Postcards from the Bleeding Edge
Wednesday, October 21, 2009

  Reframing the issues of the health care "debate"

I am despondent on the whole health care reform thing.

I view it as a circus distracting people from the real issues, actually.

I was nearly driven bankrupt, twice, by the current system, and have a long list of detailed complaints about what is wrong with it at present. Coping with the current system, as it exists, with a pill for every malady, and pills to cure the side effects of those pills, and pills to cure the problems caused by the other pills... made me considerably more sick than I needed to be, for far longer than I needed to be, and coping with the stresses of the system didn't help either.

However, living where I do now, I don't have to pay into the US system any more, and I don't intend to go back. In fact, the risks involved in going back are so high - one traffic accident, and I would be on the brink of bankruptcy again - that it is a profound disincentive to even think about visiting the USA again.

So I really shouldn't care, anymore, but I got into a debate about it the other night and thought I'd type up my side of the argument.

I think that the legions of non-medically trained auditors and lawyers and lobbyists should not exist.

I also find the idea of one nationwide universal health bureaucracy for 300 million people abhorrent. I believe that the central government of the US should be as weak as possible and mostly concerned with national defense. If a given one of the 50 states wants Obama-like health care, great! Maybe people will want to live there more.

For example, both Massachusetts and Tennessee implemented Obama-like care a few years ago.

How's it working out? Is it a success? How are the demographics changing?

It is far easier to experiment with public policy at the state level than it is to do so at the Washington, DC, level, and far, far easier to rectify mistakes. Even then (witness the decline of California vs NJ, for example) it may take decades to reverse course.

Most importantly, most of the developed world is in a demographic trap. The old are getting older; there are not enough of the young. The haves - mostly the boomer generation, now - is trying to extract as much money as possible from the have nots - the successor generations - at every step of their slow decline into senility, so their Woodstock goes on and on while we have to clean up the messes they've left behind.

There are easy solutions to the demographic problem - lots and lots of immigration, easy citizenship, and incentives for child-rearing - that aren't on the table, and won't be until it is too late.

I wrote a story once, called "the good life", which was about a life insurance salesman that sold the "good life" to those young and healthy - cars, booze, parties, trips, etc - in exchange for a few organ donations when they hit 30... And naturally, being raised ignorant and away from valid work, they'd go into debt selling off more organs and limbs, partying further, after that, until they had nothing left but a brain attached to a few machines, and big payments to make on keeping those running too, and after that... nothing.

Their organs and limbs went to the old, who were living on cruise ships....

The old preyed on the young in this brutal dystopia until there were no more young left to support them, and revolution ignited between the oldsters fighting over the last "useful" young people, who by then were being bred in jars and kept in the matrix, dreaming, until they could be harvested for spare parts.

...

Jerry Pournelle writes:



I have a long list of things that would help American health that are politically unacceptable - from banning sugar and corn subsidies (as per the above), to taxing fast food restaurants, and taxing or banning bad foods, full of carbohydrates and such (and subsidizing vegetables in return), to taxing tivos, tvs, and game consoles (and in turn subsidizing gyms, yoga retreats, and international travel)

Here's another one: Why on earth do businesses still work 9 to 5, with employees wilting under dim florescent lighting, when outside there's a sun already shining? Is it to sell more vitamin D cream, gym memberships, and anti-depressant medications?

None of these solutions are on the table. On my bad days I tend to think that modern society is oriented towards killing off those that cannot summon the will to turn off their tivos and take a walk once in a while.

Lastly I'm going to quote a few more choice words from Jerry Pournelle on the issue of the largest health care cost of all - treatment near the end of life:



In anticipation of the flames, it's probably a good idea to put on my asbestos suit now... even though that causes cancer, in the long term.

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Comments:
Okay,

A few Comments: In no particular order.

If you want to live in a Libertarian Paradise, move to Somalia. No one is stopping you.

Buddy of mine suffered a genuine injury, head trauma whilst cycling in the UK and Netherlands. When he went to have his stitches removed in Sweden, and asked the Dr what 'paperwork' he needed, he was asked only for his name.

/Some/ folks cycle touring in the US from Europe carry air-ambulance insurance so they can be airlifted BACK to Europe in the event of an emergency so they won't be subjected to the horror of American Healthcare.

I like Pournelle, he's a great pot stirrer. See the 'Somalia' reference above.

So called torte reform, and malpractice garbage is a red herring. Malpractice awards started turning down over a quarter of a century ago. The number of malpractice complaints that even make it as far as arbitration is tiny. The awards fell off a cliff a long time ago.

The Health Insurance scam is immune to antitrust law. Price fixing at every single level. Every single one.

Health care 'rationing' is a complete red herring. One is more likely to die from lack of health care in the US than any other 'developed' nation.

You want an economic stimulus? Rip the health care issue right out of the employment equation. Every single person I know, holds their jobs and lives of quiet desperation solely because of access to health insurance. An entire culture tied to totally stupid employment, clutching to their jobs with everything they have, so they can have coverage. Remove that, and watch the start-ups spring up like lawn weeds in the spring. All the folks who have a passion for building stuff, making stuff, helping others with stuff, all that, hanging out shingles everywhere, Either succeeding or failing in a proper true market sense, without a worry as to whether or not that corn fed hamburger caused a cancer that will bankrupt their dreams

The US is able to fight wars on two fronts, with no end in sight, or for that matter, even detectably in mind, escalating in the midst of a huge economic meltdown. An economy that can't even provide basic care for it's own people.

The US ranks where, 22nd in quality of life? What do the 21 countries above it have in common, I mean ASIDE from universal health care? Ummm, okay.
 
I wish one could edit comments. But that's another subject.

Get over your whining about the 'woodstock' generation. Go check your facts. Also, you may more properly term that generation the Vietnam generation.
I know a *lot* more folks who saw combat in Vietnam than I know folks who attended Woodstock. By the way, most of those veterans I've known, are dead already, from various horrible cancers or complications so no longer your 'problem'.

Further, See:

http://en.wikipedia.org/wiki/Income_inequality_in_the_United_States

Yeah, your overall concept of taxing the crap out of bad health-lifestyle choices, subsidizing good lifestyle choices is politically feasible. You'll find folks of the same mind. Rip the subsidies right out of Big-Ag, and I mean RIGHT OUT. Repeal all ag based bits of NAFTA/CAFTA, heck, just repeal those things right out. put folks back to work, invested in their own food, and their own real work, you'll see a radical increase in healthy lifestyles. Can it be done? Yeah, sure. Will it be done? Aye, there's the rub.

Just like most of the staggeringly tall wall of 'issues' that confront us, there are PLENTY of things we COULD do to mitigate them. But what will we do?
Keep trying is all.
 
Hey if you have an accident are you gonna go to the clinic on the hill and suck Socialized medicine from the second poorest country in the western hemisphere OR are you gonna go to Metropolitan Vivian Pellas hospital and pay your way?
 
BTW how do you like the boonies?
 
And another thing!!
:)

I was spoke to the creative effect of releasing folks from their -often pointless- jobs to go give their own best contribution by un-bundling health care from employment, moving to a universal single payer system.

But the benefit to society at large is only part of this, imagine the benefit to business and industry if they could bring jobs BACK without suffering the burden of being the social safety net?
Why is it industry/businesses job to provide this social service? Maybe more outfits that used to employ tens of thousands of folks would be more receptive to re engaging on these shores if they were released from this yoke.

Just a thought.

In fact, it's a win/win, all the way around, the only loosers here, are the insurance companies themselves, whose job it is, at the end of the day, to deny coverage, not provide it.
 
@john: If I have an accident I will go to wherever is appropriate, and try to pay my own way, with my own money. Now, you can certainly argue that I am still taking advantage of subsidized care, and would be mostly right, but I wouldn't wish the American model on my worst enemy.

One thing I do like about living in Nicaragua, is that in most cases, for most maladies, I can research the problem on the internet, self-prescribe something that I think might help, go to the store, and just buy it, without any further rigmarole, like a doctor's visit, insurance forms, co-pay, etc, etc.

I recently had to do this for a friend with a scorpion sting. Prescription: Coffee (and aloe, had I had any), and time. It worked.

I am certain the over the counter drugs are mis-used, but I am not one to mis-use them.

In most cases nowadays, I just gut out whatever the problem is without seeking medical aid or medication. I think that antibiotics in particular are nuclear weapons that are being misused.

All kinds of potent drugs are beginning to contaminate the water suppy, as per this link:

http://www.pharmalot.com/2008/03/gulp-the-medicines-in-your-drinking-water/

Which marks another thing I like about living here - you can buy just as many pills as you need, not 30 or 300, when 2 or 3 will do.

That marks it up for medicine. Somehow I doubt that streamlining the process of making medicines available, in the appropriate quantities, is on the ogenda of the obama team.

As for treatment, the choices I have get tougher. My intent, if diagnosed with something terminal, is to die. I've finished my usefulness to this world, and I'd like to get onto whatever lies beyond.

In between, with something treatable, but not terminal, I don't know. I've tried to retain enough capital to handle all but the most major of injuries and illnesses, based on the going rates down here.

As I note in my post, a mere traffic accident and stay in an emergency room in the US would put a serious dent in my finances.

I like living in the boonies fine, although sometimes it gets a little lonely.
 
@cpm: As usual when responding to you, I miss netnews terribly. I would like to comment further but...

I just wanted to say that what you wrote here: You want an economic stimulus? Rip the health care issue right out of the employment equation. Every single person I know, holds their jobs and lives of quiet desperation solely because of access to health insurance. An entire culture tied to totally stupid employment, clutching to their jobs with everything they have, so they can have coverage. Remove that, and watch the start-ups spring up like lawn weeds in the spring. All the folks who have a passion for building stuff, making stuff, helping others with stuff, all that, hanging out shingles everywhere, Either succeeding or failing in a proper true market sense, without a worry as to whether or not that corn fed hamburger caused a cancer that will bankrupt their dreams.

Is probably the most compelling argument for universal care I've yet read. Well done!

One minor nit in what you wrote, is that, to me, Americans seem unusually afraid of everything, probably from the 24 hour a day helping of news full of terror and fear since the advent of television, and a sorely underused critical thinking facility.

I have met hundreds of travelers from all over the world now, many from places with universal coverage, and most just don't have the kind of fears about their health and safety that Americans do, even though they are in a third world country with no access to their own countries' care. They have pluck, spunk and a willingness to adventure that so far as I can tell left the US shortly after WWII.

(I realize my sample is skewed towards world travellers vs stay at homes. I can't help it, I LIKE world travellers, and I would like to see more of them)

What would be cheaper? $13,000 of dental work or an airplane ticket to Costa Rica and the same work performed there? Will the Obama plan cover that option?

On the other hand, given that it is impossible be free independent person, and to retain enough capital to get through a medical emergency in the US, An American's health fears are very real.

*I* have a passion for building stuff, making stuff, and helping others with stuff, and creating startups. You are sadly right, America's not the place for that anymore, or for me.
 
If you want to live in a Libertarian Paradise, move to Somalia. No one is stopping you.

Somalia lacks good surf, and I'm not sure if I'd dig their styles of music.

Buddy of mine suffered a genuine injury, head trauma whilst cycling in the UK and Netherlands. When he went to have his stitches removed in Sweden, and asked the Dr what 'paperwork' he needed, he was asked only for his name.

I read a really nice article about Sweden's system while researching my responses to you today. Regrettably I can't find it right now, if I find it I will post. It makes some of the points I am trying to make, quite well.

I would like the decision making regarding medical care to revert to the doctors, to be sure, but in a more pre-HMO, 1960s sort of way than what is on the table. Checks and balances exist to weed the bad doctors out that could be made stronger. The legions of parasitic hangers-on (e.g. the insurance companies) should go, somehow.

I like Pournelle, he's a great pot stirrer.

The current thread on this topic over on his blog is quite interesting.

So called torte reform, and malpractice garbage is a red herring. Malpractice awards started turning down over a quarter of a century ago. The number of malpractice complaints that even make it as far as arbitration is tiny. The awards fell off a cliff a long time ago.

I will research this further, unless you have a cite or two?

The Health Insurance scam is immune to antitrust law. Price fixing at every single level. Every single one. Health care 'rationing' is a complete red herring. One is more likely to die from lack of health care in the US than any other 'developed' nation.

My point being is that I don't see the current reform as fixing this, I see it as mostly extending this mostly broken system into the federal government, which has enough to do already.

The US is able to fight wars on two fronts, with no end in sight, or for that matter, even detectably in mind, escalating in the midst of a huge economic meltdown. An economy that can't even provide basic care for it's own people.

The US ranks where, 22nd in quality of life? What do the 21 countries above it have in common, I mean ASIDE from universal health care? Ummm, okay.


Which quality of life index do you refer? The HDI ( http://en.wikipedia.org/wiki/Human_Development_Index ) shows the US 13th, behind 12 other countries whose population, combined, doesn't add up to the size of the US's. What I proposed in my post, actually, was that obama-like care be tried at the state level, which in many cases have populations similar to those countries.

Get over your whining about the 'woodstock' generation. Go check your facts.

Which facts?

Also, you may more properly term that generation the Vietnam generation. I know a *lot* more folks who saw combat in Vietnam than I know folks who attended Woodstock. By the way, most of those veterans I've known, are dead already, from various horrible cancers or complications so no longer your 'problem'.

I could just as easily have substituted "vietnam" for woodstock and still made my rhetorical point. I could even extend it by commenting on the pre-vietnam generation that has insisted on putting America into two wars at the same time...

Further, See: http://en.wikipedia.org/wiki/Income_inequality_in_the_United_States

I tend to think that is a entirely separate problem than health care. I have long been concerned about the income distribution in the US, and will gladly debate that another time.
 
Also @cpm:

Yeah, your overall concept of taxing the crap out of bad health-lifestyle choices, subsidizing good lifestyle choices is politically feasible. You'll find folks of the same mind. Rip the subsidies right out of Big-Ag, and I mean RIGHT OUT. Repeal all ag based bits of NAFTA/CAFTA, heck, just repeal those things right out. put folks back to work, invested in their own food, and their own real work, you'll see a radical increase in healthy lifestyles. Can it be done? Yeah, sure. Will it be done? Aye, there's the rub.

I would welcome that. What would it take to make that happen?

Just like most of the staggeringly tall wall of 'issues' that confront us, there are PLENTY of things we COULD do to mitigate them. But what will we do? Keep trying is all.

My attempt was to re-frame the debate on what would do the most good and made the most financial sense, rather than focusing in "single-payer" as solving the real problem. Or do you think that the end of life issue is going to go away?

I was spoke to the creative effect of releasing folks from their -often pointless- jobs to go give their own best contribution by un-bundling health care from employment, moving to a universal single payer system.

But the benefit to society at large is only part of this, imagine the benefit to business and industry if they could bring jobs BACK without suffering the burden of being the social safety net? Why is it industry/businesses job to provide this social service? Maybe more outfits that used to employ tens of thousands of folks would be more receptive to re engaging on these shores if they were released from this yoke.


As I said, you make an extremely good point. Trouble is, is the details. Someone has to pay the bills somehow. Various proposals exist to tax people and businesses, and penalize people that don't participate, all of which have overhead.

I'd rather just keep enough capital around to handle emergencies.

There's a thought. How about a one time check, of about 200,000 dollars, issued to every American at birth, to be used solely for medical expenses? They exceed that, they are on their own. They manage their health prudently, it accumulates interest so they can extend their own end of life as far as possible. Sounds sane to me.
 
You call yourself Libertarian (or in that neighborhood) yet you'd support government dictating our diet choices? Hey, don't you remember that skinny dude in "Supersize Me" that lived on Big Macs? You CAN eat crap and still be sortof healthy. Seriously. Just don't eat so much of it.

If it's true that as much as 80% of our health care expenses come from the management of 3 common "lifestyle diseases" (drum roll.....smoking, drinking, obesity), perhaps Japan's requisite BMI for coverage is what's needed along with some other sound logic. How many of us who attempt to lead healthy lives should have to pay for David Crosby's liver transplant? (Ok, I know, he can afford it, but most can't. And some who need livers didn't voluntarily DESTROY the healthy one they had -- another discussion). How about chronic heavy smokers needing multiple bypasses, emphysema therapy, lung transplants, etc? And of course big ol' ladrdass has to have his/her diabetes managed right up to the 3 successive coronaries that arrive before he dies of a stroke. Oh, and all of these conditions leave us depressed, so on to the psychotropics they go. Nevermind that regular exercise has been shown to be 90% effective at getting folks off antidepressants. But that's not good for big pharma, methinks.

My question is, by what right would any government loot the wages of the healthy or innocent afflicted to cover the indulgent, insidious suicide of the reckless?

Clueless in OCNJ
 
Followup on earlier comment regarding what these utopias have in common:

The 10 "happiest" countries according to Forbes Magazine are (population follows country):

10. Belgium 11 million

9. Norway 5 million

8. New Zealand 4 million

7. Switzerland 7 million

6 Canada 33million

5. Ireland 6 million

4. Sweden 9 million

3. Netherlands 16 million

2. Finland 5 million

1. Denmark 5 million


Canada, with a population lower than that of California, is the most populous on the list. Might the attentiveness of the respective governments be inversely proportionate to the populations? As Senior Taht observed, federal government is simply far too clumsy and corrupt in a land this big and diverse. Keep it at the state level.
 
@snun:

Very nice to hear from you, Steve! When are you going to visit?

You call yourself Libertarian (or in that neighborhood)

No, I don't call myself libertarian, big or little l. What would you call a guy that describes himself thusly?

"I'm a a pro-nuclear green - a gun-toting democrat - drug-taking republican - a libertarian that believes that without unionisation no-one would be literate enough to read Atlas Shrugged - a communist that's passionate about protecting private property and a socialist that hates slow trains"

"Extremely frustrated with politics as usual" is the only label that works.

yet you'd support government dictating our diet choices?

It already dictates our diet choices, via subsidy of corn, as one example. Or, by fighting wars over oil to keep the big cities full of people that otherwise could be farming their own food. Pick an effect, I'll find a cause, and vice versa.

Earlier in this thread, I made a compelling argument for a health insurance provider (government OR private) subsidizing international travel - it's cheaper to outsource dental work to Costa Rica than it is to pay for it in the US, by far.

Hey, don't you remember that skinny dude in "Supersize Me" that lived on Big Macs? You CAN eat crap and still be sortof healthy. Seriously. Just don't eat so much of it.

Didn't see the movie, I mostly read books and the Net, and look at statistics and stuff like that... then I try to make the best rhetoric I can.

(Jeeze, none of you found my "good life" story chilling and apropo? Gawd, that's depressing. Where's the prozac?)

If it's true that as much as 80% of our health care expenses come from the management of 3 common "lifestyle diseases" (drum roll.....smoking, drinking, obesity), perhaps Japan's requisite BMI for coverage is what's needed along with some other sound logic.

Possibly!

How many of us who attempt to lead healthy lives should have to pay for David Crosby's liver transplant? (Ok, I know, he can afford it, but most can't. And some who need livers didn't voluntarily DESTROY the healthy one they had -- another discussion). How about chronic heavy smokers needing multiple bypasses, emphysema therapy, lung transplants, etc? And of course big ol' ladrdass has to have his/her diabetes managed right up to the 3 successive coronaries that arrive before he dies of a stroke. Oh, and all of these conditions leave us depressed, so on to the psychotropics they go. Nevermind that regular exercise has been shown to be 90% effective at getting folks off antidepressants. But that's not good for big pharma, methinks.

I totally agree with what you say here.

In my case, getting off of the medicines, quitting my job, and going to live somewhere sunny and cheap, and getting lots of exercise was the correct prescription for me.

I think it would be good for a lot of people. Maybe not so good for the US, as the brain drain of emigration kicking in would drain the place of it's last vitality.

What do you think about the whole end of life issue? That accounts for roughly half of the costs.

And as I've been trying to do with this thread, is move the conversation to things that would actually work, rather than what the single payer "debate" seems to be actually about.

My question is, by what right would any government loot the wages of the healthy or innocent afflicted to cover the indulgent, insidious suicide of the reckless?

I came up with a way to present this to someone, using the gun to the head analogy that libertarians often use about the use of force to collect taxes... I need to write it down, more later.
 
"Extremely frustrated with politics as usual" is the only label that works."

"Pick a party and stay with it" seems to be the guiding principle for the US electorate. Mooooooo. Can a man think for himself and still have religious or political affiliation? It's lonely out here indeed. Um, Go Phillies?

It already dictates our diet choices, via subsidy of corn, as one example. Or, by fighting wars over oil to keep the big cities full of people that otherwise could be farming their own food. Pick an effect, I'll find a cause, and vice versa.

Aha! But you dinna answer my query herey. Never known you to be evasive. Hm.
Agree with the "big city" problem. There's no dignity possible in urban piety. What would Dorothy and Toto have been had they existed in North Philly (please don't mention "The Wiz"). The rural poor can make their way. What of the citified?
 
What do you think about the whole end of life issue? That accounts for roughly half of the costs.

Compelling. But I've decided I'm against it. The end of life should always be avoided.
Wow! That was easy.

When are you going to visit?

I'm attempting an extraction of Stephen's feet from the mud. Then we'll be down in a flash!
 
@snun:

Boy, I miss netnews. It was so much easier to quote individual comments and respond to them...

"Pick a party and stay with it" seems to be the guiding principle for the US electorate. Mooooooo. Can a man think for himself and still have religious or political affiliation? It's lonely out here indeed. Um, Go Phillies?"

Plenty of people switch parties at least once in a lifetime. I would like it very much if America had a functional (or even dysfunctional) multi-party system, but it doesn't.

I would like it more if more people had a better developed critical thinking capability, and I've focused most of my efforts in life (with computers, the internet and web) towards making it possible to make thoughtful choices, instead of being manipulated by television.

I love that people can carry around Wikipedia with the wikireader now.

...

I wrote: It already dictates our diet choices, via subsidy of corn, as one example. Or, by fighting wars over oil to keep the big cities full of people that otherwise could be farming their own food. Pick an effect, I'll find a cause, and vice versa.

You wrote:

Aha! But you dinna answer my query herey. Never known you to be evasive. Hm.

I have a problem often, in that I find it impossible to please all audiences.

I often outrage those who I would otherwise like to have as allies.

I know that if I had dropped the idea of subsidizing good food by taxing the bad, that you would have found what I said easier to swallow.

Had I not put that idea in there I would also have lost those who would think cheap tofu for everyone would be a great idea.

Politics is a pragmatic discipline. You need to find some well heeled majority in order to get anything done in the first place, and in order to get a majority, you tend to have to make compromises.

(Not that I think any of this is going to happen, regardless)

What do I really think? As usual, my answer is skewed - if we tore up the superhighway system we'd see a lot more food locally grown, and we'd have less need to fight wars for oil.

I *would* like it, if from a calorie count perspective, it was cheaper to live healthy than not. I am open to suggestions on the best way on how to do that.

I was not particularly serious about the idea of banning fritos, but I wouldn't mind at all if a bag of them cost more than a pack of cigarettes.

(I'm not seriously proposing tearing up
the superhighway system, either, but some part of my audience probably revels at the idea)

Agree with the "big city" problem. There's no dignity possible in urban piety. What would Dorothy and Toto have been had they existed in North Philly (please don't mention "The Wiz"). The rural poor can make their way. What of the citified?

What will keep them down on the farm?

Now I note that quality of life, in many cities, no matter how poor you are, is far better than quality of life on the farm, in part because it's just easier to keep everyone fed and warm when they are stacked closer together.

The aggregate costs of providing education, housing, food, transportation, heating/cooling, are all lower in cities than elsewhere.

NYC has an incredible population density and an efficient thermal design, and as a result is one of the most energy efficient cities in America.

Another "modest" proposal to solve the energy problem - that would also lower health care costs - would be to tear down all the geographically spread out cities, abandon the west coast and the northern parts of the USA, as well as texas, and build 49 cities as efficient - or more so - than NYC - and move everybody there.

That would cut energy requirements for the USA by at least half, probably more.

Construction of the 49 new cities would put the entire population back to work for a very long time, too.

Do I see that on the table? No!

Go, Phillies!
 
Ooh Ooh Ooh! Pick me! Pick me! Is it my turn?

Cool!

Great exchange Dave, very well done. Keep stirring the pot.

Okay, some responses and comments in no particular order:

What would be cheaper? $13,000 of dental work or an airplane ticket to Costa Rica and the same work performed there? Will the Obama plan cover that option?

Some outfits already arrange medical care junkets to foreign lands because it's cheaper than 'our best health care in the world'.

The so-called Obama care, for one thing, isn't an Obama plan, and it isn't going anywhere anyway. Obama wanted to get some health care reform law on the books, and he's failing miserably. Obama didn't write this stuff. Even Obama isn't keen on a single payer system.

blah blah

My question is, by what right would any government loot the wages of the healthy or innocent afflicted to cover the indulgent, insidious suicide of the reckless?


Somalia awaits.

BECAUSE WE LIVE IN A SOCIETY! Go look up the term sometime.

Dave;
Your point illustrated by the Forbes (like I give a crap what Forbes thinks, as they are very very very much the porblem) breakdown. Yeah, yer right, this isn't really a federal thing. It's a bad place for federal work. Where the federal government best fits, is to construct a legal framework wherein the states can be allowed to go back to their respective members, and tend to these issues as they should. In this way, as you suggest, this could be more likely be handled in a European like manner. Good point.


There's a thought. How about a one time check, of about 200,000 dollars, issued to every American at birth, to be used solely for medical expenses? They exceed that, they are on their own.


Heh,
Neat idea. But again, it's something of a, , well. The way things work now, encourages folks to game the system. I want to talk about something else now.

Trouble is, is the details. Someone has to pay the bills somehow.

Lesse, EVERY SINGLE OTHER CIVILIZED COUNTRY already does this, Gee, how do they do it? Maybe we could ask them, eh?

Get over your whining about the 'woodstock' generation. Go check your facts.

Which facts?


To be continued
 
Which facts?

Okay. The 'baby boomers' that you seem to think embody all that is evil and wrong in the US social order.

Lets break it down:

(and yes, you could have made your rhetorical argument substituting vietnam for woodstock. I'd appreciate it, it puts a very different spin on things. Paint them wit the troubles they faced, instead of the fun they had. It's a different thing)
And for the record, the 'baby boom' started in 45 and went for 19 years (by my best understanding) during which time 76 million folks were born. With the boom ending in 1964. with a US population of around 180 million or so. (extending the baby boom to 1964 is a neat trick of statistics. Folks who got home from war at age 27 in 1945 ((average age of a returning WWII vet)) weren't having kids in 1964.) Anyway. US pop in 1980 was around 220 million. I postulate that it was those born between 1964 who are the ones driving the gigantic SUVs and murder pickups that slaughter the world with their addiction to fuel. It was these who brought the Harvard MBA to the forefront of US business. It was these folks who embraced globalization and brought the entire known world to it's knees. Yeah, sure, some of this goes back in the Vietnam generation, but not all. Of the folks I know who drive gigantic SUVs, and I mean HUGE SUVs, all of them are in their 30s, not their 50s. There are a whole lot of folks who were born between 1945 and 1964 who remember open highways with fuel efficient cars, and even then (the early-mid 70s) folks who drove gas guzzlers were looked down upon. With the newer folks, folks who drive fuel efficient vehicles are the ones looked down upon. the 'Hippie' is more derided today than ever before. Even the WWII redneck honkie types weren't nearly as hateful as the 30-something Harvard MBA, granite countertop stainless steel facade fridge globalized xboxers. Between 1945 and 2005, the greatest conspicuous consumption has been in the latter 2 decades rather than the first 2.

I suppose my overarching point would be that you /may/ buttonhole a generation of people as being the devil. But you can do that to any generation. So, why bother?

Oh, yeah, it's because those of us who have entered the whitewater stretch of this river of life (the 50s to the 70s) are the baby boomers. Okay, fine. Fuck you very much. I cringe to think of what it's going to be like when folks who were born between 1990 and 2010 hit this age. You think us baby boomers are bad? The wealthy upper middle class credit card and quake nurtured children of today who 'have the best health care in the world' are probably the least healthy generation this earth has ever seen. Adolescent onset type II diabetes? Are you kidding me? Their entire bodies built from GMO corn? Okay, enough of all this.

Ever wonder why the US is in the mess it is, whereas the rest of the civilized world -while they most certainly have their messes, they aren't messes like this- doesn't?

Well, I postulate that while we were trying to get back about our lives, they were rebuilding their societies from the ashes. And maybe that's what it will take for us.

To be continued:
 

Which quality of life index do you refer? The HDI ( http://en.wikipedia.org/wiki/Human_Development_Index ) shows the US 13th,



http://www.timesonline.co.uk/tol/news/uk/article3613926.ece

On a side note, David Crosby is one case. How about a fellow who was dianosed with pancreatic cancer (a quick death sentence for ANYONE) who 'miraculously' recovered, AND got a liver transplant by travelling across the country for a donor from the organ pool to Tn? Now, as we all know, getting an organ from the pool is nigh on impossible to start with. Having a cancer diagnosis precludes any of this, a pancreatic cancer diagnosis, many times that. I'm speaking only of our best beloved cadaverous vampire Steve Jobs. Jobs got a liver that -by all standards- should have gone to someone else. Therefore that someone else died, and Jobs lives, , , Like yer story.

Okay, that's all beside any point.

Lemme try to get back on an even keel here.


My point being is that I don't see the current reform as fixing this,

well, you'd be right. :)

Also, I don't see the health care debate as being wholly separate from the income distribution issue. In fact, I see health care as a manifestation of the income issue. As others have basically stated 'I've got mine, to hell with you. Why don't you be a paragon of virtue like me? I bore myself, raised my self, without crutches like sex, parents, society, education and therefore I and others like me are deserving of all things good, and all the lessers can eat cake.' Somalia awaits.

Okay, that's overstating.

Lemme try again.

I again, see health care as being tied to income. Those with the gold make the rules. Nothing new here.

As to what to do with these old people who soak up so much resource viz health care? Can't we just kick them to the curb? Well, in many cases we already do exactly that. My question is, if we are #22, or #10 or #whatever, what to the other 21/9/whatever do? Okay, their livestyles are healthier. Maybe for one thing, they are not constantly stressed out about some whacko in government stripping them of their means to survive.

To be continued
 
To some degree, this is a non sequitur. Of these 'better off' countries. Many have drank deep from the Globalization cool aide, and as a result are sliding into the economic morass we now face. Sweden for instance, used to have healthy industry. I own a 1973 Saab Sonett. There was no assembly line as such for the Sonett. It was hand built to the tune of about 2000 a year for the years it was in production. Final assembly done in a mechanics bay much like you would see in an automotive shop. It was sold. Folks built things, and sold time. Commerce! what a concept. Saab became a multinational, and is now being passed around like a low budget escort in Vegas at a fishing tackle sales rep convention. Folks who live there, tell me that unemployment in Sweden is probably around 10%. Lots of what we used to think of as swedish goods, husqvarna power equipment, that kinda thing, is now manufactured, guess where? Yeah, that's right. Even Ikea looks more and more like Walmart every day. Accept it, so-called globalization is NOT GOOD.

On that front, let's go back to my pet peeve, Mountain Top Removal. how does this bear on health care? Well, go down to the coal fields, start asking around the towns that haven't yet been buried under the 'fill' or 'overburden' and ask who has cancer? Ask how many folks have died from undiagnosed diseases in their 50s? These are the poorest of the working poor in this country. They die horrible deaths. Yeah, it's a health care issue. THe lot of the coal miner, the very ones upon which our entire way of life is wholly dependent since the advent of the steam engine has always been a sad lot. It got better for a while until Reagan busted the unions. Now it's a miserable mess. And my guy, Carter is greatly to blame for him signing the 'Surface Mining Controll and Reclamation Act' back in '77, basically greenlighting mountain top removal.

I believe in determinism. I believe that inputs help determine outputs. And there in lays the rub. In order to have a healthy life, you need healthy water and soil. The healthiest water and soil isn't any more. The cancers and diseases will spread more widely as time goes on, not less widely. You think I am wrong on this, but I most assuredly am not.

Dave, you speak to medications getting into the water supply. Brother, right here in our nations river. The Potomac, there is so much crap in our nations waterway that we have a brand new thing. The Intersex Bass. Go google it.

It's doing that to the fish. If it's in the fish, it's in everything. People seem to forget that they are also part of the natural order. As goes the little things, so goes the big things. In fact, the little things can do well without us. We CANNOT do without them.

Sigh, Okay, lemme try to steer this home.

I say it's all related. Our energy policies determine our environmental polices which determine our trade polices which determine our health care issues. Sure, walk a mile and eat an apple a day.
Walk a mile through the diesel and coal smoke fog and eat an apple sprayed with gawd knows what pesticide(s) that work by way of endocrine interruption. Are you fraking high?

To be continued
 
It's damned hard to tell folks to improve their lifestyles on the one hand, and feed them poisoned food and water on the other.

Yes, yes yes. Bottom up grass roots matters. It has to happen. But top-down leadership and vision is essential.

I have no real issue with China, like many others. I think it's fine for China to produce goods for the world market. Folks who want to produce and trade, more power to them. But the idea of trading good jobs for cheap goods is a loosing proposition. However, it's required for the kind of gross income disparities that we have today. So, do we limit income? No. But we can go all the way back to Deming.

Let's review:

1. Create constancy of purpose toward improvement of product and service, with the aim to become competitive and to stay in business, and to provide jobs.
2. Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.
3. Cease dependence on inspection to achieve quality. Eliminate the need for inspection on a mass basis by building quality into the product in the first place.
4. End the practice of awarding business on the basis of price tag. Instead, minimise total cost. Move towards a single supplier for any one item, on a long-term relationship of loyalty and trust.
5. Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs.
6. Institute training on the job.
7. Institute leadership. The aim of supervision should be to help people and machines and gadgets to do a better job. Supervision of management is in need of an overhaul, as well as supervision of production workers.
8. Drive out fear, so that everyone may work effectively for the company.
9. Break down barriers between departments. People in research, design, sales, and production must work as a team, to foresee problems of production and in use that may be encountered with the product or service.
10. Eliminate slogans, exhortations, and targets for the workforce asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belong to the system and thus lie beyond the power of the work force.
11. a. Eliminate work standards (quotas) on the factory floor. Substitute leadership.
b. Eliminate management by objective. Eliminate management by numbers, numerical goals. Substitute leadership.
12. a. Remove barriers that rob the hourly paid worker of his right to pride in workmanship. The responsibility of supervisors must be changed from sheer numbers to quality.
b. Remove barriers that rob people in management and engineering of their right to pride in workmanship. This means, inter alia, abolishment of the annual or merit rating and management by objective.
13. Institute a vigorous program of education and self-improvement.
14. Put everybody in the company to work to accomplish the transformation. The transformation is everybody's job.

Back to #1:

1. Create constancy of purpose toward improvement of product and service, with the aim to become competitive and to stay in business, and to provide jobs.

Okay, once again: 1. Create constancy of purpose toward improvement of product and service, with the aim to become competitive and to stay in business, and to provide jobs.

Note that there is an 'and' in there, not an 'or'.

It's stay in business AND provide jobs. Not stay in business OR provide jobs.
Providing jobs is #1. #1.
No jobs, no nothing.

To be continued
 
And yes, I've read Richard Florida. I'm familiar with the concept that since we have slaves to make stuff, we can all be artists (a horrible and disingenuous paraphrase, but it's got teeth).

Globalazation is the promise that you can save $8 on a toaster oven by giving up your job making toaster ovens.

Way back when, the then-president of US Steel stated publically "We are not in the business of making steel, we are in the business of making money' I invite you to go to this site, and enjoy the photo essay of the Bethlehem Steel Plant in Pa. http://www.oboylephoto.com/steel/index.htm

(I'm using Bethlehem steel here as a proxy for US Steel, because of the excellent photo essay)

What's the health care impact of putting people out of their lively hoods?

The post-baby-boom harvard MBA hasn't made things better, for anyone except themselves.

"Let them Eat Cake" says Goldman Sachs.
http://www.businessinsider.com/goldman-exec-inequality-is-the-path-to-prosperity-2009-10

Okay, back on track.

Get folks working, there is so much we can do.

77, carter signs the SMCRA, 1995, bethlehem steel closes. Coal use since then has SOARED! It should have peaked and turned down, but no, it has soared!

Backwards, turn backwards. 1970, 203 million US. Remember 1970? I do. Folks still drove VW bugs. Made in Germany. Very few domestically produced small cars. The highways were basically empty. There was 2 people standing in line at the lunch counter.

2000, Gigantic SUVs dominate the massively constructed highways, traffic is horrible, us population is 291 million (not baby boom-boom) You can't find a dark sky at night on the east or west coasts, there are now 3 people standing in line at the lunch counter.

Did moving from 2 to 3 make that big a difference? No. It didn't. Massively, incredibly stupid lifestyle choices made that big a difference.

Okay, back down to basics. Food, Shelter, and Clothing. Ever been to a Salvation Army store? There are PLENTY of clothes to be had. Everywhere around the country, housing market is dead. There are entire towns that are standing vacant. We don't NEED any more houses. Want, maybe, but need? Shuffle the dominos around a bit, and every /could/ have a place to live. Which leaves Food.

Last I checked 1% of the population was involved in the actual work of producing food. Oddly, of those 1 percenters, a lot of them live at the poverty scale. How strange is that. 1 Percent is doing the ONLY NECESSARY WORK, and 99 Percent is wasting air and space, and the 1 percent bears the burden. Again, back to income distribution. How about treating your farmer with the same deference and monetary respect as your oncologist? talk about life style changes? Perhaps if folks cared about their food, this health care thing would be a non sequitur.

On a side note, In conversation with an Oncologist, he spoke wondering where his profession was headed, as the 'new' oncologists aren't showing up to the party. And we are headed straight into a cancer epidemic, and the up and comers are no where to be seen. Chew on that one with your next McBurger.

To Be Continued
 
And a side note to that side note, every doctor I've had a chance to broach the subject with, and it's been a few. In person and on line, is fully in favor of getting rid of all this insurance garbage and moving to single payer, so they can get on about the business of doing doctor stuff.

Okay, trying to reign myself in.

air quality, water quality, food quality, life quality. All related at a cellular level, perhaps -if you believe even part of what the fringy types are saying- at the electron spin level.

We have massive unemployment. We also have lit up the earth with stupid sodium and mercury oxide street lights. Dont' spend one single nickle on this crap for crap (cash for clunkers) and invest heavily into starting up plants to make high output LED street lights. Replace that 2.5Kwh parking lot light with a 220wh LED array. Ding! 90% reduction in the need to burn coal at night. 90 fraking percent! Raise the cost of that same power to a logical market level, along the lines of 50 to 60 cents per KwH so that real environmental reclamation can be done.

Why does google need a data center in the DC area? There is no power center there. There is no gigantic solar array, no massive hydro. Relocate data centers to where the power is. Cut the power transmission replacing it with data transmission. Improve your solar. Heck, start building the damned things as if the lives of your children and grandchildren matters. Think, damnit, Think.

Dave, you've been fiddling with low power stuff for a while. We could enjoy our current rate of shiny happy toys at 1/10th the power *if* we put a real market value on the power. What a difference that would make.

Not another single nickel goes to a car, ever ever ever again. Build transportation that works. Oh, it's inconvenient? Well, extinction is pretty damned inconvenient to. Sure, there is room for cars where it's fun, and trucks where there is no logical option. But as a day to day regular thing? No fsck'n way. It's insane.

Bike, walk, ride. Since 99 percent of us aren't doing useful work anyway (heh) get serious about telecommuting. And un bundle health care from work.

There is a lot we could do.

And yes, it's all relative to health care.


Blogger wouldn't let me post this in one screed. So I had to break it up. Sorry.
 
And another Thing!

Heh,

Your mention of the efficiencies inherent in very high density living, such as New York, New York spurred a memory.

Back in '89, The EPA informed Metropolis that is had to construct a water filtration system to the tune of 8 billion, and thereafter spend 300 million a year to maintain it?
So, what did New York do? They spent 2 billion (that's 1/4) reforesting 2000 or so square miles of the Catskills. Done. Fin. Again, still again, just like pretty much always, it is not only better, easier but often cheaper to un-fsck a problem than it is to apply the 'techno-fix'. Those 2000 or so square miles of forest are now doing the job they have done for hundreds of millions of years. Making life possible. Forests work.

And that's my rebuttal to the techno-fix debate that is surely to arise here soon :)

I'm also still stuck on the 'poor lifestyle choice' part of this. 'Why should I pay for $stupid etc'.

We have ALL made a poor lifestyle choice. That's where we are today. Where do we go tomorrow? That too, is a choice.
 
I had a conversation in jabber with ethanol about all this this morning. He didn't post here, because, well, let me put it in his own words:

I read through your post last night, thought about throwing in, then decided it wouldn't be anywhere near enough fun to justify the time spent. (sorry)

The subject of health care in America fills me with a very weird combination of enervating ennui, cynicism, and white-hot rage.
That last one because I remember what it was like to have lost my job and health benefits (unless I wanted to pay thousands of dollars a month that I might need for something else, if I didn't find another job soon), and then get sick and need surgery.

I remember what it was like to delay going to the doctor, to negotiate with him, about what tests he could and couldn't perform (since I was paying for them out of pocket), to have a conversation about which antibiotics were most effective and which ones were available as inexpensive generics.

The richest f-ing country in the history of the world, and I had to worry about that s**t, while anybody anywhere in europe, Canada... f**k, anybody in costa rica... is covered...

...and people here are still bullshitting about tort reform, which adds, maybe, 1% to the total wasted medical expenses in the US.

They already had tort reform in ten or fifteen states--texas cut malpractice payouts to the bone--and it has had no effect at all, a negative effect in most places.


Me: I am still looking for statistics on that. What I would like to see is a cost breakdown of various procedures in various places and see where the money goes...

Ethanol resumes: There was an article in the new yorker a while back, about (I think) mcallen texas. It is a long article but worth reading.

I am, I guess, cautiously optimistic because it looks like something will pass. I worry it's going to suck. My hope is that it will a) suck somewhat less than the status quo, and b) suck in a way that it creates an unstable situation which will ultimately collapse into actual universal health care.

One of the many things that p**s me off about the debate part (that's aside from how p****d off I am about the status quo of health care)

How to put this? Ah.

I know many people who can look at the copyright debate and see, very clearly, that disney and universal and the other big content companies are fucking with the law so they can continue to charge rent forever, sucking money up out of the economy that they did not earn.

I also know many people who can look at the financial system and see, very clearly, that the big banks and investment companies are sucking up taxpayer money by the billions and giving back nothing of any value.

And yet many of these same people look at health insurance companies and shudder at the very thought of making them compete against medicare.

What the F**K? We spend twice as much money per capita on health care in the US, and 40% of the excess is spent by insurance companies. What they spend it on, mostly, is trying to avoid spending money on actual health care.

 
I said:

"My question is, by what right would any government loot the wages of the healthy or innocent afflicted to cover the indulgent, insidious suicide of the reckless?"

You responded:

"Somalia awaits.

BECAUSE WE LIVE IN A SOCIETY! Go look up the term sometime."


Ooh burn. Ak.
Ok. Thanks for your most thoughful and insightful response. I have heeded your advice and looked up society. Let's see... 13 definitions at dictionary.com. Not one of them mentions the abandonment of personal responsibility and reason as part of the equation. But, indeed, that nugget does seem to be the modern interpretation. Free riders are as big a part of the problem as the many villans at which you take aim.
 
Someone said:

"Your point illustrated by the Forbes (like I give a crap what Forbes thinks, as they are very very very much the porblem) breakdown.

LOL. I'll take the Forbe's breakdown over one that rates "nations" like Vatican City and Monaco atop its list. Indeed, the counties listed by Forbe's operate largely in antithesis to Forbes. I'll credit them for that.
 

Free riders are as big a part of the problem as the many villans at which you take aim.


Hardly.

Let me see if I can follow your logic along for a while.

For clarity, the original question posed was:


My question is, by what right would any government loot the wages of the healthy or innocent afflicted to cover the indulgent, insidious suicide of the reckless?


Well, right off, I'd have to say that the indulgent and reckless here are a pretty big bunch of folks. All of our energy companies, all of our chemical industry, all of our defense industry fits into these categories.

But let's take this question a little further. Your question begins with;
by what right would any government loot the wages

This can be restated as by what right would a government levy a tax.

Well, that's a long and quite old question, in a modern context it has to do with providing services. And if we can consider the issue of taxes settled, then it changes the entire discussion.

At that point, it is NO LONGER YOUR MONEY, it becomes OUR MONEY. So, it's a question of how do we spend OUR MONEY.
Yes, Ours, as in collective. As is Communist. as in Socialist.

Does society at large have the right to 'loot' wages? A whole lot of case law says yes. A whole lot of philosophical ethics debates in the social context says yes.

Now that society has done this, does this same society have the 'right' to spend OUR money to help people? I say yes. Does helping people include providing health care? I say yes. You may not. That's a debate we can continue.

On my bear-baiting comment concerning
Somalia awaits:

http://www.huffingtonpost.com/2009/05/06/somalia-libertarian-parad_n_197763.html

For that I apologize. For the rest, no.

On the Forbe's list, touche` fair enough. Monaco is pretty nice though. It's been a while since I was there. Never been to Vatican City.
 
Not directed at anyone in particular, Really. Just an observation.

http://img9.imageshack.us/img9/8140/leftvsconservatards.png
 
Here's an interesting story on NPR on the history of the US health care system. Apparently, it wasn't planned, it just kinda happened this way. More accidental than deliberate. Good reason to revisit I think.
http://www.npr.org/templates/story/story.php?storyId=114045132
 
You said:

"Well, right off, I'd have to say that the indulgent and reckless here are a pretty big bunch of folks. All of our energy companies, all of our chemical industry, all of our defense industry fits into these categories.

I can agree with you. However, the statement is a lame obfuscation stratagem that ignores the original premise. Mommy says that two wrongs don't make a right. Big industry is often reckless. Are you suggesting that excuses the obese, drunken, puffing masses that burden the medical system? I don't believe it does.

You said:
"This can be restated as by what right would a government levy a tax. Well, that's a long and quite old question, in a modern context it has to do with providing services. And if we can consider the issue of taxes settled, then it changes the entire discussion."

Again, broad and shallow dismissals like this are too convenient. Devils are always in the details. I don't accept that because we may agree that taxation and regulation ARE necessary, we should simply accept bureaucratic social engineering to any point. This is really an examination of limits. Government power can't be limited if it's duties aren't enumerated.
So, no, the question of tax is pretty far from "settled". It should be scrutinized to no end.
 
Hey Snun;

Perhaps you could restate? I think that perhaps I might be misreading you.
 
You posted a link to an image:

Not directed at anyone in particular, Really. Just an observation.
http://img9.imageshack.us/img9/8140/leftvsconservatards.png"


It makes an important point. If we have so much money to fight elective wars, why on earth aren't we better funding health care? It's a compelling quiestion, albeit simplistic. It's also a logical fallacy called "false dilemma" and it childishly polarizes the discussion in the most partisan way.

But rhetoric is the truth of the day in these parts, I see. Ideaology rules. So, excellent work.
 
You might reduce it that way. But you have to read into it.

On it's face, it simply states that some folks are opposed to using our money to kill people, and some folks are opposed to using our money to save people.
Now, it's true that some may be opposed to both, or even in favor of both. But your point is clear.

Simple. No reduction required.

Thanks very much for your clarification.
 
Ideology does not rule with me.

I'm too busy to participate in this discussion for the rest of today (I will comment tonight), but I would appreciate it if everybody chilled out a little, took a look at each other's points and found the ones on which they agree, and work on that for a while.

Everyone seems to be talking past one another. Very few of the points that I initially raised have been discussed, and most of the follow on ones ignored in favor of broadsides aimed at trivial points.

This is not what I had hoped for from this discussion.

I personally am delighted to have a cynical progressive (ethanol), a raging environmentalist (CPM) and a passonate libertarian (snun) all in the same room together.

Maybe some light will come from the heat, but it won't unless you read each others links and walk at least a few feet in each others sandals.
 
You said:

"Does society at large have the right to 'loot' wages? A whole lot of case law says yes. A whole lot of philosophical ethics debates in the social context says yes."

This is the logical fallacy called "appeal to authority". Again, it does nothing to directly support the premise of taxation (which I support, btw). Lawyers and philosophers say so? Well, that's nice.

Can we please throw away the nebulous and pleasantly academic euphemism "society" and call the bureaucratic machine that taxes us what it is... our government? Despite what it's supposed to be and at times tries to be, it is largely a collection of self-interested, palm-greasing lawyers. As such, they often do questionable things with "our money" as you call it... such as fighting these elective wars. So, to return to my original question, every expenditure by government should be met with some healthy cynicism such as, "By what right?"

More than 1/3 of Americans are obese. And that number is climing. THAT is, IMHO, our main health crisis. That it is completely preventable makes it very frustrating. Since it is forseeable that the morbidly overweight might make up a majority here soon, I see the looting (yes LOOTING) of funds to cover their lazy gluttonous asses practically unstoppable. Majority rules? Help!
 
"Ideology does not rule with me."

I know. Please excuse that insinuation. You reject it as I do.


Everyone seems to be talking past one another. Very few of the points that I initially raised have been discussed, and most of the follow on ones ignored in favor of broadsides aimed at trivial points.

Fair enough.


"I personally am delighted to have a cynical progressive (ethanol), a raging environmentalist (CPM) and a passonate libertarian (snun) all in the same room together"

Hey, now you're calling ME the libertarian :))) Touche! Unfortunately that shoe doesn't quite fit me either.
 
Okay, , ,
Moving forward.
Scenario, the 'compassionate libertarian doctor'. (hows that for a set up?)

The compassionate libertarian doctor might choose to not treat someone with a certain type of diabetes? Why?

Well, this is something I just learned, after reading up on what the heck do you do about insulin in a collapsing society.
Turns out, for some types of diabetes, you don't need insulin at all. (wait! wait! don't get the flame thrower out yet). Actually, in these modern times, you do need insulin. You need this because we mostly lead sedentary lives and are obese. Begging to Snun's point earlier. But Why?

This kinda brings up Dave's point concerning American timidity. Yeah, it's rare that you see a kid out riding a bike and eating an apple. Look at the freaking laws! (back to snun again). Government hath mandated thou shalt never allow a child to ride a bike unless armored lest thou fall afoul of the child welfare laws, and so on. Riding a bike is DANGEROUS! To be avoided at all costs. Go google the off-duty firefighter in North Carolina who shot a cyclist in the head because he was out riding with his kid. The guy was wearing a helmet, which deflected the bullet, saving his life. But the point is clear. If you bike, you are risking your life. Don't cycle. Stay home. In the basement, washing down the doritos with a 32oz coke, and play Rape and Mayhem IV on the Wii. Kids are only allowed to play in (adult) organized soccer games and so on. No unsupervised time. Well, I know what wholly supervised time does for me in my 50s, it makes me fat. Unsupervised time, otoh, is where exercise happens. Okay, where was I? Oh yeah, (some kinds of) diabetes and insulin.
Cool article in the last issue of the Rivendell Reader (#41, you can get it online). Turns out this guy suspected he had diabetes of some kind. Lotta symptoms that come and go. Kinda tricky to diagnose. Guess what? It's actually kinda easy to diagnose. Get a bagel, some strips and a blood sugar meter from the drug store.

(here's a link)
http://74.125.113.132/search?q=cache:r-MCaKuaWssJ:www.rivbike.com/assets/payloads/75/original_RR41_web.pdf+rivendell+reader+41&cd=1&hl=en&ct=clnk&gl=us

Go home, wait a while. Eat the bagel. Wait 2 hours. Prick finger, measure blood sugar. In this guy's case, his blood glucose was 230. Diabetic. Done deal. No blood screening had caught it. He went not to 1, nor 2 but 3 different endocrinologists, trying to nail down what it was actually. They were all kinda clueless. he basically self-diagnosed (a very bad idea, don't try this at home) himself with Latent Autoimmune Diabetes for Adults LADA or type 1.5 diabetes. Dr's never heard of it. Doesn't really matter, 1.5 *will* become type 1. Which means insulin for life. Or does it? He's told to get on insulin, eat 'better' but yeah, he can have carbs and sugar in moderation. Now, he's just demonstrated that he can spike his blood glucose to 230 within 2 hours of eating a bagel. Why on earth would anyone like this ever allow a single carbohydrate to pass their lips? Well, simply put, they wouldn't. He eats mushrooms, eggs, fish, vegetables, avoids carbos as far as he can (which is pretty far) and guess what? He is doing fine. No insulin. At least not yet. The science does support this.

However, the ADA (american diabetes assoc) knows that carbos are so much a part of the american diet that it considers them unavoidable. So, treat with insulin, and go with God.

Is there room for improvement here? Yeah, I'd say so.
 
I am running about 15 comments behind on this thread, and am still working on something else...

I was trying to get everyone to see where they agreed. I am certain we all agree that the current medical system sucks rocks through a straw.

I am pretty sure most of us, maybe all of us, think that it is going to get much worse and "something must be done" The chief causes are various (me: demographics, snun+cpm obesity and bad behavior, possibly more)

Do we agree on that much?

I can probably say comfortably that snun and I think that "something should be done" at the state level, and ethanol at the national level, and I don't know where cpm would fall on that particular question.

Anyway (I am way behind you guys - don't you have day jobs?)

I have three specific questions right now.

First, a really hard one:

1) What do you think of the end of life issue? In your proposed society, whatever it looks like (feel free to describe), how do you handle extraordinary expenses near the end of life? More bluntly: how, why, where, and when, do you turn off grandma? Who decides?

snun waved his hands on it, and gave a flippant answer. Nobody else even bothered to try to answer. Try. It's a really important question that will define the shape of the end of your life, too.

2) snun proposed that health insurance rates be tied to the individual's BMI, as they are apparently done in Japan.

What little research I've done on this appears inconclusive (wikipedia).

Theoretically, I like the idea, as it has better built-in feedback mechanisms to reward healthy behavior. I haven't (yet) been able to find details of the japanese plan, however, and perhaps there would be a better way to price coverage than the BMI. ?

3) It appears ethanol's statements regarding tort reform are correct, that multiple states have dramatically reduced malpractice awards and legal expenses for such, and the resulting decline in those state's actual medical expenses barely rises above the statistical noise.

I'm very interested in a more detailed analysis of this, and whether my tentative conclusion, above, truly matches the facts.
 
And then, there is the nifty thingee raised by Dave, (and by extension, Jerry, who isn't playing tonight) The Big Scary End of Life.

I have no earthly idea. At a total loss, me.

Folks i know personally, who 'made it' (that being beyond 3 score and 10) most recently was , , ya know what? I don't mean to cheat ya'll, but this stuff is intensely personal, not just to me, but to others close to me. In all cases but one, the end was more or less pretty clean. Some hospice care, and not much in the way of medicine. Just a warm and quiet and as comfortable as made sense for those final days. Living wills, pretty important. I have one. no doctor stitck as my alzheimers suffering dad put it in one of his rare moments of partial lucidity. I just don't think I can speak to this. Maybe others can. I know what I want for myself. I recently had to go under for a 'procedure' (get ready you youngsters, it's coming) The only thing I left the folks waiting for me was 'no lawsuits, have fun with the parts.'.
 
On that note, I did pop into irc for a bit, and quizzed some folks I know in Stockholm, NZ, and a few others places, and none of them had any first hand experience but they all pretty much allowed that it's a mess. For folks who are okay with shedding this mortal coil, it's not such a big deal. They don't do Terri Schiavo in quite the same way. They respect folks who want out. And they respect folks who can't say, so they allow the disease to progress, learning what they can along the way. It's tricky, and messy. And yeah, expensive, and the subject to some debate.

If you are asking me, what I would were I king of the world, Brother, I have no earthly idea. I'd call up enun or something and ask him. Because I know we'd disagree, and I'd weigh what he has to say. Because I just don't know.
 
Fed vs State,

I dunno. To some degree, a lesser degree today than 20 years ago, I still see the federal government as 'the enemy', however, after having soldiering for it myself, worked for it, with it, against it, paid taxes to it since I was 13, and so on. I don't see it as the monster some folks do. And honestly, I really don't see what a lot of the complaint is all about. The federal government pushes the agenda of the wealthiest all over the world. At gun point. Yet, all this push back when folks raise the spectre of using these resources and moneys to provide health care.

We already have a federal government health care system, it's called medicare. Is it any good? I dunno. Is it any worse than what we have now? I dunno. I read that at least some doctors would much rather deal with one centralized entity, than all these for-profit insurance companies. However, on the other hand, it's these same for-profit insurance companies that have created the economic environment wherein we can have all these hospitals and such. Wanna talk bureaucracy? Depending on what information you are trying to access, insurance companies design their flow charts to keep you from getting answers. Deliberately. The government may simply be incompetent, but I'll take incompetence over malice any day.

Federal vs State? well, you've got a good argument there. Sure, why put this on the feds when the states are scaled better for this sort of thing. I'll buy that for a dollar. Then it's up to the fed to create the legislative framework to allow for this. But I think I said this already.

And no, I don't have a job (today). My salary/hours has/have been cut. Thanks you insensitive clod! :)
 
Publicly administered health care works adequately, in theory, at the state level if and only if the state has a reasonably functional government and is large enough to take advantage of negotiated pricing and economies of scale.

California is certainly big enough, with it's 30-odd million residents, but its government is a dysfunctional nightmare. Texas, ditto, though for different reasons.

Wyoming and North Dakota, each of which has a population about twice that of Santa Cruz County, wouldn't have the negotiating strength to control costs.

Massachusetts could probably do a good job. Or, say, a confederation of the plains states, negotiating as a group. But if you're going to coordinate on a level higher than states, you might as well use the federal government; that's what it was invented for.

The fact is, both Medicare and the Veterans Administration do an extremely good job, and they're administered by the federal government, so I don't see why anyone is worried about that.

Regarding the issue of the last two years of life... I always find this subject tasteless, vaguely silly, and rhetorically cheap. Yes, most of the health care costs come in the last year of life. Also, your car keys are always in the last place you look for them. Neither of these facts is very surprising. The thing is, how do you know in advance which place is going to be the last one you look in? And how do you know in advance that any given year is the last one, and any potentially fatal illness that comes along isn't just a crisis that will pass?

And even if you do know in advance, how do you decide what's worthwhile? Our mutual friend Bruce, he knew. He died of a disease that virtually always kills within a year. Soon as that diagnosis came down, they could have said, "well, you're basically a walking corpse now, so piss off, we're going to save our money and let you die." Instead they did their damndest to keep him alive for a few more months with his granddaughter. You gonna tell her it was a waste of people's insurance premiums to spend them that way?
 
Here's a tidbit on Japanese health incentivisation...

http://www.thehealthcareblog.com/the_health_care_blog/2008/06/maging-obesity.html
 
Sorry... direct link

http://www.nytimes.com/2008/06/13/world/asia/13fat.html?_r=1&partner=rssuserland&emc=rss&pagewanted=all
 
David said:
"...The chief causes are various (me: demographics, snun+cpm obesity and bad behavior, possibly more) Do we agree on that much?"

I think so. For me the issues of demographics and exorbitant end-of-life costs are very difficult, if not impossible to really Solve. That is why I think we should start with what we can change... let's get healthier.

Disclosure... I occasionally smoke, regularly drink (seldom to excess), and have struggled with my weight for years (topped out at 240#). So it's with some self incrimination that I cite our bad habits. I believe that with the money saved from reducing lifestyle illness, we can offset to some degree the impending demographics problem and make the end-of-life expenses more tenable. No, it's not going to fix everything. But it is something we can and should be endeavoring. The questing remains, what is the best way to get folks to march in step?

Of course, the corruption of insurers and the HMO-doctor-patient relationship are not solved by thin vegans. But perhaps they would not have gathered so much steam if we weren't sitting on our squishy asses so much. It's a troubling paradox that as we pay more, our physicians make less; money disappearing into the coffers malpractice insurers and Leonard Abramson and his ilk.

But as sure as Natasha Richardson couldn't get a medevac, I'm one to tread very carefully into state control.
 
The volume of comments on this thread is still too much for me to handle rapidly, but I did spend some time yesterday doing some fact-checking.

* Supersize me

The wikipedia pages on this documentary were quite illuminating and interesting.

http://en.wikipedia.org/wiki/Supersize_me#Alternative_experiments

In looking at the discussion archive, I don't see any evidence of astroturfing. So
my conclusion is Supersize me is great rhetoric, and bad science.

If anything, it points to portion control as being the key to better health.

* Intersex fish (google for intersex fish)

Regrettably this particular study is behind a paywall. And, although the study took place over a decade, no trendline, control set, or much of
anything else is presented in the articles about it.

The conclusion is immediately drawn by most of the articles that female characteristics in these fish is abnormal and man-caused. From what little I've read of the paper, no
such conclusion is drawn. Here's a link to the actual paper:

http://tinyurl.com/yjzxekg

I may well ante up to read it (it's 20 bucks) because the "spin" on it in the press is making me a little crazy. (hit google, try 5 random links across the top 5 google hits)

This sort of context-free science reporting drives me insane. I want cites, damn it. History. Context. Preferably data going back before industrialization. The actual paper would be good to read, for starters... whatever happened to the free exchange of ideas in science?

There are plenty of gender confused animals, starting with amoebas and working up.

Have these fish been studied before? What is the natural occurance of intersex characteristics?
Have there been controlled studies of these species of fish in a more pristine environment? Were any similar studies conducted prior to 1995 in these areas? What were those results?

At least the articles and paper point in a good direction for further research.

* Effects of Tort Reform

I'm still looking for good references on this topic.

* My Biases re "Bigness"

I distrust Big. Big Science, Big Pharma, Big Government, Big Business,
Big Religion, if there's a "Big" part to it, my skepticism kicks in immediately.

There's a Big reason my current hardware/software project is called PocoBella - in spanish, it means "small beautiful" - thus far, it's a mostly successful attempt to disprove the idea that everything people currently are doing on the web and in the cloud belongs there. A lot of it can - and probably should - be done in the individual's home.

But I digress.

* Exercise

Observing 60+ kids getting on the beach to play futball (soccer) caused me to reconsider my role in the OLPC project. What right did I - fat, depressed, old and tired -have, to take their ball away and slam them in front of a carpal tunnel causing laptop?

* Portion control

An anecdote about soda pop...

Monday I got a mixed case of soda pop - all flavored with delicious, natural cane sugar - everything from fresca to coke in the original formula (even the original bottle). I got the case because I don't get to the store much, and the bottles were recyclable.

One surprising side effect about recycling is that I can keep track of where my empties are, instead of being out of sight and out of mind, if I had thrown them in the garbage.

I was shocked to realize that I - faced with this oversupply - drank 2-3 of these a day, where before I was drinking water (usually adulterated with coffee). That's a lot of calories!

One method to handle oversupply is to exercise self control, another is to simply not buy the stuff in the first place. I am leaning towards the latter, lacking the former. In some ways I like being carless and unable to get to a store easily.
 
snun said:


Of course, the corruption of insurers and the HMO-doctor-patient relationship are not solved by thin vegans. But perhaps they would not have gathered so much steam if we weren't sitting on our squishy asses so much. It's a troubling paradox that as we pay more, our physicians make less; money disappearing into the coffers malpractice insurers and Leonard Abramson and his ilk.


I couldn't agree more.
Well said.
 
On the 'gender confused' fish. This isn't a gender confusion issue. This is a intersex issue. Not the same thing.

In my case, it's a case of being too close to an issue. While I ain't no scientist, my social and peer group is pretty much comprised of scientists, and more than just a few wildlife biologists, some of which have been tracking this issue for a while, and are involved in the research. In my mind, this is one place (there are many, me thinks) where the scientific method falls down. Yeah, I know I'm stumbling through a canyon of logical fallacies here, but it just seems to me that folks in general, the scientific community in particular, is strangely particular about which issues it chooses to be skeptical. This sorta shouts out to your 'big science' comment.
 
Back to my earlier and somewhat off-topic remark concerning the compassionate libertarian. It occurred to me that I do know a compassionate libertarian. Here's a screed: http://www.acresusa.com/toolbox/reprints/Salatin_Sept03.pdf it's a fun read. And it kinda is germane to the topic.

On the 'real' soda pop. Man, nothing quite like an iced down 'real' coke in the afternoon after a hot day. Something we can't even do up here in anymore. As a rule, I quit drinking all that stuff a few years ago. My chronic headaches went away when I gave up aspertame. However, I still get a case of 'real' soda from time to time. Small bottler down in NC. Blenheim's Ginger Ale. (uses beet sugar) But a case lasts me a very long time. 2 or 3 a day? Naw, let that go.
 
I realize that I have a lot left to address on this thread, I hope nobody minds if I take my time, I have a bunch of things on my plate right now.

Data point. I spoke to the friend that had gone to Costa Rica to get her dental work done. This was the quote from a higher end office in the capital.

COSTA RICA: $3400.00 (1 week of treatment needed)

Where the quote in the USA was $13,000.00.

So, let's spend that money wisely...

Air Fare To/From Costa Rica from SF: $400 dollars

Hotel+food: 100/day = 700 dollars

Total Cost of treatment: $4500.00
Total Savings: $8500.00 (and, presumably, the option to stay at a cheaper hotel, or vacation for weeks or even months longer)

Does the idea of fixing American health care include outsourcing the care or not? This seems to be a rather compelling example of where an individual choosing their own health care would make a better/cheaper choice than the government.

(not that she can afford either treatment at the moment)
 


Does the idea of fixing American health care include outsourcing the care or not?


I should *hope* that further exploiting gross income/economic disparity doesn't become policy.


This seems to be a rather compelling example of where an individual choosing their own health care would make a better/cheaper choice than the government.


I'm a little set aback here.

I'm having a hard time even expressing a restatement.

Lemme try.

The individual is making a better choice than the 'government' by using the disparity between a 3rd world economy and a first world economy. Therefore, this is better than a government provided health care option?

I'm not even sure how to frame that thought process.

A great deal of the point of a so-called 'global' health care option is to avoid folks having the flee our shores to receive health care.

Perhaps I am mis-reading you?
 
Further,
on the actual situation you describe. It's a no brainer.

go to costa rica. By the way, what necessary dental treatment requires a week of work? You can rebuild an entire head in that time, including recovery (if all goes well). Not that it matters. Just curious.

FWIW, dental work can be shopped. I've paid as much (out of pocket) as $800 for a tooth extraction and as little as $50. The difference between urban and rural. Not saying you could find a semi-retired dental artist plying their trade out in the sticks to do the work for that price, but you might.
 
Komatta toki wa otagai ni tasukeaimasho.
 
I've been sick.

I have had an ear infection for a months now.

I went to the local (free) clinic for an examination but the line was too long and my ride was waiting to return me to the house.

So I went to the pharmacist, who suggested an anti-inflammatory, cleaning with alcohol and a mild anti-biotic cream. I didn't describe my problem well, possibly he thought I basically had said I was surfing too much and my ears hurt.

While the suggested drugs helped, the infection stayed on at a low level and came back with a venganza last week after I foolishly went out surfing after a heavy rain - in any part of the world, that means that man-killing bacteria have got into the water.

I was in awful pain. My glands got infected, too. I couldn't turn my
neck.

I went to wikipedia, researched the problem, self prescribed a few more heavy duty compounds...

I went to the free clinic to try for another examination, but they were closed, and I was again, low on time.

So I went to the pharmacia and bought them, over the counter. The owner broke the Cipro package in half and charged me half the full price for it, a nice touch (somewhat) as I do feel that most drug regimens are overprescribed and the spare pills wasted. (that said, it is foolish to develop strains of resistent bugs by not doing a full treatment)

A common tranq, "V*" is over the counter here, so are the famous compounds extolled by the spam bots for enha g your s x life.

Total cost of both treatments? 30 bucks. Total time taken out of my day? 10 minutes (minus the hour r/t to the pharmacia) I think the pharmacy acted responsibly in suggesting the milder treatments earlier, and I would probably have got the same treatment had I gone through the normal medical process in the USA, at far greater expense and hassle.

The downside of this, however, is that American-level competent medical *care* only exists in the hospital in managua that treats embassy staff and expats, and that is about 3 hours away from where I live.

I was prepared to spend the day - or longer - getting care up there. I still may, although I am MUCH better and can hear again, my glands are like little rocks (down from being big rocks). Perhaps I need another course of treatment to be rid of this problem.
(I really hate doctors anyway)

So, getting back to the problem of medical care here, if you need surgery fast, you're in for a long, bumpy ride to the hospital.

Still, I find the ready availability and low cost of what are commonly prescriptions drugs here to be a real advantage over the states.

On the other hand the relative scarcity of medical care is a huge disadvantage that is certainly life threatening in many cases.

I am certain the states will have much better care available in the cities than in the country, however, maybe to as low a level as what is here in some counties.

Also:

Living out where I do, a full medical kit would be a good idea to have.

Recently I had a friend who had a scorpion bite and I had nothing besides coffee and time to offer her.

In the case of anaphalatic shock, things like adrenalin (epi) pins are
over the counter, too. I think I will plant some Aloe vera, and acquire other crucial items needed for a jungle medkit up and including a shot of morpheme.

I'm told that a month long stay in that hospital is about $3k. So if you survive whatever you have, you won't kill yourself after seeing the bill. There is also a $600/dollar per year insurance policy that hospital sells directly - that will cover more major work by spreading the risk much like how blue shield used to work. I'm not using that, I prefer to just keep 3k around, accumulating interest. I may, as I get older and more rickety.

I'm exploring treatment options in costa rica, as it is only a short boat ride away, compared to Managua.
 
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