| Sunday, August
23, 2009
Was your brain cancer a life ending disease that
shouldn't have been treated? Roe vs Wade and privacy.
Jerry;
The conversation about the expense of treating people during the final
year of life should be alarming to most people, you in particular. You can
make a cogent argument that it is foolish and perhaps even inhumane to
"waste" money providing sophisticated medical treatment to people who are
"just going to die anyway." However; there are some practical questions to
consider. I suggest that you consider them in context of your own recent
experience with brain cancer.
How do you predict who is going to die and who will survive?
How high does the survival rate have to be in order to qualify your
treatment as life saving medical care rather than merely a futile waste of
money on someone who's just going to die anyway?
Should your age and probable life expectance even if treatment is
successful be a factor in deciding if you get treatment?
Do we want the Feds making these decisions for us?
Should we retain the right to get unapproved treatment by paying for it
out of our own pocket or do we want to have a single payer system that makes
it illegal to get medical care outside of the system? This is analogous to
banning private shools, tutoring and suplementary instructional materials
such as your wife's reading programs.
Should we grant the government a vested interest in restraining the
development of sophisticated and thus expensive, life prolonging medical
treatments such as radiation treatments for brain cancer so that there will
never be a demand for these expenditures?
Jim Crawford
Those are relevant questions. In my case there was
another factor: since they could not diagnose what kind of brain cancer I
had, there was no "standard" treatment, and some oncologists have told me
they would not want to order treatment of an unknown tumor. Fortunately the
Kaiser physicians ordered the radiation treatment -- no chemo therapy
because they didn't know what the tumor was, but the radiation seemed
indicated. I do not know what decision might have been made by a government
commission that sets standards; would the new health care authority give
such discretion to local pysicians?
I don't know.
At the moment we have a system that about 80% of
the population are satisfied with. The identifiable problems are (1)
transferability of insurance on changing jobs, and (2) a number of people
with no health insurance. Of that second category, a number are younger
people who are self-insured and don't want to spend money on health
insurance (as I didn't when I was young; I bought "dread disease" and a very
high deductible "disaster" policy, and otherwise we paid our own medical
bills. As we got older and had more children, health insurance seemed
indicated, and eventually we got into the Kaiser program, which we have
stayed with for at least thirty years now).
The question is, do we make major changes in a
system that satisfies 80% plus of the population in order to "fix" the two
0utstanding difficulties?
Of those two, one would presume that there's an
affordable "fix" to the first.
The second raises the moral question: who is
"entitled" to health care paid by someone else? If that be everyone, we
can't afford it; we will have to ration health care resources, meaning
cutting back on what is offered to those at present insured. There is no way
to afford "insurance" entitling everyone to what those insured at present
get.
And of course the notion that those who don't at
present have insurance might be covered by some minimum benefits policy is
not at all considered: equality trumps liberty here as with organ
transplants. (The very wealthy can get around the waiting lists imposed by
equality by going out of the country, and the very very wealthy have
shopping options from organlegger nations, but that is seldom discussed.)
Freedom is not free. Free people are not equal.
Equal people are not free. And it is not at all clear that it is "equality"
to give to those who didn't buy an insurance policy the same benefits as are
given to those who did. But perhaps that is another discussion.
But it is very clear that the changes intended in
the present health care proposals would end the present system and take us
inevitably toward the intended result of a single payer universal system. It
is also clear that a majority of the nation doesn't want this. It is not
entirely clear that the present government cares what the people want, since
the people don't always know what's best for them. "Arguing with you is like
trying to have a conversation with the dining room table." Our masters know
what's best for us. We don't.
Incidentally, we still won't have equality: members
of Congress will not be forced into the single payer system.
==
Healthcare
Data for the US for 2006:
Number of deaths for leading causes of death
(1) Heart disease: 631,636
(2) Cancer: 559,888
(3) Stroke (cerebrovascular diseases): 137,119
(4) Chronic lower respiratory diseases: 124,583
(5) Accidents (unintentional injuries): 121,599
(6) Diabetes: 72,449
(7) Alzheimer's disease: 72,432
(8) Influenza and Pneumonia: 56,326
(9) Nephritis, nephrotic syndrome, and nephrosis: 45,344 S
(10) epticemia: 34,234
http://www.cdc.gov/nchs/FASTATS/lcod.htm
The first thing that jumps out at me in these numbers
compiled by the CDC is that the top 4 and number 6 have a lot in common.
According to the Mayo Clinic, "Many forms of heart
disease can be prevented or treated with healthy lifestyle choices and diet
and exercise."
http://www.mayoclinic.com/
health/heart-disease/DS01120
The American Cancer Society says, "Regular use of some
established screening tests can prevent the development of cancer through
identification and removal or treatment of premalignant abnormalities;
screening tests can also improve survival and decrease mortality by
detecting cancer at an early stage when treatment is more effective."
http://www.cancer.org/downloads/
STT/860009web_6-4-09.pdf
The National Stroke Association says, "Up to 80% of
all strokes are preventable."
http://www.stroke.org/site/
PageServer?pagename=PREVENT
The American Lung Association (and many others) link
Chronic lower respiratory diseases (COPD) with cigarette smoking.
http://www.lungusa.org/site/apps/nlnet/
content3.aspx?c=dvLUK9O0E
&b=4294229&ct=5296599
As for diabetes, the American Diabetes Association
says, "Most Americans who are diagnosed with diabetes have type 2 diabetes",
and "Small changes in diet and exercise can prevent type 2 diabetes from
developing or slow it in its tracks."
http://www.diabetes.org/
food-nutrition-lifestyle/lifestyle-prevention.jsp
Those 5 causes of death in 2006 are over 87% of the
listed total, and all share a high expectation of prevention and/or control
with early detection and treatment. Preventive care is in the scope of
healthcare reform.
If there is a significant increase in the obituaries
that begin with "died peacefully at home", I can't help but think that there
would be a likelihood of a corresponding decrease in the total costs for
that last year of life.
Your recent dance with the radiation treatments seems
to anecdotally bear that out. You don't appear to be lingering in that last
year just yet (and I for one am happy for that).
I do find some irony in the observation that by virtue
of marrying the right woman and being eligible for Medicare, you enjoy the
benefits of affordable, high quality healthcare.
Bruce
I do not understand your definition of
irony. As to life choices, thirty years ago I decided that the evidence was
clear: smoking costs about ten years. Since you can get a lot done in ten
years, I quite smoking (after some forty years; when I started everyone
smoked and the Army provided cigarettes in the ration packs). I don't quite
understand the reference to marrying the right woman. I did that fifty years
ago, and health care choices were not part of the decision. As to
eligibility for Medicare, I was offered no choice in the matter, but I have
paid self-employment taxes for very many years, so if anyone would be
"eligible" it should be me.
In any event, I would not have
described my experience as a dance, but I will take some credit for marrying
the right woman and and paying my self-employment taxes for forty years.
As I have been saying for some time:
to make everyone eligible for the same benefits is beyond our financial
capability without lowering the benefits for all, which is to say,
rationing. How the rationing is to be done is a major part of the debate
(and inability to agree on how it should be done a major part of resistance
to this "reform"). Of course a private insurance company that offers premium
reductions for those who stay at recommended weight, don't smoke, and do
regular exercise will be accused of "cherry picking" and exploiting
inequalities, and you may be sure that the morbidly obese will find lawyers
to challenge the practice.
There are insurance companies that
offer lower premiums to selected groups, such as current and former military
officers; indeed, such companies typically offer rates far below those of
the next competitor. Of course they are letting the US government select
their eligible clients. In the past, health care insurance companies have
used similar means for selecting clients. Group insurance is almost by
definition "cherry picking". Should this be continued?
Clearly the best insurance strategy is
to have none (thus avoiding premium payments) until you know you are sick,
then get insurance from a company that cannot turn you down for pre-existing
conditions. Of course companies in that category generally don't last long
in a competitive environment. A "public option" that can't go broke because
it is subsidized by tax money would have the problem that most employers
would prefer to send employees to that than to buy a more costly private
policy. The next best strategy, in my judgment, is to belong to a good HMO.
Alas, those are scarce; I belong to a very good one, but many are not happy
with their HMO and the concept of requiring everyone to belong to one, which
at one time was popular among public policy wonks, seems not to be so
popular now.
If you can put all that together into
a universal plan that we can afford and which would survive lawsuits, you
will have done better than the current Congress.
The President promises that you will
be able to keep your present plan if you like it; but one does wonder how
that can happen if the company giving the insurance has to compete with a
publicly subsidized competitor.
I don't have any solutions here beyond
asking the obvious question: is everyone entitled to have someone else pay
for his/her health care? If so, who is the someone else, and how was that
obligation acquired? And on what basis does the entitlement rest?
==
The problem isn't the lack of health insurance -
health insurance itself *is* the problem.
The advent of health insurance has created a false
economy in which everyone assumes he's going to get more in benefits than he
pays into whatever type of insurance scheme, public or private, he's paying
into at any given moment.
Outlawing health insurance would solve the problem
quickly; a true market would develop, with the medical equivalents of
Wal-Mart, Bloomingdale's, and everything in between springing up.
House-calls, compassionate nursing, and other niceties long-departed since
the advent of GOSPLAN-type insurance bureaucracies would spring forth yet
again; combined with a tax credit (not a break, but a *credit*) for donating
monies to charities set up explicitly for the purpose of providing health
care for the indigent would largely serve the needs of the poor.
Prices fall, choice expands, the poor are served -
everyone wins.
Unless, of course, the object isn't to provide health
care at all, but rather to extend the tendrils of government into all
aspects of the lives of the proletariat in order to ensure their 'lifestyle
choices' minimize the healthcare expenditures of the State. But that
couldn't happen in America . . . could it?
---
========
Common Unsense
Below are some excerpts from an article on a
conference about how to work with NASA. I felt it was more of a cautionary
tale about why Govt officials should never be allowed to touch money. I
assume parents prepare their children for government jobs by teaching them
how to eliminate any shred of common sense from their work.
Still, the excerpts do provide light entertainment.
"Another potential hurdle for entrepreneurs is the
government's reliance on contracts that allow it to modify requirements
midstream, panel members said. Often, government officials are wary of
contracts that set a fixed price for goods or services, according to Muncy.
As a result, NASA often conducts research-and-development programs under
contracts that pay for the cost of developing a piece of equipment then add
a negotiated fee. "That dramatically raises costs and stops investment of
private resources to meet government goals," Muncy added. "Conduct a
cost-benefit analysis to see if you want to work with the government," he
said. "When you get money from someone, there are strings attached. Don't
forget to look at the risks and the strings."
Davidian advised entrepreneurs to find the people
within government agencies who support their endeavors. "Find your champions
within government," he said, adding that those champions can help
entrepreneurs succeed.
One champion of private industry is NASA Ames Director
Pete Worden, according to the panel members. "He's created a friendly front
door for entrepreneurs," Muncy said.
Worden said. "NASA should midwife new industries."
The space agency has not always embraced that role,
however. Conference participants cited many cases in which NASA did not
support entrepreneurs. Zero Gravity Corp. of Las Vegas, for example, faced
stringent requirements for handling combustion experiments aboard the
parabolic flights designed to support NASA projects even though no such
experiments were contemplated, Davidian said. Another benefit to working
with the space agency is that NASA officials will often support risky
research and development projects that are unlikely to be funded through
other sources, Pittman said."
http://www.msnbc.msn.com/id/32496569/ns/technology_and_science-space/
http://www.msnbc.msn.com/id/32496569/ns/technology_and_science-space/page/2/
R
Indeed.
=====================
The dragon in the backyard.
<http://www.economist.com/displaystory.cfm?story_id=14209932>
--- Roland Dobbins
==========
Potemkin villages in China erected to fool
bureaucrats.
<http://www.weirdasianews.com/2009/08/22/china-house-house/>
-- Roland Dobbins
===========
Subject: TSA
Dr P;
After spending the week traveling from Los Angeles to
New York (Rochester to Chicago, JFK to LAX ) I was struck at the regional
differences in post 911 travel at Los Angeles International vs. JFK. At LAX
when you check in your bags and proceed to the TSA security checkpoint, you
are herded into a roped off queue where TSA agents YELL AT YOU to make sure
YOU ARE FOLLOWING PROCEEDURES. As if the LOUDER THEY SPEAK, THE MORE YOU
WILL UNDERSTAND THEM.
At JFK with American, the lines were organized, there
were color flat screens well in advance telling you what to place in bins,
to take off your shoes and place electronics in a separate tub (side note: I
travel with way too many electronics) all in all a pleasant experience.
I have traveled through LAX over the years since 911
both domestic and international, and all times find the TSA presence to be
disorganized and inefficient. Individual agents can be nice to travelers,
but most are, well mean.
Is it intimidation at LAX and kindness at JFK?
Robert
I haven't had a particularly
unpleasant experience with TSA since Jacksonville, Florida a few years ago.
On the other hand, I work at being pleasant about being ordered about. It's
a good lesson in humility. I always wonder if they really think they are
making us all safer.
=========
'The school system gets about $7,560 in state funds
for each enrolled student. Its enrollment target is 83,777, and "any
student above that translates into more funding," Wasko said.'
http://www.msnbc.msn.com/id/
32523214/ns/us_news-education/
print/1/displaymode/1098/
- Roland Dobbins
==========
'I cannot Conceive of the Necessity of becoming a
Slave while there remains a Ditch in which one may die free.'
http://www.city-journal.org/
2009/19_3_urb-conservative
-revolutionaries.html
Roland Dobbins
During the Cold War there were
also those who said "Better to live on our knees than to die on our feet."
Also known as "Better Red than Dead."
Die Gedanken sind
frei.
======================dw
f
g
TOP
CURRENT
VIEW Sunday
The
current page will always have the name currentmail.html and may be
bookmarked. For
previous weeks, go to the MAIL HOME PAGE.
FOR THE CURRENT
VIEW PAGE CLICK HERE
If you are not paying for this place, click here...
IF YOU SEND MAIL it may be published; if you want it private
SAY SO AT THE TOP of the
mail. I try to respect confidences, but there is only me, and this is Chaos Manor. If you
want a mail address other than the one from which you sent the mail to appear, PUT THAT AT
THE END OF THE LETTER as a signature. In general, put the name you want at
the end of the letter: if you put no address there none will be posted, but
I do want some kind of name, or explicitly to say (name withheld). Note
that if you don't put a name in the bottom of the letter I have to get one
from the header. This takes time I don't have, and may end up with a name
and address
you didn't want on the letter. Do us both a favor: sign your letters to me
with the name and address (or no address) as you want them posted. Also,
repeat the subject as the first line of the mail. That also saves me time.
I try to answer mail, but mostly I can't get to all of it. I read it all, although not
always the instant it comes in. I do have books to write too... I am reminded of H.
P. Lovecraft who slowly starved to death while answering fan mail.
- Day-by-day...
- Monday -- Tuesday -- Wednesday
-- Thursday -- Friday -- Saturday
-- Sunday
-
-
Search engine:
or the freefind search
Boiler Plate:
If you want to PAY FOR THIS
PLACE I keep the latest information
HERE.
MY
THANKS to all of you who sent money. Some of you went to a lot of
trouble to send money from overseas. Thank you! There are also some new payment methods. I am preparing a special (electronic)
mailing to all those who paid: there will be a couple of these. I have
thought about a subscriber section of the page. LET ME KNOW your thoughts.
.
If you subscribed:
CLICK HERE for
a Special Request.
If you didn't and haven't, why not?
If this seems a lot about paying think of it as the Subscription Drive
Nag. You'll see more.
Patron Subscription:
Search: type in string
and press return.
For platinum subscription:
For a PDF copy of A Step Farther Out:
= = = = = = = = = =
For a Regular Subscription click here:
= = = = = = = =
Strategy of Technology in pdf format:
To order the nose pump I recommend, click on the banner
below:
Entire Site Copyright, 1998, 1999, 2000, 2001, 2002, 2003,
2004, 2005, 2006, 2007, 2008 by Jerry
E. Pournelle. All rights reserved. |
