In the simplest form as promulgated by Joe, personalized economics involves giving as little money as possible to the government and possibly other cooperative instruments in society. Personalized medicine involves getting as much care as possible using all the bells and whistles of today’s technology. While rich people can perhaps afford the care inherent in personalized medicine, those less well off will have to rely on the help of others, whether from the government or insurers.
The election may be over, and controversy over the meaning of taxation may seem like a strange diversion. If, however, this country does not figure out how to spread the wealth around for healthcare—to balance the wants of Joe with the needs of the community—we are in for serious trouble, another of those Big Ones looming in America right now. In my next column, I will discuss further this difficult balancing act, especially as money for healthcare gets scarce.
Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center in Durham, N.C.