Health Care issues, government shut down, marvels, and other matters of interest.

 

Mail 793 Tuesday, October 08, 2013

The following is by a highly successful cardiologist, and sums up some of the problems with health care; factors which must be considered.

One of the issues in medicine is that things simply cost more than they did and the care is much better than it was 30+ years ago when I started. As an example, when I started in medicine if your knee hurt because of arthritis, I gave you 2 aspirin 4 times a day. We knew that could hurt you, but it made the pain more bearable. Now we send you off for an artificial knee! We’ve gone from a cost of a few pennies per day to a cost of tens of thousands of dollars.

In my own field, when I started if you had a heart attack, I gave you nitroglycerin and spoke with your widow after it was over. Then I begin to give you thrombolytics (clot busters) and that put my conversation off with your widow for a few years. Now I rush you off the the cath lab, put in a drug coated stent and give you aspirin and Plavix and your wife is stuck with you for decades if you have a modicum of common sense. The care is staggeringly better!

The cost of all of this has increased and not in small way. This problem is worse in the US than anywhere else as illustrated.

<http://b-i.forbesimg.com/danmunro/files/2013/08/cost1.png>

Is universal health care part of the answer? (The below is stolen from Dan Munro)

* There are about 200 countries on planet earth – and only about 40 have a "formal" healthcare system (which includes access, delivery and payment for citizens within a given country).

* The U.S. remains the only country (out of the 40) without "universal access/coverage."

* All of the countries in the chart above, almost all of them except the US, have universal health care (note that they don’t all have the government paying for all of health care). The cost is less and the quality of care is mostly better.

Why don’t we have/approve of Universal Health Care in the US?

Fear – which is largely fueled by three things.

1. A false assumption (with big political support) that a system based on universal coverage is the same thing as a single payer system. It isn’t. Germany is a great example of a healthcare system with universal coverage and multi-payer (many of which are private insurance companies).

2. An attitude and culture of what’s loosely known as American Exceptional-ism. There is simply no other country on planet earth that can teach us anything. Our entire raison d’etre is to be the world’s beacon of shining success – in freedom, liberty, democracy – and really everything (but especially technology).

3. A fierce independence that has a really dark side. It took another Quora question to really help me see this one. The question was: P <https://www.quora.com/Positive-Rights/Why-do-many-Americans-think-that-healthcare-is-not-a-right-for-its-own-taxpaying-citizens> ositive Rights: Why do many Americans think that healthcare is not a right for its own taxpaying citizens? <https://www.quora.com/Positive-Rights/Why-do-many-Americans-think-that-healthcare-is-not-a-right-for-its-own-taxpaying-citizens> Here’s the #1 (395 upvotes) answer by Anon (a Brit):

The fundamental mythos of American culture, is that no matter how poor or humble your birth, you can through grit, spunk and hard work become wealthy and prosperous.

On the face of it, and from the perspective of a class divided Europe, that seems incredibly noble and empowering. The idea that there is that much social mobility, that anyone can forge their own destiny is a powerful part of the American psyche. When it happens, it is an incredible thing. Something Americans can feel proud of.

However, there is a dark side to this mythos. Which is this… if anyone can win through hard work and effort, anyone who doesn’t win, therefore deserves to be poor.

At the core of all the anti-health care reforms is the single concept "why should I pay for the healthcare of those losers."

Added together, these 3 things all contribute mightily to the runaway healthcare system we have today. Today – the NHE for USA is $3.5T per year – and it’s growing at (arguably) ~5% per year (for as far as the eye can see).

So can we fix this in the US? Not without some open discussion. There are a LOT of painful things that need to be done. We need Tort reform, we need to reduce the cost of medical education, we need to decide if EVERY person can have stents or artificial knees and how do we decide.

One really, really good thing we should be doing is looking at the 39 countries who DO have universal coverage and see how they do it. For example, the national health service in Great Britain has great public support, their costs are something like 8 times less and their life expectancy is better. What do they do that we don’t?

You are correct, in general Kaiser does a very good job controlling costs, so does the state of Oregon. What is done at Kaiser and in Oregon that could be applied elsewhere?

Complex issues, worthy of national discussion.

Best,

Mark

The question of deserving and undeserving poor is the heart of the matter: does government have the right to take money by force and distribute it to those who most would consider undeserving, and if so, from whence does the government derive that right? Note that I make no comment on charity: what one voluntarily gives for cultural or religious reasons is one’s own affair. The Biblical Command is that if anyone asks of thee, give; but that is not the basis of a government’s right to property for redistribution.

I reserve the right to post this again with a longer discussion. I had intended to do this a week ago but it has not been a great week and now I have this flu like thing sapping my energy so I will leave it to be thought about.

 

A not quite random selection from a vast amount of mail on the subject of the shut down.

Dr. Pournelle,

First, please use my pseudonym Terrier1.

I ran across the attached article today. Bluntly titled "Treasury Default = Depression," it outlines in three well-written pages what will happen if the U.S. government defaults on its debts.

Richard Bove, the author, concluded with the following: "It is actually shocking that I would write a comment of this nature. The devastation to the United States would be so severe that it would take decades to recover from the Depression caused by a default and the dumping of trillions of dollars of U.S. Treasury securities on the global markets…God spare us from the fools who lead us."

I work for the Los Angeles County Sheriff’s Department. I fear that a default, with a collapse of the dollar and the resultant spike in prices for food, fuel, and other essentials, will cause riots. We’ll be at the tip of the spear in dealing with those riots. I’d rather not see it happen, and I am infuriated that the "shutdown" hasn’t shut down the pay of that Washington crowd that has gotten us in to this mess.

Terrier1

The article is a pdf; mostly is it about terrible consequences of an actual Treasury Default.

Global Skills Outlook 2013,

http://www.telegraph.co.uk/education/secondaryeducation/10362749/Young-worse-at-maths-and-English-than-grandparents-and-behind-almost-every-other-nation.html

Report here:

http://skills.oecd.org/

http://skills.oecd.org/skillsoutlook.html

Our current education system is guaranteed to produce about 50% graduates unable to do anything useful enough that someone would pay money to have them do it. Some will recover from that. Others will go into lifelong debt to get, in college, the education they should have got in high school. This system will continue so long as we deliver them bound to the Iron Low bureaucrats of the Federal Department of Education. It makes for a serious situation, since a great number of our people are probably not needed in a real economy; possibly as many as half. Of course they will continue to vote. This is a situation unparalleled in history.

I do point out that Rome discovered that it was cheaper to give the masses bread and circuses than to recruit ever larger security and defense forces.

Dear Jerry,

This email is prompted by your comment about Obama’s "refusal to negotiate anything" being "small and petty". By way of a preface, let me say that I did not vote for Obama at either opportunity, nor is "ObamaCare" my favored approach to a "system" of healthcare provision. (Nevertheless, the conservative portrayal of Obama as either an incompetent bungler or a Machiavellian incarnation of Hitler and Stalin has puzzled, and, sometimes, amused me.)

Past government shutdowns most like the current situation, but with sides opposed, were during the period from 1981 to 1986, when we had a Republican President and Senate with a Democrat House. Reagan negotiated, yes. But he did not negotiate over a law that had been duly passed by Congress, signed by him, upheld by the Supreme Court, and, in effect, sanctioned by a subsequent election. Do you really imagine Reagan would have negotiated on any such law? If the law had been one that was as much a "hot-button" for the Right – say banning abortion (allowing for an alternate universe without Supreme Court umbras and penumbras) – as healthcare is the for the Left?

Obama might well be "small and petty", but I don’t see any evidence for it in this particular situation. If Obama negotiates on this, there will be more hostage taking in U.S. politics than has occurred in all the terrorist hijacking taken together.

Gordon Sollars

And your thesis is that Obama, who contrary to the " law that had been duly passed by Congress" suspended the provisions requiring businesses and some labor unions to comply with it, was moved to go to the trouble to put up barricades — which had to be brought in from a distance — to close off a turnaround at Mount Vernon? And thus he is the one to be commended?

Jerry Pournelle

Chaos Manor

Dear Jerry,

It’s not my intention to commend Obama for anything in this situation -except for not negotiating. As to the suspended provisions, of course, those who wanted them to go into effect immediately want ObamaCare to fail, not succeed. And, I hope you will agree that Republican presidents have also used their powers to skirt laws in the past – and will do so again. Obama is wrong, but that is not the same as being unreasonable or "small and petty". If you had not made a comment about negotiating, I wouldn’t have bothered you with an email.

The Mount Vernon barricades were not my concern. Perhaps that was a deliberate strike by Obama against the Republic, or perhaps it was a decision by a mid-level functionary about how to best protect a closed facility. In any event it is only one small matter in the current context.

Gordon

I would say that sending Park Rangers to close a WW II memorial which is not fenced and is normally viewed by anyone walking through the Mall just as a bus load of WW II veterans arrives comes under the heading of mean and petty. It cost more to do than doing nothing. And the vets police their own areas when they leave. No, this wasn’t an accident.

The Shutdown Government: Powerful, Punitive And Petty http://thefederalist.com/2013/10/08/the-shutdown-government-powerful-punitive-and-petty/

"Pournelle’s Iron Law of Bureaucracy. This brilliant “law” has two parts. First, “in any bureaucratic organization there will be two kinds of people: those who work to further the actual goals of the organization, and those who work for the organization itself.” Second, in every organization, it’s the people in the second category who always end up running things, while “those dedicated to the goals the bureaucracy is supposed to accomplish have less and less influence, and sometimes are eliminated entirely.”"

HD

We keep hearing about the government shutdown, but did you know that 83% of the government continues operating during this shutdown?  http://tinyurl.com/pnthn9q

Other than protecting the public and POTUS from deranged drivers, what is the unpaid 83% — now guaranteed back pay when government resumes — doing that is so essential and must occur in these times of crisis? 

While we have no word on the bunny inspectors, we do know that it is a priority to ensure that an 80 year old man and a 77 year old woman, whose home is on federal land, cannot access their home during the government shutdown.  They’ll have to live elsewhere until the government resumes.  http://tinyurl.com/qx2nu43

Also a major priority, enforcing an embargo on privately owned businesses — even to the point of posting guards — to ensure that no economic activity occurs at these places during the shutdown.  http://tinyurl.com/mlyspym  This is because government cannot afford to allow these institutions to generate profit while 17% of government is shut down; so it only makes sense to expend resources on an embargo of these businesses. 

Also a major priority is ensuring that an immigration rally planned to take place at the National Mall, which is closed for the government shutdown, occurs as planned. http://tinyurl.com/m8dv2nl

—–

Most Respectfully,

Joshua Jordan, KSC

Percussa Resurgo

And the beat goes on.

Kill the F35 FIRST, put the money into feeding hungry kids. THEN we can talk about other things.

Otherwise, the hypocrisy of crying poverty while continuing to fund that waste of money makes all the other discussion nothing more than a pathetic joke.

Money Talks, and B.S. Walks.

Park Service OKs immigration reform rally on ‘closed’ National Mall

http://washingtonexaminer.com/park-service-oks-immigration-reform-rally-on-closed-national-mall/article/2536908

"A planned immigration reform rally will take place on the National Mall on Tuesday even though the site is closed due to the government shutdown <http://washingtonexaminer.com/section/government-shutdown> ."

Let me see if I have this straight. Ninety year old, wheelchair bound veterans flown in cannot be allowed to commemorate their honored dead, because the government is closed. However, an event which is blatantly political and to the advantage of the current ruling party, with the support of the SEIU and AFL-CIO, is perfectly acceptable. How stupid do they think we are?

Serving Officer

Hello Jerry,

You had written you were unable to source the statement: "The determination of which services continue during an appropriations lapse is not affected by whether the costs of shutdown exceed the costs of maintaining services."

I found the original in a pdf from the Administration.

http://www.whitehouse.gov/sites/default/files/omb/memoranda/2013/m-13-22.pdf

Continued health and good cheer to you.

Michael Crow

Florence, KY

MIT Technology Review: The First Carbon Nanotube Computer

Jerry,

Interesting! It was announce last week.

Regards, Charles Adams, Bellevue, NE

<http://www.technologyreview.com/news/519421/the-first-carbon-nanotube-computer/>

"Materials News

The First Carbon Nanotube Computer

A carbon nanotube computer processor is comparable to a chip from the early 1970s, and may be the first step beyond silicon electronics.

By Katherine Bourzac on September 25, 2013 .

For the first time, researchers have built a computer whose central processor is based entirely on carbon nanotubes, a form of carbon with remarkable material and electronic properties. The computer is slow and simple, but its creators, a group of Stanford University engineers, say it shows that carbon nanotube electronics are a viable potential replacement for silicon when it reaches its limits in ever-smaller electronic circuits.

The carbon nanotube processor is comparable in capabilities to the Intel 4004, that company’s first microprocessor, which was released in 1971, says Subhasish Mitra, an electrical engineer at Stanford and one of the project’s co-leaders…."

Phyllis Chesler is in most people’s minds the quintessential feminist. She bared some of her past yesterday in the New York Post, of all places.

It seems she spent some 6 months in hell as an American bride – in Kabul, fourth of four wives of a rich Afghan. This naive little orthodox Jew fell for a typical Muslim line and became another trophy for a rich Muslim.

She tells about the treatment she received, her near death, and her escape

here:

My life of hell in an Afghan harem

http://nypost.com/2013/09/21/my-life-of-hell-in-an-afghan-harem/

NOW I can understand her a whole lot more. I suspect she has conquered a fair amount of shame admitting all this. If so that explains a lot of her silence about Islam and Muslim treatment of women. It may also explain why she dove so deeply into the "feminist cause". While I cannot support her cause very much at all or agree with her politics I can respect her more now. This woman has been through hell and escaped. That has to affect people and color their life from then on.

{^_^}

Administration incompetence

I’ve recently read rather a lot of comments assuming the incompetence of the Obama administration. Perhaps so. However, two things occur to me.

First, I see little evidence for greater incompetence than normal. Invasion of Iraq? Dismantling of the Iraqi army? Earlier, fumbling of Watergate? Bay of Pigs? Things go wrong. A lot. "Nine tenths of everything is garbage."

Second, a few months ago I heard over NPR a comment from President Obama that I thought made sense, and increased my confidence in, at least, his level-headedness. The gist was that any problem which actually reaches the President’s desk is almost by definition intractable. If there had been a clear solution, it would have been solved before it reached him. Therefore all presidential decisions will be based on insufficient information, and with no reasonable assurance of the outcome. Yet decisions have to be made.

Or, as Mr. Rumsfeld put it in a much-mocked (and yet intelligent) comment: there are the known unknowns, and the unknown unknowns. That’s simply the context in which we operate.

Yours,

Allan E. Johnson

This requires either no comment or a fairly long one. I have not time for a long comment. Readers will recall that I was not in favor of the invasion of Iraq, and I was in favor of throwing the Taliban out of Afghanistan and going home after a couple of thousand American warriors and support troops expelled the Taliban from power. Leave Afghanistan to the Afghanis. The American policy seems to be one of Incompetent Empire. I prefer Competent Republic (We are the friends of liberty everywhere but the guardians only of our own), or of competent Empire using auxiliaries rather than Legions to govern out provinces. And I prefer a Republic to Empire. But Incompetent Empire is not attractive.

NASA’s Plutonium Problem Could End Deep-Space Exploration

http://www.wired.com/wiredscience/2013/09/plutonium-238-problem/

Too bad Newt wasn’t elected president. He wanted to divert NASA’s mission to going back to the moon and establishing a permanent presence there. If we were doing that, we could go back to those moon landing sites and salvage the plutonium that was left behind back then. There were five Snap-27’s at 8.4 pounds of plutonium each which is 37 pounds. NASA’s current inventory is 36 pounds. So making the moon our space program’s priority would more than double their plutonium supply.

Even if it were possible to still buy it from the Russians for $45,000 per ounce, which it isn’t, getting some for free as a by-product of a space mission appeals to the frugal side of me. 37 pounds of plutonium at that price would be $26,640,000 which appears to be a lesser cost than manufacturing it.

Please withhold my name as I still want no attention from the IRS auditors. Please instead refer to me as "Bowman".

 

Dealing with the Gomer Gestapo-eh?

"Crows are of the same color everywhere." – German Proverb

http://libertycrier.com/3-important-lessons-from-a-canadian-border-crossing/

But hey, a police state’s GREAT if you’re the police, eh?

Cordially,

John

Re: Yochai Benkler on the NSA

Jerry,

Found this through Bruce Schneier’s blog.

http://www.theguardian.com/commentisfree/2013/sep/13/nsa-behemoth-trampling-rights

Some excerpts:

"We have learned that in pursuit of its bureaucratic mission to obtain signals intelligence in a pervasively networked world, the NSA has mounted a systematic campaign against the foundations of American power: constitutional checks and balances, technological leadership, and market entrepreneurship. The NSA scandal is no longer about privacy, or a particular violation of constitutional or legislative obligations. The American body politic is suffering a severe case of auto-immune disease: our defense system is attacking other critical systems of our body."

"What did we actually know about what we got in exchange for undermining internet security, technology markets, internet social capital, and the American constitutional order? The intelligence establishment grew by billions of dollars; thousands of employees; and power within the executive. And we the people? Not so much. Court documents released this week show that after its first three years of operation, the best the intelligence establishment could show the judge overseeing the program was that it had led to opening "three new preliminary investigations". This showing, noted Judge Walton in his opinion, "does not seem very significant"."

"Given the persistent lying and strategic errors of judgment that this week’s revelations disclosed, the NSA needs to be put into receivership. Insiders, beginning at the very top, need to be removed and excluded from the restructuring process. Their expertise led to this mess, and would be a hindrance, not a help, in cleaning it up. We need a forceful, truly independent outsider, with strong, direct congressional support, who would recruit former insider-dissenters like Thomas Drake or William Binney to reveal where the bodies are buried."

So, predictions and suspicions that the NSA has been lying about the supposed fruits of all this invasive surveillance have been shown true. Hardly surprising, and still disconcerting. If anything, in fact, I think that the NSA’s and Administration’s claims have been shown even more untrue than most of us suspected.

Regards,

George

Librarian fired after speaking up for child who read too much  – NY Daily News

http://www.nydailynews.com/news/national/new-york-librarian-fired-speaking-child-read-article-1.1460319

When a meritocracy is no longer a meritocracy.

Freedom is not free. Free men are not equal. Equal men are not free. As it was in the beginning, is now, and ever shall be, per omnia secula seculorum.

American Thinker: Memo to Hillary

http://www.americanthinker.com/2013/09/m-memo_to_hillary_clinton_what_a_difference_at_this_point_a_year_makes.html

<snip>

America’s progressives have lost the tether of well-controlled lies and public perceptions that anchored their decisions in cool calculation. …The progressives have entered a nightmare world of their own making, in which the respectable veneer — the well-creased pant leg — has given way to a relentless series of distractions aimed at preventing everyone from hearing that pounding American heart beneath the floorboards. Calculated corruption is giving way to madness. …

In practice, this means that their tactics will become more aggressive, and even less restrained. Benghazi and its aftermath are just a hint of what is to come. It will henceforth be "go for broke" time, all the time. The scandals, authoritarian lurches, manufactured crises, and open breaches of faith with their oaths and their nation will become ever more intense and brazen. And there will be no joy in this unraveling for constitutionalists, who will be not onlookers, but victims.

The smooth, soporific drift into the abyss is officially over for America. From here on out, the ride gets very, very rough — that is what happens when progressivism’s wheels come off. Hold on.

Jerry

From APOD, Rotating Moon from LRO (a video):

http://apod.nasa.gov/apod/ap130916.html

Don’t miss.

Ed

Subject: Not Enough Money for Education?

The Glendale, California school district will now monitor the social media activities of all 13,000 public school students. There is much wrong with this on many levels. One is the expense.

I never ever again want to hear that there is not enough money to teach reading, writing, and math.

—

Dwayne Phillips

I am prepared to argue that our Capleville school with two grades to the room gave better education than our $13,000 per year per student California school. And by better I mean in all ways better.

The best way to make the schools better is to fire the worst 20% teachers. Then start the reforms,.

Syria Infelix

Dear Jerry:

As I occasionally publish in journals of archaeology as well as the physical science , I have a duty to report something that seems germane to the catfight over nerve gas in Syria, now that Rand Paul has raised the false flag issue.

At the 2009 Archaeological Institute of America annual meeting, Simon James of the University of Leicester recorded finding a pile of bodies in a tunnel dug during a siege of the Syrian city of Dura, on the Euphrates circa 250 AD.

He laid out physical evidence that the intact skeletons he found were Roman soldiers killed by the release of poison gas, specifically an acid cloud of sulfur dioxide. His slides showed why- sulfur crystals and pitch were found on the tunnel walls where the countermine dug by the besieged Romans intercepted the Persian attackers tunnel beneath the city walls.

It’s a chemical slam dunk that igniting such a mixture can yield lethally asphyxiating gas.

James expressed the view that after gassing the Romans,the Persians stacked them like cordwood in a heap, then set fire to their tunnel props. He also pointed out it was nothing new, citing the usual Classical texts describing the use of poison gas, but concluding that third-century Persian warriors were technologically precocious in that they pulled it off in terms of the operational art.

This much is sure : they did conquer. and abandon Dura, which then lay undiscovered for 17 centuries, albeit the Persians reportedly once again deployed toxic fumes again in 1256, against the Mongols attacking the Alamut, the ancestral stronghold of the Shiite sectaries then called Assassins, from whom descend the Alawites in charge of Syria today.

If you want to go abroad in search of monsters, it’s a very promising direction.

Russell Seitz