Analysis: Did you see this coming?

Key Points

"I put instant coffee in a microwave oven and almost went back in time.""I was a peripheral visionary. I could see the future, but only way off to the side.""Whenever I think of the past, it brings back so many memories."-Steven Wright

These often-errant predictions serve as cautionary tales, since no one except Warren Buffet can really predict the future.

This truism occurred to me recently while observing some of the recent financial debacles in the United States and remembering what I wrote in this space long ago on the general topic of our economy. Early in 2008, I expressed concern that the U.S. unemployment rate had just ticked up from 4.7% to 5%. With some economists projecting that number may reach 10% (some states are close to that already), in retrospect a 5% unemployment rate seems like nothing. My predictions did not include a recession; I instead expressed hope that the economy would not get much worse and parents wouldn't be coming home to tell their kids that they had been laid off. So much for hopes for the future.

I give myself partial credit, however, for noting in that same column that the possibility of an economic slowdown was real, so ophthalmologists should think twice before expending capital on things such as upgrading their excimer lasers. Speaking recently with an ophthalmologist friend who owns an excimer laser, I learned that his volume had declined from an average of five to seven laser procedures per day to two procedures per week! Fortunately for him, he recently declined to fund a new laser.

Last night I took a group of my faculty and staff to dinner to celebrate a job well done for my department. In a fairly large restaurant with excellent cuisine and a reputation for great service, only two other tables were occupied during the evening. Although it was a little sad to see business so poor, fewer people dining out during an economic recession was something I certainly could predict.

I definitely did not predict, in a much earlier column here, the price-demand curve for non-refractive ophthalmic services and medical care in general. The point of my article was pretty much that we physicians were fortunate to work in a basically recession-proof industry.

That was way off.

Within the past few weeks, I read a front-page newspaper article about a man who had to decide how to balance his household budget. Given the rising costs of gasoline and other necessities, he made ends meet by not taking his two children for their annual checkups with the pediatrician.

An ophthalmologist friend, who used to grab lunch quickly because his office was always backed up, now can take 2-hour lunch breaks because his volumes are down. Another ophthalmologist recently had five patients cancel cataract surgery in the same week. The ophthalmologist's staff reported patients calling the office to postpone care or surgery because they were concerned about the Medicare co-payments. Supposedly 20% of Americans now are reducing expenditures on medical care due to the economy.

So we're to the point that medical care for our children is a discretionary item, less of a priority than digital cable. Blurry vision from a cataract is something that can be dealt with next year or whenever the economy sorts itself out.

While it may be impossible to peer into the future, it increasingly appears that accessing medical care may not be the recession-proof priority for Americans that it has been in the past.

Peter J. McDonnell, MD director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

He can be reached at 727 Maumenee Building, 600 N. Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu