Health Care and Equality, with stories; commercial space; the lost war on drugs; and the Iron Law in action

Mail 798 Wednesday, November 13, 2013

Commercial Space is real:

6 satellites ready for space

Each one is a 10 cm cube loaded into a dispenser. They will fly to ISS next month. You can post the picture.

Someone told me Von Braun thought kicking sats out the door of a space station was the best way to do it. You heard this? Want to ask your readers? Would love to get a source.

Rich Pournelle

I remember that everyone thought von Braun said something of that sort, but I don’t recall him saying it when I was listening.

Subj: Thomas Aquinas and Philosophical Realism

http://wmbriggs.com/blog/?p=9884

Being a report on a Conference featuring, amongst others, Michael Flynn

— yes *that* Michael Flynn! 😎

>>Thomistic realism is the kind of realism you most likely have in mind when you bother to think about the subject at all. Stuff exists, it’s out there; other people exist; trees make noise if nobody is around to hear them fall, and so on. …<<

An antidote to much currently fashionable Stuff and Nonsense.

Rod Montgomery==monty@starfief.com

Mike Flynn is always worth reading when he makes Thomas Aquinas relevant in the modern world. Actually I have always found Aquinas relevant, but one must be careful of the translation, and alas, I no longer read Latin fluently.  Mike is a good teacher of Thomistic philosophy.

We have a great number of items on health care. I have selected a broad sample.

The President on Healthcare Coverage and the Midterms

Jerry,

For those that only believe in the nuanced, here are the President Obama’s own words:

"So let me begin by saying this to you and to the American people: I know that there are millions of Americans who are content with their health care coverage — they like their plan and, most importantly, they value their relationship with their doctor. They trust you. And that means that no matter how we reform health care, we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. (Applause.) If you like your health care plan, you’ll be able to keep your health care plan, period. (Applause.) No one will take it away, no matter what. My view is that health care reform should be guided by a simple principle: Fix what’s broken and build on what works. And that’s what we intend to do."

President Obama’s remarks at the Annual Conference of the American Medical Association on June 15, 2009, Hyatt Regency Chicago, Chicago, Illinois <http://www.whitehouse.gov/the-press-office/remarks-president-annual-conference-american-medical-association>

No nuance there. Nowhere did the President say, "for those that have non-junk policies," like his apologists are saying.

Although President Barack Obama has no election of his to worry about, I hope the consequences for the Democrats in the midterm election are as grave as those that befell President George H W Bush after

"I’m the one who won’t raise taxes. My opponent now says he’ll raise them as a last resort, or a third resort. When a politician talks like that, you know that’s one resort he’ll be checking into. My opponent won’t rule out raising taxes. But I will. The Congress will push me to raise taxes, and I’ll say no, and they’ll push, and I’ll say no, and they’ll push again, and I’ll say to them, ‘Read my lips: no new taxes.’ "

President George H. W. Bush’s Address Accepting the Presidential Nomination at the Republican National Convention in New Orleans, August 18, 1988 <http://www.presidency.ucsb.edu/ws/?pid=25955#axzz2jJOspjAE>

Special healthcare for the Congress, the President, and the Courts, and unspecial care for us.

A pox on their houses! Tar, Feathers!

As Bill the Cat would say, "Pfft!"

Regards, Charles Adams

 

 

Insurance and state rights

I am continually floored by otherwise reasonable people repeatedly comparing state mandated auto insurance with federally mandated health insurance. It’s a false comparison.

Setting aside the significant difference between state powers and federal powers for a moment, auto insurance is generally required under the notion that driving an automobile can be inherently dangers to others should you fail to drive in a competent manner and the insurance is their protection from your negligence.

How is requiring a single man to pay for coverage which includes maternity leave protecting anyone from his actions? How is having health insurance protecting anyone other than that person?

As far as the state/federal issue goes I find an appalling number of people have no understanding of federalism, no concept of state rights and still fewer see states as sovereign governments.

Regards

Will

Will Nonya

 

States Rights is just another way of saying that the Constitution created “A Nation of States” i.e. a Federal Republic. It was never intended to be a national democracy. And our school system has few civics teachers who understand the point of federalism and states to begin with.

From the Sacrament Business Journal via Weasel Zippers:

Specific language in the contracts major health insurers signed with Covered California to participate in the exchange required them to cancel the individual coverage which is at the center of a growing national debate.

Anthem Blue Cross, Kaiser Permanente,Health Net and Blue Shield of California have confirmed to the San Francisco Business Times that their Covered California contracts, signed in August or September, required the cancellations. Other plans on the exchange are subject to the same contract language.

More: http://www.bizjournals.com/sacramento/news/2013/11/01/covered-calif-insurers-non-compliant-can.html

On a healthcare related note my Dad, a WWII vet, called the VA today to get an appointment for his annual checkup. They scheduled him on a Saturday! Told him they that they had to start making appointments on Saturdays due to a sudden ‘increase in business’. Hmmm….

-Blair

 

Jerry,

http://blogs.wsj.com/peggynoonan/2013/11/04/obamas-catastrophic-victory/

One reason for the increased cost of Obamacare policies – MUCH higher taxes on insurance companies to pay subsidies http://blog.al.com/breaking/2013/11/rep_mo_brooks_blue_cross_to_pa.html <http://blog.al.com/breaking/2013/11/rep_mo_brooks_blue_cross_to_pa.html>

http://www.nationalreview.com/corner/363083/obamas-weapon-mass-deception-has-senate-dem-fingerprints-all-over-it-deroy-murdock

Ted Cruz is starting to look less opportunistic and more realistic

http://www.rushlimbaugh.com/daily/2013/11/04/the_obamacare_death_panels_have_arrived

http://www.nationaljournal.com/white-house/will-insularity-incompetence-and-lies-doom-obamacare-20131104

http://ph.news.yahoo.com/n-korea-developing-electromagnetic-pulse-weapons-135357782.html

Jim

Health Care, Freedom, and Equality: More

Dear Jerry,

Along with a number of others, I wanted to respond to your friend the doctor. You tended to focus on the obligation or lack of it from the Constitution (or elsewhere) to make me pay for your health care. While that concerns me too, maybe a simpler issue is more likely to engage your friend. He thinks that loads of other countries have better medical care than the US. I doubt it; I have relatives in Israel, which is pretty modern and actually at the forefront of developing new medical technology – and everyone there knows that you go to the USA for most major operations.

But say that it’s so; these other countries are better. Does that mean that the United States should set up a medical system that matches them? I don’t think so. Our current federal government is just not capable of it.

Most of my relatives are very liberal. I remember asking them five years ago, as the struggle took place over the health care bill: “Tell me the truth. Is this the health care bill that you pictured?” Pretty much all of them answered me, “Of course not. They were going to raise taxes and pay for everyone’s health care! It’s insane: How did they end up with this thing that’s written by health insurance companies and Big Pharma?”

A question for my relatives, and your friend the doctor: Can someone believe in both these statements, or are they contradictory? 1) It is appropriate for the US federal government to run the Coast Guard and help build the interstate highway system. 2) The United States federal government is currently controlled by politically connected special interests, is acting as a conduit to funnel money from middle-class taxpayers to the special interests that control it, and is right now more barnacles than ship. It is currently very difficult for that government to get anything worthwhile done.

Is it possible for a rational person to believe both of them? In fact, don’t most rational people conservative or liberal believe both?

And if they do, what are they arguing about? It isn’t proposition (1) (which makes it seem odd that so many liberals quote it as proof of something). It isn’t even (2), as everyone basically agrees on that as well. It’s a corollary of (2): Given that that is so, we should be very reluctant to put the US federal government in charge of anything important.

Dear friend doctor. I am sorry. I share your concern for the sick poor people of America. You aren’t going to be able to help them this way. Regardless of your plans and intentions, what you _actually end up with_ will be far more costly, far more cumbersome, and will kill far more people than it helps. The rules created will all be the result of political deals somewhere in Washington, nothing to do with what American health care needs. Perhaps you’ve noticed that this is happening already. I work at one of the premier teaching and research hospitals in America, and I can already see how we are diverting resources to handle edicts from Washington that force us to do things that aren’t good ideas for us. And we’re huge; we can handle it. Smaller hospitals will get killed, and so will medical practices. Doctors will shift to concierge practices where the patients are 100% responsible for dealing with insurance. Some of my doctors already have. All the lucky people who can now get insurance for the first time may find that they simultaneously cannot get doctors or hospitals.

That’s all assuming that they eventually get their website working properly. Have you noticed yet that they are incompetent?

Join the real Reality Based Community.

mkr

 

Yes They Can

Pass now to days of universal health care: can the Mayo Clinic exist? For that matter, can “Cadillac Plans” such as I have had with Kaiser for more than twenty-five years continue to exist under single payer universal health care? Could the Kaiser system itself survive?

——————–

To answer your question… YES, if you are in Congress…

“Why should Frank Herbert have access to better health care than I can get?” Or Bill Gates, or – but you get the idea. If we ever get to single payer universal health care that will be a question that must be answered. Why should anyone have access to something better than everyone can afford?

——-

I have to ask if these expensive procedures exist because of the research that went into creating them?

Was the motivation for doing the research from the expectation of a large financial reward?

Once the procedures were created, was there a financial incentive to make them cheaper and more mainstream?

Places like the Mayo Clinic can develop new techniques because they exist. They can do that here in the US, or in Borneo and Thailand, or some other more civilized place.

 

You wrote: "I invite comment. If we have universal health care, will it allow Bill Gates and Frank Herbert options that you and I won’t have? How? Will physicians be allowed to offer concierge practice to the rich? How will physicians be paid?"

My answer: VIPs will always get needed treatment, whether they be useful celebrities, really rich donors, or party officials. Streisand, Soros, and Sibelius will get whatever they need. The Koch brothers will get their care from their personal physicians and the black market. You and I are screwed.

But surely the Affordable Care Act will see that we all get affordable care? This is its intention.

 

 

Jerry,

I guess, in these chaotic times, that you and perhaps myself have lived past the time (times?) where the county doctor comes to the door. I suppose we have to find him and go to his door. Whether he will accept cash payment or not is an interesting question. I suppose maybe I and I hope not you, have lived to the time of the old curse "may you live in interesting times."

I imagine that the system set up will render my payments to the ‘independent’ physician moot. I imagine that the quality of care that I receive from undocumented ‘doctors’ in time may be diluted, you may however benefit. You know your doctors, or at least trust them.

I can go with the state sponsored "good enough docs" and must live my life with the declining quality of the ‘back alley physicians’.

In some way I find myself envying your position. I don’t know my ‘doctors’ and I have yet to meet them. You have the unique (at least in this time frame) of knowing your physicians, and they knowing you, albeit your individual condition(s)….

I have a generic (I assume) condition that a generic doctor has to diagnose. Who reads the ‘nets anyhow?

 

"If we have universal health care, will it allow Bill Gates and Frank Herbert options that you and I won’t have? How? Will physicians be allowed to offer concierge practice to the rich? How will physicians be paid?"

Dear Dr. Pournelle:

I would guess the answer to your question lies in the reification of concepts you have already explored under several different forms (variously in High Justice, and of course in Oath of Fealty), and which appear to be starting <http://www.economist.com/node/21541391> to <http://www.economist.com/node/21541392> happen <http://reason.com/blog/2011/12/06/seasteaders-take-to-the-land-in-honduras> in actuality (albeit at the moment with uncertain <http://reason.com/blog/2012/10/04/honduran-private-city-plan-shot-down-by> prospects <http://reason.com/blog/2012/10/30/another-blow-to-the-cause-of-honduran-fr> ): moving the elite institutions offshore, either in the current metaphorical sense, or literally (as in seasteading).

We already have a thriving <http://www.medicaltourismresourceguide.com/medical-tourism-in-2013> –albeit somewhat under the radar <http://www.npr.org/blogs/parallels/2013/11/12/244611440/will-colombias-gamble-on-medical-tourism-pay-off> –international "medical tourism <http://en.wikipedia.org/wiki/Medical_tourism> " trade: it seems likely the next step will be for the Mayo Clinic and others to expatriate themselves to friendlier venues, which will of course accelerate both the pace and the volume of medical tourism: a vicious (if you are the single-payer government) or virtuous (if you are the prospective individual consumer) cycle, but in any event a self-reinforcing one.

Very respectfully,

David G.D. Hecht

Indeed.  Which was really the point.

 

Universal Health Care

Jerry,

You ask if elite care will still be available under universal health care with a single payer. The answer seems obvious: yes. You can bet that the President, the Congress Critters, and their ‘best friends’ will have access to a level of care unavailable to everyone else. It will likely be provided by the same doctors and at the same clinics and hospitals that the rest of us go to, but they will not have all the odd limits that will crop up in all of our care. There will be that therapy, drug, or surgery that is inaccessible to the rest of us because of some cost-benefit analysis that they will receive without question or hesitation. There will be that extended care or therapy that mysteriously stops for us before it can do the most good, but will go on and on for them, regardless of benefit.

The cute thing about it is that even though these people can afford to pay for the elite care, they wont. The rest of us will through our taxes and co-pays. After all, it is universal health care with a single payer and everyone has a right to that care without additional cost.

I know it sounds cynical and bitter, but look at how Congress keeps itself above and beyond the law of the land in almost every other way. I don’t think any other conclusion is possible.

Kevin L Keegan

 

 

"If we have universal health care, will it allow Bill Gates and Frank Herbert options that you and I won’t have? How? Will physicians be allowed to offer concierge practice to the rich? How will physicians be paid?"

If we get universal health care Bill Gates will simply fly to where his physician is. I don’t expect this to be in the US, but [Canada, Mexico, Bahamas].

I predict he will find no shortage of very smart, very excellent, US-born physicians who will care for him there.

I don’t know where Mr. Herbert, or you, or I, will get our care. I predict what we’ll experience will be similar to the care we experienced in the military. Generally ‘ok’ to ‘meh’: expect lines, impersonal care, and bureaucracy.

—

Brian Dunbar

 

 

Two Interesting Stories of Health Care:

 

Health Care, Freedom, and Equality

Jerry,

I have lived under quite a few health care environments over the past four years in multiple countries. I’ll give you my perspective on my experiences. I visit the doctor more often than not for sinus/ear infections due to allergies and the amount of travel I do for work so I visit the doctor a couple of times a year.

1. Concierge Care – Houston, Texas

I signed up for this in 2009 as I was tired of waiting 2-3 hours past my appointment time to see my doctor. I had very good insurance but it made no difference. I learned about concierge care, did some research and interviewed doctors before I found the one I liked. At that time it was $1500 out of pocket a year but that came with a very comprehensive 2 day physical that included complete blood work, EKG, stress test, hearing, eyes, the whole nine yards. The physical alone was worth half the price I paid.

I was given my doctor’s cell phone and home phone numbers. He was on call to his patients at all times. This service limited a doctor’s practice to 800 members. He had his overhead costs covered right off the bat. Staff was minimal (less paperwork to process) and doctor visits could be scheduled an hour before you needed to see them. When I needed to visit there was no wait and the doctor spent a good 30 minutes with me every time.

Interesting thing is that they accepted insurance, including Medicare/Medicaid. The annual fee limited members per doctor so filing claims only required one staff member.

2. Expat Singapore 2010 – 2011

Moved to Singapore for work early 2010 and lived there for two years. They have socialized medicine. They also have private medicine. Your choice. I had expat insurance and could go anywhere but I went to the local clinics more than private doctors. Great thing was open pricing. I could call any doctor and ask how much a visit/procedure would cost and they would tell me. Completely open pricing. I could go to the cheap subsidized clinic and wait 30 minutes or I could go Cadillac to an expat doctor and pay a significant amount more. My choice.

I needed to get immunized for every tropical disease in Asia and went to a clinic in a shopping mall. 30 minute wait, 7 immunizations, total bill $20 US cash. I had a bad sinus infection, went back to the clinic, waited 30 minutes and had a doctor visit and my prescription filled for a total of $30. No insurance was involved at all.

When I needed a physical I went to an expat doctor and had the 2 day comprehensive everything physical. $1800 US.

All options are available and you can choose (if you have money).

Social care in Singapore is very good but there are limits. If you are diagnosed with cancer the state will treat you until you go into remission, once. If the cancer comes back they will give you opiates to ease the pain until you die. If you don’t want to die you have to pay for treatment yourself.

3. Expat Norway 2012

European socialized medicine. Within 1 month of moving there we were assigned doctors. No choice. Our neighbors were a nurse and anesthesiologist couple and they flat out told us to go to private doctors and to not use the state system. So there is a state subsidized system that everyone pays in to, and a separate private one that is used by those who chose to.

I encountered the state system the day we landed in Oslo. I had such a severe ear infection that as soon as we got to the hotel we dropped our bags off and went straight to the emergency room. Waited a long time and eventually saw a very young doctor. I told him I had an ear infection and antibiotics would clear it up. He looked at it, gave me some drops that “could cause possible permanent hearing damage” as he did not wait to make a call on antibiotics and referred me to a state ear specialist. $100 as I did not have Norwegian papers at the time. I did not use the drops.

Visit the specialist the next day and it is going back into the Old West. The array of instruments was spectacular and the autoclave nearby was assuring. He took a look and asked if the previous doctor has prescribed antibiotics. He was pissed when I told him no. To rule out the wild prognosis from the younger doctor he needed to take a sample for testing. I nearly came out of my chair from that particular violence and it is a miracle I did not punch him in the face. It was gratuitous and I was just an animal going through the system, just another guy to get through. Being from the US probably did not help my cause. $200 US.

After that I went to private doctors and was treated much better, albeit at cost.

Late last year I had an accident and cut three tendons in my hand that required surgery. Emergency room, surgery two days later, and a 3 month recovery. I was in the state system but at a teaching hospital so I received tremendously good care including physical therapy weekly for 5 months. Out of pocket maybe $300.

I also had a 50% income tax rate and a 25% VAT on all purchases including food while I lived in Norway so I consider the surgery and therapy a wash.

4. US 2013

Back to concierge care. I could not be happier. Shopped for the right doctor, found him and I’m set until the government comes and screws that up.

Overall, state care works at a lowest common denominator of care. I got lucky in Norway with the hand surgery. But both places I went had private options that cost more but provided more.

I have one body and one life and I take my healthcare seriously. I am willing to pay for it. Seeing the disaster that is looming with Obamacare I envision a lot of people leaving the system entirely to form private relationships with doctors outside of government control. I do not think anything good is going to come out of the path we are on.

Regards,

M

 

Universal Health Care and Equality-

Hi Dr Pournelle,

I just wanted to comment on "free" healthcare. If there is universal health care a separate paid system will develop alongside it. The big questions would be what is the quality of the "free" system and how expensive the paid system is, and is it available.

In the past 8 years we’ve lived in Mexico, Italy and Colombia. All three have universal health care, in Colombia one can pay a social security payment that is very low and reasonable and you can go to the public hospitals, which looked pretty terrible from the outside. We had private insurance so we went to the shiny new hospital that gave great care at a reasonable cash price, then we were reimbursed.

Then we moved to Italy where the healthcare is free. It was paid for by a 8% payroll tax that is taken off along with the 45% income tax. The key difference there is there are no deductions, so 53% tax is 53% off the top.

The healthcare there is very similar to what we received in the early 70’s at the Navy hospital in New Orleans, and the public health hospital we went to after they closed the Navy hospital, dumping Navy dependents among the riffraff.

The one key difference is in Italy there is no great incentive for doctors to be thoracic surgeons, so the best doctors

are pediatricians. There are really excellent pediatricians in Italy, just very little technology. To get an ultrasound

we had to travel an hour to Bologna, then it took a week for results. No trauma center in a city with 100,000 people,

so when young man was killed in a motorcycle accident down the street from the office, they sent a helicopter from

bologna. In the end, I made a deal with the company’s personnel people and paid the private insurance premium

so that we could use the good system of private hospitals that exist. Plus the 8% tax made for very expensive free healthcare.

Here in Mexico, everyone has a right to health care, there is also a pretty good private health system. We pay very reasonable cash prices in the private system and get pretty good care. It appears that many of the doctors in the private system have day jobs in the public system, so we get weird appointment hours of 7pm. I’ve heard horror stories about both the private and public systems; private hospitals that overdiagnose and operate just to increase the bill, public hospitals that are dirty and shabby. the public hospital I’ve seen looks pretty shabby, but they have a CAT scan machine.

The best outcome I can hope for in the US is that we end up with a crappy public system and the private systems switch to a cheaper cash price. Obamacare could be avoided just by paying the tax and going all cash, with insurance only for hospital stays.

The worst case would be a crappy public system, plus a private system that still keeps the current outrageously expensive price structure so that only movie stars and the 1% get good treatment. That is the sort of system that will breed revolution; instead of the sans-culottes we’ll have the sans-chemos and the sans-Cat scans.

The US lacks the uniform population and nice wine that makes the Italian system bearable, perhaps instead of pushing to repair the soon to be broken health system we should push for better, cheaper wine.

best regards,

Joe

The War on Drugs

The official complaint filed against the police is in a .pdf in the document. Evidently the man was pulled over at a traffic stop, a drug-sniffing dog started barking, and he was rectally searched 8 times and came out clean.

http://www.techdirt.com/articles/20131105/05401425129/cops-subject-man-to-rectal-searches-enemas-colonoscopy-futile-effort-to-find-drugs-they-swear-he-was-hiding.shtml

The one ray of sunshine is that the police were evidently honest and didn’t try something stupid like planting crack on him to justify all the hullabaloo.

I’m at the point where I’m willing to legalize pretty much all forms of drugs, though I myself indulge in nothing more powerful than caffeine or occasional alcohol. My cost-benefit analysis is as follows: Cost: No-knock police raids, militarized operations, and a way of life alien to that desired by the founders. Benefit : A street price increase on drugs, but continued addiction and the problems which come with it.

So far as I can tell, the war on drugs costs us all a great deal and benefits no one save bureaucracies and politicians who have made it their hobby horse.

Respectfully,

Brian P.

I have long thought that the war on drugs was lost from its earliest days. I would have thought we would have learned from Prohibition – and we repealed the Amendment that made the Volstead Act constitutional. If it took the 18^th Amendment to allow the feds to make possession and sale of alcohol within a state a federal crime, and we repealed that, which Article of Amendment makes the DWA constitutional? I asked Speaker Gingrich that one night in the Capitol and he had no answer, and began thinking about it, but apparently he was distracted because nothing came of it. But the question remains. Where do the feds get the right the forbid growing and smoking pot in your own back yard?

I find it intriguing that you wrote the passage below regarding the discussion about the Permanent Underclass just down the page from a discussion of computers "coming alive."

"The American education system, coupled with the drive for higher and higher minimum wages, seems designed to produce a society which would rather buy robots than hire citizens.

I suppose it is not appropriate to ask, Why wouldn’t it? Robots don’t form unions to demand guns, and they don’t feel entitled. And what do our schools qualify the lower half of the class to do." (emphasis added)

What if they did?

Nick Hegge

 

 

 

 

Exceptionalism

You derive most of your success from the fact you had a virgin continent to rape, at just the right time. There is no inherent superiority at all. With views like:

"I would agree that we have a cultural disdain for people that do not take care of themselves, and I think this is a right and proper disdain. I did not say people that cannot take care of themselves."

You are in fact a barbaric people. Simple and vindictive. You are also done. Fork is ready.

Chris Carson

This has been said before. I recall the Soviet Chairman speaking before the United Nations telling the United States that “We Will Bury You.”

The Mote in God’s Eye

Dr Pournelle

NASA photos <http://www.buzzfeed.com/awesomer/the-most-spectacular-nasa-photos-ever-taken>

God’s Eye is number 12. Is that the Mote north of the center of the picture?

Live long and prosper

h lynn keith

“If the draft rule is approved, it would allow the EPA to regulate virtually every body of water in the United States, including private and public lakes, ponds and streams.”

<http://pjmedia.com/blog/epa-stealthily-propels-toward-massive-power-grab-of-private-property-across-the-u-s/?singlepage=true>

——

Roland Dobbins

But that has always been the goal. At one point they tried to say that a mud puddle was navigable water subject to Federal control, and fine a man for draining his swamp. A Federal Action. The Iron Law always applies.

Freedom is not free. Free men are not equal. Equal men are not free.