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October 19, 2009
One in Ten in UK have experienced ID Fraud
Tracy Walters, CISSP
Be careful out there.
An independent Cambridge University review of UK primary education criticises Labour policies: <http://tinyurl.com/yzatwom> <http://tinyurl.com/ykbx47t >. The Labour Government has dismissed the report entirely.
Postal strike--already there are currently about 30M pieces of mail in the backlog <http://tinyurl.com/yffj2jy> <http://tinyurl.com/yktklnm> <http://tinyurl.com/yjtj42u > <http://tinyurl.com/yhuxrja> Look up 'winter of discontent' http://en.wikipedia.org/wiki/Winter_of_Discontent
> for a historical background.
Back to the Cold War <http://tinyurl.com/yfffrs3>
Why student loans have been delayed this year <http://tinyurl.com/yhockvv >
Judicial decision on copyrights <http://tinyurl.com/yg2k43q>
Harry Erwin, PhD
"If you can't be a good example, then you'll just have to be a horrible warning." (Catherine Aird)
End of Life Health Care Costs [comment on the Friday essay in View]
While this won't solve the problem of End of Life Health Care costs immediately it may provide a long term solution.
The basic mechanisms are already in place with Health Care Savings Accounts (HCSA), the ones that are "perpetual" not the you must spend it before the end of the year idiocy, and high deductible, $5,000 per year or more, Medical Insurance.
This puts the End of Life Health Care decisions in the hands of patient and their family. They can make the decision whether the benefits of the procedure are worth the cost of the deductible.
There are, of course, many other benefits to this already existing program. It puts the patient back in control of the costs of care and should put the insured in the position of owning the policy.
The only real problems are two fold:
For people over about 35 to 40 and with no chance to build up their HCSA during the younger healthier years this might not be an attractive alternative to traditional Medical Insurance. This is not a good reason to keep this from moving forward. All that is required is to allow those over a certain age to "opt out" and continue with "traditional" coverage.
The real reason that this isn't going to happen with the current Congress is that it does not require an increase in the size of Government.
The Nanny State will take care of you unless you make over a certain arbitrarily determined annual income. If you do most of it will be taken away to meet the "Needs" of others.
Marx probably said it best:
"From each according to his ability, to each according to his need(s)."
But wait, that has been tried and it doesn't seem to work very well as far as producing wealth to be redistributed to the needy.
It is a consensus of people I respect with credentials in the healthcare business that the real problem is that the healthcare system serves the payers, and the payers are not the patients; putting patients back in control of what is spent, and making any treatment come at something more than a nominal cost, is the only way to control costs.
As an example, I got sufficiently weary of my symptoms this week that I went out to Kaiser, more for reassurance that I wasn't getting something worse than in any real hope they'd be able to do anything for me.
Increasing healthcare costs
I've heard a lot of people talking about increasing healthcare costs, but no one defines exactly what that means. I think costs are increasing because there's a whole heck of a lot more we can do, can treat, and can cure these days than even a decade ago.
So how about this? Let's look at the cost of an appendectomy over the last 30 years, using the same drugs, procedures, equipment, etc that were available then (or the nearest equivalent), remove the effects of price and wage inflation, and see how much it costs today. My guess is that it really hasn't gone up all that much - if at all, and I'll bet there's a fair chance it's actually cheaper today than back then.
To use your situation as an example, 30 years ago, you'd probably have been just admitted to a hospice. Today, you're cured. Did costs go up? Sure. Death is cheap. Likewise, much of the health outcome in the US is due to lifestyle choices, rather than healthcare quality. I challenge the premises of the debate, and do not concede that we have a crisis at all.
If we're going to talk about 'out of control costs', let's compare apples to apples.
The reason costs go up for public healthcare is that the "minimum" advances to keep pace with the latest developments, no matter how expensive. In theory, everyone ought to be able to go to the Mayo Clinic at the first sign of something serious. After all, if the rich kid can go there, shouldn't my kid be able to go? But since that is impossible, the result is to move much medical research off shore where only the very rich can get at it.
It comes down to the question I keep asking but no one seems to answer: where does the obligation to pay for someone else's medical bills come from? It can't be a Judao-Christian obligation; it can't be a requirement from Almighty God. It certainly wasn't part of the Constitution when I was growing up: when I was a kid, if a comic book wanted to portray a criminal you were supposed to be sympathetic with, he was stealing in order to get the money for a critical operation for his child. No one suggested that taxes pay for the needed operation, or that the doctor ought to be forced to do it for free.
I agree that the pressure is for rising costs -- and of course as the procedures are done more and more often, the costs come down. What used to be enormously expensive and done only by a very few is now quite standard.
The Swiss system is said to have been working well, but costs keep rising: what you expect to get from your doctor expands when you discover you don't have to pay for it.
- who decides?
Of course there are details to worry about. Clearly we can find some cases in which we'd all agree that prolonging life at great expense just isn't worth the money it's costing us. I can also cite cases of 96 year old grandmothers coming out of quadruple by-pass heart surgery with a couple of good years (possibly more) of life ahead. Now what?
In1995 my 87 year old grandmother had diverticulitis. She spent a couple of weeks in the hospital. Afterwards her doctor told her he was sure she wasn’t going to make it. She lived another 10 years with 8 of those years being good ones. She suffered several small strokes and was bed ridden the last two. My father and uncle put a hospital bed in her house and each would stay with her for a week at a time. They knew that she would not last any time in a nursing home and they were willing and able to take care of her.
If we look at the cold hard facts the doctors should have let her die in 95. She was already old and not contributing to society, just a drain. Is this what we want in our health care? My family would have paid any price to have her around another 10 years, but what about the person that has no one?
This is going to be an even bigger problem in the future with an aging population. I don’t know all the answers but I know I don’t want to live in Logan’s Run. At least with our present system the individual’s and the family’s wishes are considered but can you imagine the bureaucracy making these decisions.
Thanks for the website and the many years of enjoying your works.
Jerry, you wrote:
"The moral dilemma comes when you try to plan out who shall make these end of life care decisions? "
Perhaps Nolan and Johnson got it right in Logan's Run?
Last 2 years
2 points about "last 2 years expenses": 1) the "margins" of anything are always most expensive, and there will always be a margin. So there will always be a "last 2 years". A moving target. 2) How do you know in advance which are going to be the "last" 2? That's only information available in retrospect, generally. So to cut off the last 2 years' care would translate into withholding ANY expensive geriatric treatment .
The Inuit let the oldsters choose for themselves when to board a passing ice floe. <http://mail.yimg.com/us.yimg.com/i/mesg/tsmileys2/03.gif>
Of course the solution is to have a cutoff age after which you simply don't authorize payment for treatments. In practice that is likely what will happen, but with exceptions for people like Ted Kennedy.
All I know about the actual practices of the Esquimaux comes from novels and hearsay; I have no direct information, and I doubt that many are abandoned to the ice floes in the 21st Century in any event. But Thurow's point was that something like that would certainly save money.
One wonders, though: one suspects that as the average age of the decision panelists gets higher their attitudes may change.
Ed Koch at age 84 recently received quadruple bypass and valve replacement surgery, and including aftercare the cost will be approximately one million dollars, paid for by his insurance thru his law firm. Under President Obama’s plan, the insurance companies will not be permitted to write any new policies, nor extend existing policies that provide such expensive care for someone as old as Koch, those people will have to pay out of pocket. Ed Koch does not like that proposed change to the health care system.
Robert Samuelson in Newsweek noted that the Democratic health care plans will basically be a wealth transfer from the young to the old. We can spend out national wealth on economic growth, science and technology, or we can spend it on health care and transfer payments; up until now, American has decided to differ from Europe and spend the money on growth and scientific progress. Over the last 100 years, the American way seems to have worked better.
Darryl Miyahira, Honolulu, Hawaii.
data point on "free" health care -
Hi Dr Pournelle,
Just to give you a data point on what free health care looks like. We're living in Northern Italy and our primary insurance is the Italian national insurance, we also have a private plan from the company. We pay a 9% tax for the italian insurance and $200 euros per month for the private plan. Everyone in the country legally gets a health card that means free hospital stays and medicine and just a small charge for diagnostic tests. Dentistry is not included.
Italian health care looks a lot like a hospital from the 70's, fairly drab, not much high tech, but the care in the hospital for children is very good. If a child is sick he gets immediate priority and bypasses all the waiting. The pediatricians are excellent and even worked around my non-existent italian. I don't think they do much for trauma patients locally, when a motorcycle wrecked outside our office, the medics immediately called for a life flight helicopter to fly him to bologna. (60 miles to the nearest trauma center is pretty far)
The problem is with seeing anyone except a GP. My wife needed an x-ray for a wrist problem, it took one week to get the xray and get the results, the GP looked at it and said she needed to see a specialist. Making an appointment to see a specialist requires a trip to the medical administration building, the wait time to see a specialist was one month. In the end, we paid cash to a private clinic, 200 euros and an afternoon later the problem was diagnosed and fixed.
There is no rationing here, but by adding enough bureaucracy I think anyone that is working either avoids the doctor or pays a private doctor rather than missing several days of work. There is much less diagnostic equipment, not only long waits for x-ray results, but long waits for ultrasound tests. Italians think that their health system is the best and are deeply offended by any implication that it's not the best, of course they are used to levels of bureacracy that make me long for the fast moving lines of the louisiana dmv.
Joe G. Ravenna, Italy
Switzerland requires co-payments. What happens in the US if someone shows up at an emergency room without the copayment? But the Swiss systems sounds as if it might work -- in a population of mostly literate and rational people dedicated to liberty and mostly imbued with a strong work ethic. Socialism worked extremely well in Sweden for the first couple of generations when people continued to believe that you ought to work and the welfare system was to take care of those less fortunate. As that attitude is replaced with "Somebody's got to work. Who should it be, me?" the results aren't so clearly beneficial.
M0nastaries have free health care. It is not always true among all populations that the demand for a free good is infinite, but the Swiss health care system shows that demand affects the system. "Demand for health care is low in January, but by December when the deductible is past, it becomes very high."
Of course we have no idea what the real plan will be when it finally gets adopted.
October 20, 2009
File under you've got to be kidding ...
Fifth Circuit grants Katrina victims standing in global warming class action suit via US Legal News - JURIST by on 10/20/09
[JURIST] The US Court of Appeals for the Fifth Circuit [official website] has ruled [opinion, PDF] that 14 victims of Hurricane Katrina [JURIST news archive] have standing to sue companies for allegedly contributing to global warming [JURIST news archive], which they claim played a role in increasing the severity of the hurricane. The court found Friday that the plaintiffs had presented enough
I've seen you comment on Scrivener more than once and I read this at Macworld.com this morning. Thought you may be interested - looks like a fairly long trial deal and some discounts
My experience with Scrivener is that if I worked solo and liked having complex project creation tools, I would like this; but in fact I find that OneNote or some such plus a good text creation editor that does spell checking and autocorrecting of the many typing mistakes I make is all I need. My habits are pretty firmly in place now.
That is not to say that I don't recommend those still looking for tools to try Scrivener. I know several successful writers who use it. I do point that if you do much collaborative writing, you'll want to talk this over with your partners.
Fake 'Conficker.B Infection Alert' spam campaign drops scareware
Whereas the theme remains the same, the botnet masters have slightly modified the message:
The campaign is an example of a — thankfully - badly executed one in the sense that with Microsoft’s Security Essentials recently gained momentum <http://blogs.zdnet.com/security/?p=4512> , even the average Internet user would notice the suspicious timing of the offered “antispyware program”.
Tracy Walters, CISSP
As always, be careful out there.
Microsoft Security Essentials - Week One -
Tracy Walters, CISSP
KUSC Pledge Drive
"Anyway, this is one of those nagging reminders. I won't spend as much time on that as KUSC does every ten minutes. You have been nagged. Thanks to all those who have recently subscribed or renewed."
It wouldn't be a bother with a nag every 10 days or once a month. I have you in my queue to resubscribe in January.
I like having you around on the web. You bring a note of sanity in these "Crazy Years."
Charles Adams, Bellevue, NE
I can't believe this would surprise anyone because I have been expecting to see this sort of thing since data started getting shipped offshore. Of note, I believe the RNC and DNC offshored their member databases some years ago.
I am shocked, shocked...
Resuming the health care discussion (end health care discussion)
problems with the Swiss system
The key phrases I see in the Swiss health care system article you linked to today are:
1. The government proscribes what the policies will cover
2. the government sets the prices
Ye Gods! Of course it will eventually collapse.
It depends on the republic; some may be capable of self-discipline. Most are not. The Venetians lasted a long time, but they had a very complicated government structure built on the principle that no one was ever entirely trustworthy, and inefficiency was part of the price of freedom. But a bureaucracy of inquisitors and assassins kept in check by committees and councils makes for a very complex structure. Anyway they were unable to defend themselves against Napoleon carrying Liberty and Equality across Europe on the bayonets f French soldiers.
Subject: A health care discussion
It's a lot simpler than that. The health industry is capitalistic, and as for-profit corporations with investors they would be culpably negligent not to have a range of offerings at price points 1%, 2%, 5%, 10% (and more!) beyond the current budget. To date, they have certainly satisfied their duty to their investors.
This fact, plus a little time examining the results of compounded growth, should tell you that at some point, you MUST decline to purchase something on their price list. And there will be human faces to go with that decision.
You can say that health care is a public service, and then have a panel make that decision. Or you can keep health insurance private, and keep raising the price until enough people have dropped off that you can afford to provide almost everything to those who are still with you (and the math says that this process must continue perpetually). In either case you will have a long and sad list of people who were not treated. So far as I can tell, this unhappy list must exist, and all we can try to do is make this list as sensible as possible.
Regarding actual payment, the article in The Atlantic:
is the most coherent description I've read for how capitalism might be reintroduced into health care.
Regards, Andy Valencia
Canada and the Iron Law
It's not so much the nature of the parts as it is the number, size, and arrangement of those parts. Oxygen and chlorine are composed of the same parts, but differ in their number and arrangement. It is the number and arrangement that appear to matter.
In most western democracies the civil service is very similar to the old aristocracy, but instead of owning land they own government jobs, and the appointment is for life, not transferable by primo-geniture. But you couldn't fire your local Lord and you were well advised to be respectful... The US was an exception to this for a while, but is joining the ranks of modern western liberal democracy. It's part of growing up.
: Wall St terrified of health care issue
I think Wall street is secretly terrified of the health care issue… Anyone else charting commodity prices vs. progress towards the President’s more expensive agendas? It’s a bit late to join in, but oil, gas, and precious metals are all rising. My worthless amateur guess is that people with a lot of money are betting heavily on either massive inflation or a market crash.
I may be restating what has been said, but part of the problem with health care costs is that we're in a place that's maybe halfway to a goal. One hundred years ago, aspirin, appendectomies, and amputations plus childbirth and the occasional sutured wound were pretty much it.
In about 1950 or so, treatments began to get more effective--Leukemia was generally considered 6 weeks, 6 months, or 6 years from diagnosis to death depending on the form--sub-chronic, chronic, or acute. Diagnosis and treatment were palliative. By the 1970s there were remissions of enough length to be considered a cure.
In the early 80s, AIDS was a death sentence. By the '90s, there was a combination of drugs that could at least slow the progress of the disease and lengthen life by some years. Now, we're approaching the point where AIDS might be considered a dangerous but chronic condition, provided one has some means to pay for the treatment.
We couldn't do then what we can do now. If medical progress continues, in a century or so this debate may well seem quaint, because autodocs or something similar at the local pharmacy will handle everything that's in any way routine. Costs will level.
That's a big IF, though. I wonder what health care 'reform' will do to research funding. Even today, physicians who treat Medicare-eligible patients by using an 'unapproved' drug or procedure will not be allowed to treat Medicare patients for two years. This is true even if the patient isn't interested in Medicare or is willing to bet his life savings on the chance of a cure. (I verified this by asking a physician of my acquaintance.)
Anyone with the money will leave the country for treatment in Thailand or some such. I fear the heavy hand of government. Some years ago there was an article written by a pathologist (Discover magazine "Vital Signs" column) in which the pathologist told the oncologist that a patient had hairy-cell leukemia. The oncologist replied, "Oh, thank God" because an effective experimental chemotherapy had been developed; the treatment phase lasted about half a month, and most patients were either 'cured' or in very long term remission. The insurance company would not pay for this treatment, although it would pay for 'standard' chemotherapy--six months with no real chance of a cure. The hospital had some available funds, and the patient did recover.
I wonder how likely the government will be to give approval, and if approval is not given, will the government then give approval to allow a hospital to use donated funds? Will the government allow hospitals to receive donated funds? Will anyone have funds to donate after we've 'shared' with everyone else? I fear the only certainty in this mess is that we won't have anywhere near the freedom we once had.
On the other hand, this may solve the energy problem. Just put a pulley on the caskets of the Founding Fathers. They're spinning in their graves as is.
Health Care Costs
I was at the birthday party of a fellow LASFS member, and one of the people there mentioned her daughter's experience with health care costs.
She recently had a baby, by C-section. The incision got infected, and the doctor wound up prescribing a heavy-duty antibiotic for it. She took her prescription to the pharmacy, and was told Medicaid didn't cover that particular antibiotic for superficial injuries. If she wanted the pills, it would be something like $180.
Well, she didn't -=quite=- faint, nor did she laugh in the pharmacist's face at the notion that a C-section is a "superficial" wound. Not quite.
She did go back to her doctor, who discovered that if he prescribed the same drug, in tablets that were twice the strength, the price for filling the prescription dropped some 80% -- much easier to manage out of pocket.
My friend at the party cited this as evidence that we need a third party, preferably a government one, paying for all prescription medication.
My comment was a price discrepancy like that is the kind of thing you see only when the patient doesn't know, or care, what medicines cost, because a third party pays the bill. I guarantee, if people had to consider the price of their prescription drugs, you'd see a lot fewer price discrepancies like that. If the 125 mg tablet costs five times as much as the 250 mg tablet, I'd buy the 250 mg and use some of my savings on a pill cutter.
One aspect of the healthcare sausage currently being made in Congress is a mandate that everyone _must_ have health insurance, with a fairly substantial fine for non-compliance. Under what provision of the Constitution is the federal government empowered to fine citizens for not purchasing health insurance? Should this not require a constitutional amendment, as with federal income tax?
I have always thought that Federal drug laws require a Constitutional Amendment but no one seems to care. I am not at all sure how forbidding hashish was part of the Constitution. Or Marijuana.
Noonan On Obama Care
As always, Peggy Noonan is worth reading:
Mark E. Horning, Physicist,
Government payscales for doctors?
Government pay scales for doctors? Well, the gov't already does that - augmented with bonuses to make the salaries attractive: back when I was a gov't doc our salaries could not be higher than that of Congress critters - without the free flights, free food at Congressional cafeterias, etc. But the general principle is the same.
But go'vt docs work 40 hours a week, not the 80 hours that private practice docs do. Overall, docs work 60 hours a week, so if they all go on salary we effectively lose one third of our doctor time.
Then there is the fact that clinics and offices will have to be paid-for by the gov't. Docs pay for them now, for the most part.
So simple, yes? Of course the politicians would decide when you need a new clinic, eh?
To Jerry Pournelle,
You wrote: "But one reason health care costs so much is this business of the last two years of life. If we could eliminate those two years we would no longer be spending more than others."
It's true that the last years are the most expensive, but I know of no civilized country, especially those with socialized medicine, where care are withheld for the dying or elderly. If you want to compare US health costs to costs in other countries, they both should include the cost of care in the last years, as no one is really arguing against it.
Trying to frame the US debate, on the issue of care to "grandma", seems disingenuous to me.
Bo Andersen, Denmark.
Does Denmark pay for all costs of end of life: feeding, respirators, intensive care, etc.? That is the usual way of limiting last year of life costs: just don't pay for extraordinary measures (which is sort of the same as assuming that everyone has opted for DNR). I am not really familiar with the policies of other countries in such matters, but I do note that their last year of life costs are far lower than those of the US. I do not know why.
I am also not well qualified to determine what are and are not "heroic" measures to prolong life, and of those which ought to be paid for by the public. I went through this before: we are not talking about the costs to families and estates. It's what the State ought to pay for that's up for discussion. How many revivals of Aunt Minnie to I owe her nephew Horace? (We are assuming that Aunt Minnie isn't cogniscent.)
My apologies to all for including so much, but it's hard to be selective: once we concede that health care is an entitlement, the implementation becomes very highly complex. Another reason to go slowly and incrementally, I would think, but apparently that argument has not been overly persuasive.
The cry seems to be "do something and do it now, even if it's wrong." Sometimes that's the case: a ship being blown ashore may drop anchor or raise sails and try to claw off shore; either may work, either may fail, but doing nothing (or doing both) will inevitably fail. I think it obvious that we are not in that kind of crisis with healthcare.
Shades of Larry Niven and John Cramer...
Plausible as any I guess.
One trusted reader comments :
Words fail me
Continuing with its tradition of bringing us news no other network will touch…
Me, I'm glad they do such stories. Of course I'm a Niven fan... (And do note that the story first appeared in the New York Times)
For a PDF copy of A Step Farther Out:
October 21, 2009
This is your standard Pledge Week nag. This site operates by the Public Radio model: it's free, but unless we get enough subscribers it can't continue. This week the goal is for new subscribers, but I do thank all those who recently renewed. Now on to the mail.
Global Warming and the Courts
Dr. Pournelle --
This from the WSJ Law Blog:
Hurricane Katrina Victims Have Standing To Sue Over Global Warming
"The suit was brought by landowners in Mississippi, who claim that oil and coal companies emitted greenhouse gasses that contributed to global warming that, in turn, caused a rise in sea levels, adding to Hurricane Katrina’s ferocity."
"The central question before the Fifth Circuit was whether the plaintiffs had standing, or whether they could demonstrate that their injuries were “fairly traceable” to the defendant’s actions. The defendants predictably assert that the link is “too attenuated.”
But the Fifth Circuit held that at this preliminary stage in the litigation, the plaintiffs had sufficiently detailed their claims to earn a day in court. "
First the politicians pronounce on the science and now the courts are involved. People on both sides of AGW are looking forward to this case going to trial but I'm afraid little good can come of it, regardless of the outcome.
NERVA and ROVER
Dear Dr. Pournelle,
Here is an interesting technical article on Rover and NERVA, Nuclear Thermal Rockets, examining their feasibility today based on the original programs some forty years ago.
We could have a hundred thousand lbf, 900 Isp Nuclear Thermal Rocket engine flight ready in seven years. Overall mass of a manned planetary mission would be reduced by a factor of twenty five with such an engine.
The maddening thought: We could have had that engine in 1980, and have been using it for the past three decades. We could have had a permanent manned lunar base these past twenty five years, and the first generation of off-world humans would just about now be finishing grammar school.
Instead we have streaming video of foul mouthed urchins, Twitter. "Information Wants To Be Free!": and imperial wars without end the better to grab the last of the oil. If in 1970 you had written this future as a novel, we would have laughed at you. After all, surely we would never be such fools, now, would we?!.
I was Barry Goldwater, Jr.'s first campaign manager, and after Barry was in Congress he worked to keep the NERVA program going. He managed for a few years, but it was eventually zeroed out. We got a tested 800 ISP at one point. NERVA is the propulsion system in wide use in my novel Exile to Glory (now available with other stories in that civilization from Baen as Exile -- And Glory! It's still a good read, if I do say so.
The cost of treating the old
Bo Anderson says that he "know[s] of no civilized country, especially those with socialized medicine, where care are [sic] withheld for the dying or elderly."
Here's the money quote:
"Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can ... have fluid and drugs withdrawn and many are put on continuous sedation until they pass away. "
Note, fluid can be withdrawn. And food too; although it doesn't mention that in this article, there are many cases in the news where this has been done. So the inconvenient elderly are starved to death - with sedation, so it doesn't hurt. Maybe.
You don't need to look in the crystal ball, you can just read the newspapers.
Terry Schaivo was killed by denying her liquids; she died of thirst. At one point a state trooper physically prevented her mother from giving her an ice cube. (He must be proud of doing his duty.) We like to believe that "she couldn't feel anything." Perhaps so; does an earthworm feel?
In theory this was her own wish as testified by her husband (then living with another woman and their children), but the costs of keeping Schaivo alive almost certainly figured in his initial (and long delayed) decision to turn her off. If the state is going to allow someone to die of thirst, it would seem a bit more humane simply to increase the morphine dosage, but apparently that is illegal because of the danger of addiction to narcotics.
My take on healthcare, as an independent small business owner, is that I can no longer afford health insurance until I get to Medicare age. Up until this year I have always carried a policy, but when the last round of cost increases came around, I took a long hard look at the policy I was able to supposedly "afford" and found it so full of loopholes as to be worthless. If I paid it, I would end up going bankrupt from the premiums. If I stopped the policy I would have at least a fighting chance of staying solvent until 65. So I join the ranks of the uninsured. There IS a crisis, as far as I am concerned.
When I hear of "penalties" for not having insurance through a private company, I hear the worst of capitalist socialism. I guess they might just have to cart me off to debtors prison, but I believe that any "penalty" would be as unconstitutional as a poll tax and any enforcement would be struck down by almost any Supreme Court.
My thoughts on what would work is a national standard policy with a $1000 per year deductible, fixed rate for everyone no matter age,sex, physical condition, $3,000,000 to $5,000,000 lifetime cap (with inflation adjustments), and co-pays on ALL procedures. There would be BY LAW no other competing policies or group insurance in this range. Insurance companies could vie for covering the first $1,000, deductables, and amounts over the lifetime cap ONLY. No government entity, business, military organization, or any other group could negotiate for lower rates or compete on the basic policy. From the President on down, every legal citizen would have this basic coverage.
How would it be paid? Simple. The real beneficiary of a nation full of people in good health is the economic engine of that nation. Premiums would not be paid by individuals (other than co-pays and deductibles) but by tariffs on goods entering or exiting the country. That takes the burden off of ALL business owners, and directly links a cause and effect.
FWIW, The ancient Greeks on one island had a well respected Kean Code for people living on the island. If they reached age 60, they were required to drink Hemlock. A rather famous poet of the age slipped out to Athens, where he lived to 90. Also, during WWII in the south Pacific, there was a tribe of headhunters who would bury their old and disabled up to the neck in sand, and leave them so that they could die. The cultural imperative was so strong that even after being introduced to Western culture, many of them demanded to be allowed to die that way. Both of these oddities were reported in the late 1940s National Geographics. I bring this up to point out that the issue of healthcare costs to society are not new, and have been dealt with in extreme ways in the past with full general agreement of the population. Now if we could just require all politicians to take Hemlock after two terms in office...
While in Sparta, if you lived long enough you automatically became a Senator. Of course being a Spartan man was somewhat dangerous...
What is old! -
My son once asked me when I would be "old". He was in his very early twenties so old enough to understand the words but not "get" my answer: "Old age receeds exactly as fast as I have birthdays." He couldn't imagine being thirty, much less in his middle forties, (as I was then.) But he is now in his mid-twenties and the father of two children...he is starting to get it.
I think of the Logan's Run answer, (In the book the age was much younger, 21?) I think about the Eskimo leaving grandma on the ice. Of the two solutions to old and a drag on the system, I prefer the Eskimo solution. The family and the old one decided when it was time. However, our culture seems to fear being old, infirm, and dying. My mother chose to not fight her final illness in spite of the urging of the doctors. Her cancer, at best, would give her a couple of very painful years bought at the cost of frequent and painful surgery. You pretty well had to catch this one before you had symptoms to have any hope of even five more years. Cost wasn't an issue. My father's varied life circumstances left him with three insurances, what one didn't pay for the others would. He never received anything more than an itemization, no bills. My mother went through one surgery and found out that they were not quite truthful about the pain.
My mother chose and we consented.
We actually had to intervene several times. Hospice was not the right place as they couldn't keep her on the IV meds that kept her comfortable. She couldn't reliably swallow, but one of the doctors was such a proponent of a particular hospice care home that we had orders in her record, at the nurses station, and kept a family member around just to keep her from being moved. He was later found to have more than a casual relationship with that home. Sometimes we had to gently remind the doctor about to examine her that nothing he did would actually help her, did we have to move her? We also had to convince the nursing staff, once she was unable to vocalize, that she was, (or was not ,) in pain. (Mostly she seemed a bit PO'd about having to die just when she had her life set up just how she wanted it.) Eventually her nurses learned what we knew...certain things were just my mother trying to communicate with us, and others indicated pain. I was glad my mother had the hospital for she needed far more care than we could give her at home, but I was glad we were a part of her care.
I was very glad for the pallative care.
So, we still used a lot of resources in my mother's last year. Not as many as they wanted to give her. I am deeply in favor of giving anyone and everyone pallitave care when they get to the end. But when should we withdraw active treatment? Who decides and who pays? (There is an old saying about the one who pays the piper calling the tune.)
I know some folks would spend everything to keep grandma alive. I know that I am not too likely to live to be very old. I appreciate that you are still kicking around, Jerry, but if your care put a great financial burden on your wife and finances after you passed, would you choose the treatment?
I don't know how to educate people to accept an inevitable end and choose pallitave care over active surgeries and the like. But, if the culture accepts that there is a point, past which no medicine will really save their loved one, and the few years...good or not, may not be worth it over all...How do we choose?
In previous times it didn't much matter. The medicine wouldn't much save you anyway. I guess we are the victims of our own medical successes? I know I could not look at a poor someone and let them end out their life in screaming pain. I think that is where the idea of medical care for everyone, without really thinking that you are forcing others to pay for it, started out.
I know that if I lose my medical insurance, or possibly if I fall into a limited category in some future national plan, that I will die much sooner and in much pain. I accept that all people will die. But don't want to before I am kinda done with what I want to do. Yet, I don't really control it. Maybe that also is a source of this debate: the illusion of control.
This is wandering around, so I definitely won't feel bad when you delete this half-way through. I just don't see easy answers. Because Medicare helped pay for your insurance, Jerry, you lived. Because I had insurance, I live. My mother couldn't be saved by any insurance and had the wisdom to see it. How do these things translate into public policy?
This can't be said often enough
Some days reading the news is like living in a Flashman novel.
October 22, 2009
Global cooling may not be the only problem due to low sunspots. Looks like some electronics may also have reliability problems.
A complex article mostly demonstrating just how little we know about the Earth/Solar interactions. Our Sun-worshipping ancestors would not be so much surprised. The modern members of the Scientism cult think we know far more about the Old Gods than we do.
If the source of your moral values is pragmatism, does it not make sense to find out what does and does not work?
I have known Stewart for a long time, and I have always considered him a friend. I haven't had any contact I remember since the days of Clementine, the SDI-derived experiment that indicated the presence of water ice on the Moon. [corrected; original said Columbine. sorry.]
which is curious, since it appears to be an account of entrapment. I say appears to be: I have no information not easily available on line. I would have thought Stewart intelligent enough to take more precautions; and I do not remember any particular Israeli fervor in the dozen years I knew him. It's an odd story. More if I learn more.
DARPA is looking at vacuum energy with the Casmir Effect
Research in a Vacuum: DARPA Tries to Tap Elusive Casimir Effect for Breakthrough Technology DARPA mainly hopes that research on this quantum quirk can produce futuristic microdevices By Adam Marcus
"Named for a Dutch physicist, the Casimir effect governs interactions of matter with the energy that is present in a vacuum. Success in harnessing this force could someday help researchers develop low-friction ballistics and even levitating objects that defy gravity. For now, the U.S. Defense Department's Defense Advanced Research Projects Agency (DARPA) has launched a two-year, $10-million project encouraging scientists to work on ways to manipulate this quirk of quantum electrodynamics."
Regards, Charles Adams, Bellevue, NE
I know very little about the potential of practical applications of the Casimir Effect, but from what I do know I applaud investigations of this type.
Power satellites in the Wall Street Journal
Found this in today's Wall Street Journal -- Five Technologies That Could Change Everything.
I’ve been following the continuing saga of the ACORN child prostitution scam story, with a new video (Philadelphia) up yesterday. The audio is mostly shut off, and it comes with a challenge to ACORN: You’re suing us for recording without permission. Will you give us permission to release the audio, so that people can hear if you were lying or not? Surely you have nothing to hide?
They (Breitbart + Fox News) did it before as well. They released the first video, waited for ACORN to say that there were a bunch of other cities where the scam had failed, then released videos of those other cities. Waited for ACORN to say that the partial videos had been doctored, then released the full unedited versions.
Good clean fun, of course. But also a new paradigm of The News. “I’ll decide when to release the news, and how much to release. I feel no obligation to tell you what I know. I am entirely partisan, my goal is to destroy ACORN; my releases will be timed toward that goal.”
Of course there have always been partisan news releases; think Dan Rather and the National Guard memos, timed to hurt George W Bush during the 2004 campaign. But I don’t recall a case where they said so. Fox News is pretty partisan (Obama’s people insist!), but they wouldn’t be able to get away with this. But they don’t control the timing of this story; Breitbart and his two young friends do.
: Bill whittle today
I know you will like this one.
I forget just how little of modern history is taught in the schools, and how little generations later than mine know about "Peace with honor", appeasement, and the Road to War in the 1930's. Whittle gives a good overview. Superficial as it would have to be in that short a talk, but better than nothing.
Poor immigrant Latinas have healthy babies, but by age 2 or 3, their toddlers begin to lag behind white middle-class children in vocabulary, listening and problem-solving skills, according to two studies released Tuesday
The Times article is interesting. It purports to show this is a proof of the need for Head Start, but no study I know of can detect any difference between Head Start and non Head Start children 3 years after they have left the Head Start program; which is terrifyingly disappointing, because Head Start is one of those programs that would more than pay for itself if it worked. Me, I think Head Start ought to try to teach the kids to read, but the NEA is having none of that. Incidentally today's paper shows that most teachers don't think they learned much in their education classes in college, but that's another story.
This one is annoying: is there some simple cultural explanation? Like keeping orange juice in high lead content pitchers?
October 23, 2009
Ultracapacitors Make City Buses Cheaper, Greener
A fleet of 17 buses near Shanghai has been running on ultracapacitors for the past three years, and today that technology is coming to the Washington, DC, for a one-day demonstration.
The implications for nuclear power are obvious...
WSJ and Space-based Solar Powe
"A ground receiving station a mile in diameter could deliver about 1,000 megawatts—enough to power on average about 1,000 U.S. homes."
It's encouraging that the WSJ is taking an interest in space-based solar but not so encouraging that they quoted one megawatt for the power consumption of the average U.S. home.
-- Mike Johns
'Hunting has been banned in parts of Austria after freak storms with tennis ball-sized hailstones killed up to 90 per cent of the wild game population.'
---- Roland Dobbins
Curiouser and curiouser...
Did someone actually pay for this study?
My first thought was ‘Did someone actually pay for this study?’ But it does point out that someone with an extreme view will do ANYTHING … lie, shout down, demean, whatever…to convince others that their view is correct. Those who yell loudest and most often are the ones people hear.
Tracy Walters, CISSP
Global Warming Enthusiasts come to mind.
Rainforest similar to ours flourished at 3-5° hotter
Alas…the lack of diversity will probably trigger hue and cry from the far left…. J
Tracy Walters, CISSP
October 24, 2009
"Clearly, their objective with those people was to terrify them first and embarrass them second."
The advertising campaign from Hell...
|This week:||Sunday, October
I took the day off.
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