Wanting the impossible: more on cutting health care costs
Ah, it seems so easy.
We all know that there’s waste in health care. We all know that there are unnecessary tests and treatments, and that if we could figure out what they are and eliminate them, health care costs would lower and we would all benefit.
The problem is that it’s only ex post facto that we can know in each individual case what the unnecessary procedures might have been—and sometimes not even then. The rest of it is mere statistics, and often “garbage in, garbage out” ones at that.
If, for example, we know that back pain is common but that only a tiny percentage of cases will ever need surgery and the rest will heal on their own, how does a doctor decide what tests to run in order to find out which category Patient A fails into? I speak of back pain because it’s something with which I’m all too familiar, having hurt my back fairly severely nearly two decades ago. I never had surgery, but I didn’t lack for opinions that said I should. The only problem (well, it wasn’t the only problem, but it was one of the many problems) was that each doctor I went to over about a twelve-year period recommended a different type of surgery, and gave me different odds for post-surgical improvement.
Since all of these doctors had very fine reputations it was sobering, to say the least, to hear their disagreement. None of them was able to explain all of my symptoms, some of which were puzzling and rare. Some suggested that, without surgery, I’d continue to become worse. A few said that without surgery I was likely to improve. And initially, when I’d first been injured, the highly-recommended doctor I visited had said it was only a muscle strain and did not order an MRI until eight months of fairly severe pain had gone unmitigated, and my symptoms had actually worsened from the exercises he had me doing when he didn’t realize I had a severely herniated disc.
None of this inspired confidence, and so I postponed the decision to have surgery. And postponed it and postponed it. Then, as the years wore on, my symptoms did in fact improve. Does this mean I was correct in refusing surgery? Hardly; maybe I’d have been even better if I’d had it. Perhaps I could have gained many pain-free years during which I suffered instead, as well as removing some limitations I still face.
But perhaps not. I will never know, and I’m at peace with that. I did the best I could and the doctors did the best they could.
I’m the sort of person who does research, and so even way back then, without Google, I pored over the medical literature to help me figure out what to do. And what I found was—confusion. The research was contradictory. Much of it was poorly designed, as research with human subjects often is. And even the best of it dealt with statistics and probabilities that were far from ideal: if there was a 50% chance that someone with clinical findings and test results that more or less (but never exactly) coincided with mine would get a 50% improvement from a certain surgery, what did this tell me? How much would I have to suffer to be willing to have a go at it with odds like that?
Although the decision was ultimately up to me, it was also clear that each of my doctors brought his/her own biases and preferences into the mix. Some seemed rather knife-happy; others were ultra conservative. Some favored a certain type of surgical intervention, others had a different procedure they preferred and with which they were more comfortable. Some required a particular series of tests as part of the diagnostic workup; others thought some of those tests to be unnecessary and dangerous. And on and on and on.
I learned from this and other medical encounters that except for a fairly limited number of conditions, medical science is not in a very advanced state in terms of offering a clear path for dealing with a certain problem. This is not due to some nefarious scheme on the part of doctors to keep easy cures from us, it’s just the nature of the beast. Nor did I encounter many doctors who seemed to be eager to perform surgery just for the sake of getting money; nearly everyone seemed to be earnestly trying to give me the best advice they could in solving a knotty problem.
Which brings me back to the topic of the day: how can we cut the fat that we know is in health care? The difficulties involved in making such decisions are profound, as well I know, but it’s not as though the Obama administration is the first to confront them. Patients, doctors, insurance companies, hospitals, and researchers have been wrestling mightily with them for decades, and the evidence is still conflicted and difficult to apply.
The difficulty lies not only in our lack of clear information to guide us. Some of the problem stems from the fact that we want an impossible combination: the very best health care possible with no person left out because of inability to pay, and a system that is affordable. Since the very best health care is only affordable if a person is either very rich or very healthy (or, preferably, both), there’s an inherent contradiction there.
Which brings us back to Obamacare, which ignores the contradiction by pretending that it does not exist and/or by pretending that we can cut through the Gordian knot by relying on research to tell us exactly which procedures are necessary and which are not—and to somehow do all of this without rationing health care or limiting patient freedom of choice in a way that the public will find onerous.
And any system that injects the federal government into the decision-making mix though a public health plan is almost by definition going to be costly and inefficient, whatever the administration promises. What’s more, such a system is likely to slowly but surely (or maybe even quickly and surely) crowd out the private alternatives.
Take a look at these current suggestions for health care cost-cutting (hat tip: Maggie’s Farm):
Under the [health care providers] groups’ proposals, certain types of care could see cutbacks, potentially sparking concerns among consumers. For example, the American Medical Association, which represents doctors, is proposing to “reduce unnecessary utilization” in areas including Caesarean sections, back-pain management, antibiotic prescriptions for sinusitis and diagnostic imaging tests…
These have been tried for years, and are all subject to the sort of problems I described when speaking of the history of my back problems. And everybody knows—or should know—how poorly the Canadian system, for example, meets the needs of its chronic pain patients, and how difficult it is to get an MRI there.
If you would like to emulate Canada, see what you think of this—not only is the wait long for MRIs, but the system is nearly impossible to bypass even if a patient wants to pay out of pocket:
After one month, you can’t wait any longer. You decide to dip into your savings to pay for a private MRI. To your dismay, every healthcare facility you call turns you away (except those in Quebec because of a 2005 Canadian Supreme Court decision), claiming that it’s against the law to sidestep the public health system to purchase certain procedures privately, like MRIs.
No wonder you constantly hear of not just rich but middle-income Canadians and high-profile politicians heading south to the States to skip the line, get tests like these done privately, and pay out of pocket.
Part of the reason the Canadian system can continue to function without a revolt (aside from the general affability of Canadians) is that the United States acts as a sort of safety valve for all save the poorest of its citizens. But what will the Canadians do when we’re all in the same leaky boat?
Ah, but Obama can move the sun and earth and stars and stop the rise of the oceans. So I’m certain that he and the wise Democrats now in control of Congress can find a way to do what no previous administration and no country on earth has ever managed to accomplish—to reconcile these contradictions and make the best health care on earth both affordable and available to us all.
How refreshing it was to hear this news. Three cheers for Justice Ginsberg. We can only pray that now the SCOTUS will courageously stop BHO & Co from trampling the sanctity of contracts and precedents that our economy’s trust is built upon.
Right now there is tremendous pressure on physicians to order tests and treatments. Malpractice lawsuits drive tests (and treatements) over prudent levels and patients want actions.
I have noticed that some of the Dr’s I’ve seen lately are gently trying to discourge patients (me) from demanding tests or premature treatment. They explore this gingerly, but they now or guess that I’m not someone who wants the full scope of medical services. My daughter was in her first car accident recently (more psychic than physical trauma). The emergency room resident did his screen and then laid out why no scans were recommended. We were an easy sell, but I get the impression that most people aren’t.
If there were significant patient contributions like in the old days of regular major medical, I think the decision making process of Dr and patient would actually improve. With the patient having a financial stake the Dr would be obliged to layout his/her thinking on the why of testing or treatment.
Sharing the decision making with real participation would help a lot.
One area of enormous waste and expense is defensive medicine — the tests performed when the likely return is low, but the risk to the physician in a lawsuit is perceived as high. (“Doctor, were you aware that, if you had ordered the MRI, my client’s cancer would have been detected earlier and may have been curable?” Never mind that the chances of finding that cancer with the MRI were extremely remote; that the standard of care did not recommend such a test under the circumstances; that the patient had had dozens of other tests which were negative, and was a hypochondriac to boot). Many of these costs are now hard-wired into the system, and tests get done reflexively, especially in the ER. There is, of course, no restraint on the trial lawyers in this upcoming health care miasma, as the Democrats are largely bought and paid for with trial lawyer contributions.
neo,
I have a condition called Meniere’s Disease. It was diagnosed two years ago and I had been suffering from it for some time. It’s a devastating condition, because you never know when a bout of vertigo is going to grab you. And there are variabilities in this condition. For some people, the vertigo lasts only a very short time. For others, like me, it can last for days. Typically, when it happens I am down for the count and in bed for up to two days.
I needed quite a workup of tests in order to rule things out, including a brain MRI with dye, in order to rule out brain tumor. I also had to go to an ear, nose, and throat specialist for further tests. This disease also accounts for some of my high frequency hearing loss and my tinitus (fortunately, my tinitus is not an annoying kind).
Diagnosing complex ailments and diseases cannot conform to a template designed by a government apparatchik. The nature of the beast is so complex that it defies “management.” I understand this. I get it, and always have.
The mindset of the collectivist statist is entirely another matter. This kind of inflexibility and imperviousness to reality is not something that surprises me, since I encountered this way of dealing with reality many years ago when I was on the Left. In discussions with such people I would often say, “Well, our positions says thus and such about these things, but I’ve discovered things in real life that beg for re-adjusting our thinking.” Or, “Our critics say that this aspect of socialism fails and there are these reasons why it happens. I am inclined to look into their arguments more deeply, and see if there is another way to re-work our theory. And if it cannot be found, what does it say about our store of theories?” These people would stiff-arm my concerns, which became another reason why I was always on the margins of the society of fellow-travelers. My loyalty to their orthodoxy was suspect.
And I can see the same patterns at work in the way that the Left is constructing its statist solution for health care. There are too many lazy assumptions and too much ideological rigidity. These people pretend to be our intellectual betters and the wise saviors of society, but in reality they show little understanding of the very nature of the problem.
If that does not frighten a reasonably sane and intelligent person, then I don’t know what will.
Here’s a thought.
Take a look at a picture of Americans at a fair today and compare it to a picture of Americans at a fair in the 50’s…..
You’ll see something striking.
Thinner and fitter people then.
Heavier and out of shape people now.
Who is responsible for the rise in health care costs?
US
We the collective with our lawsuits against doctors, feeding our fat hungry faces, drinking, drugs, extreme sports playin’, free sex, octomom, wanting every doctor visit for free, demanding that we fund every pet cause because we are this close to solving parkinsons, autism, amnesia, etc…. and if you oppose all of this you are a right wing NON-CARING extremist!
Twenty years ago this August I was diagnosed with advanced ovarian cancer. That’s right, twenty years. I went from a routine ob-gyn visit to tests to surgery within days. I’ve read the medical report; I had tumors lying against many major organs, but in no case had they grown through the wall. The surgeon teased them away.
Does anybody reading this seriously think that under Obamacare, with decisions travelling to Washington and back, I would have lived to see my children married and hold my grandchildren?
Lessee Wenda.
Under Canadacare as an example.
Maybe. If the wait for the surgery wasn’t toooo long.
How to decide?
Decide not to decide. Under circumstance A (age of 65 plus, for example)med B for breast cancer is simply not allowed.
Under circumstance C (woman under 25, for example) Pap smears are simply not allowed.
I believe those are two from the Brits’ NHS.
The deaths involved are…tough turkey, guys. You wanted NHS, you got it. And there’s not a damned thing you’re going to do about it, either.
On the other side of the coin (than the way the winds are blowing with the comments), my primary care doctor blew me off over 5 visits and acted as gatekeeper vs. giving me a simple test (such as a chest x ray) while my undiagnosed heart failure worsened (quickly, as it accelerates near the end)… since treatment consists of trying to slow the failure he took years off my heart’s life (hopefully I’ll keep going via a transplant). Scr*w him, lawsuit time baby. Anyone that buys into this managing health care costs via social science stuff is an idiot. As neo mentioned garbage in and garbage out. They’ll manage costs by letting the sick die earlier (vs. providing $$$ / real care).
I just can’t wait to see what restrictions are placed upon the treatment of atypical, non-responsive psychological disorders. Thirty-five years of chasing relief from back pain will be as nothing. For the latter I recommend a TENS unit, by the way.
Thomass, your story is both heart-rending and infuriating. I wish you the best of luck.
Government health care will not increase the number of physicians or nurses. It will just spread them more thinly.
Got an MRI in Canada about a year ago. Took me 1 year to see a specialist and then 6 months to get the MRI. In the end I talked to a friend of my fathers whose brother is a surgeon in the system. MRI two weeks later. Thinking that universal coverage will help poor people afford health care is almost laughable. Universal health care just changes the system from one based on money and commerce to one based on who you know.
And when the Reverend Jesse Jackson and his ilk figure out that universal health care has a disparate negative impact on the poor (and minority population), then we can expect it won’t even matter “who you know” as it will be illegal or unconstitutional to seek treatment outside of the universal health care system.
My 3 primary recommendations for health care reform:
1) Tort reform, as per others above.
2) Make health care true insurance, so it doesn’t pay for every leetle thing. For example, cover costs of care only after large deductibles. Medical Savings Accounts are an example (despised by Democrats).
3) Allow true competition in health care delivery. Compete on cost, convenience, and quality. Right now Dr Dufuss gets paid the same as Dr Wizard for the same service by Medicare, Medicaid, and the big private insurors.
Mr. Frank:
The number of health care professionals, including doctors, has not increased proportionally with the increase in population. What is needed is more schools of medicine, nursing schools, pharmacy schools, etc. That will increase competition among the providers, potentially decreasing costs, and increasing availability. What good does “free” Obamacare do if there are no health care providers or facilities close to home?
This would seem to be a natural counter-proposal for Republicans and/or Libertarians to make.
As amusing as it sounds… the TV show House is actually more accurate for how hard it can be to diagnose someone than the gov’t by desks solution that gov’t health care would require…..
March Hare-
More schools won’t make more health care professionals; more people who want to be in health care does that.
As it is, there’s stories all over of folks quitting medicine because their moral beliefs aren’t respected, or because the stress of dealing with the paperwork isn’t worth the pay, or because folks just treat them cruddy.
I agree with all the suggestions above.
1. I have been aware for over 20 years of the deliberate restriction of slots in medical schools and nursing programs. It means that a lot of people who are quite qualified to be medical professionals do not get accepted.
2. Yes, tort reform is essential.
3. More competition, not less, is an important ingredient to the solution.
Still, we do have a problem of there being a lot of people (outside of illegals) who do not have insurance and who work in jobs where it is not provided and what they make is not enough money to cover the very basics of life, let alone buying insurance. Portability is another issue, and COBRA is not a viable, long-term solution, especially in a time when more and more it is the case that older workers are canned primarily to reduce insurance costs. And many of these people end up being independent contractors who have to pay the much higher insurance rates. Finally, there is the issue of pre-existing conditions that prevent some people from having coverage.
Making the government run the health care system is the wrong way to go. Incentivize people being able to buy their own policies, with subsidization for those who make under a certain income, and provide some kind of subsidy to the insurance industry to cover those with pre-existing conditions.
FredHjr:
I knew that sounded familiar. The astronaut Alan Shepard had that condition, which took him off flight status for years. He had an operation which was successful, and commanded the Apollo 14 mission to the moon.
people think that their tools are reality, and their models are reversable.
that is, they believe you can summarize things (make analog digital), and then reconstitut it the other way… (and not with curve fitting).
so what you start with is all these infinitely smooth scales, and that goes through their summary process, and they then use that to output a small set of scales.
invariably the number of columns are arbitrary… so there is not even a method for boiling down, all to often its the personal preferecnes of the researcher, or the number of columns they can fit on a page.
on top of it the policy makers are often very mathematically illiterate, so they dont even realize the natural effects let alone consequences.
also. much of these things are a false argument… the argument of what they lose and such is based on ownership of the people. that is unless your planning that each person does X work in a pure life, you cant claim that if they act differently get sick and dont do X work, they cost society.
in other words, they are not working out whats good for us, they are working out how much they are willing to spend on their herds now that they own us and they are looking at us like machinery in production.
if you own yourself, then the only person that can be cheated out of the end is you.
Wow, what a timely article, from my perspective.
Last summer, I badly injured my left leg, and was in pretty serious pain. My doctor concluded it was a ruptured tendon, but only a small one, and that it would heal on its own with time. After weeks of continuous pain and very significant weakness in the leg, I went back. This time, he ordered an MRI, and found that I had ruptured my Achilles tendon. He didn’t find it the first time because it ruptured at the upper end, rather than the more common lower end, and apparently I didn’t complain loudly enough about the pain.
The strength gradually came back, but I continued to have significant pain, bad enough that it would wake me up at night, and I couldn’t walk properly. I finally went back yet again, and this time he suspected a pinched nerve (possibly caused by changing my gait, due to the ruptured tendon). This time he ordered an MRI of my back, and found serious problems with that. I am now undergoing treatment for the back, and making some slow progress.
I’m sure he thought the first MRI was “unnecessary,” but not doing one probably cost me months of unnecessary pain.
Oh, bother Says:
“Thomass, your story is both heart-rending and infuriating. I wish you the best of luck.”
Thanks. Also keep in mind, the terrible use of primary care physicians is the norm in public healthcare systems. It stinks that my private insurance stuck me with it but you’ll all be stuck with it under government care…. And it is designed to save money by blocking your access to specialists and tests… which will hurt you.
If you had a ppo or non managed care plan you could just go to a specialist… and go around the GP.
Thomass,
I understand that some PCP’s do take their gatekeeping function more seriously than they do the Hippocratic Oath. I have heard of them, but I’ve been fortunate to avoid them. In the future, under Obamacare very few of us will be able to avoid gatekeepers of all kinds.
I had a PCP back in 196-2002 who went to bat for me all of the time, especially at a very important time. In early 1998 I was diagnosed with left hip osteoarthritis, which was devastating to me because of the pain and it eventually forced me to quit playing hockey. Anyway, the problem with hip replacements at that time was that the materials being used were not very long-lived. One could be facing a replacement of the replacement (and that’s a more risky operation) in ten to fifteen years, given the fact that the kind of plastic used for the acetabulum wore out. I tried to get into a program with a surgeon out in LA at UCLA Medical School named Amstutz who was doing hip resurfacing, where they don’t sever the head of the femur. The dislocate the hip joint, clean up the femoral head and acetabular joint, and then insert a metal stem cap into the femoral head, with the female end in the acetabulum. Well, I was a candidate, but got into the program too late because the gov’t shut down the program by saying to the surgeons “No more devices for you!”
My backup (Plan B) was at Massachusetts General Hospital. This one too was out of the NH Anthem network, so my PCP had to go to bat for me and he did. A surgeon at Harvard Med School named Harris had worked with an MIT scientist and they figured out how to make the plastic used in the acetabular inserts more durable. Every material on this earth has in its chemical structure a thing called a free radical. That is what makes the material prone to wear and destruction over time. Well, these guys found out that by using a neutron beam on plastic you took the free radicals out of the chemical structure and made the plastic incredibly durable. They tested it on these machines that would just hammer away at the plastic, simulating normal and aggressive human use. After the equivalent of thirty years of human life, no wear at all. It all made sense to me because I was 45 years old at the time and did not want to have a revision of that hip down the road.
My PCP got the insurance company to cover my surgery out of the network. It was not an easy battle, but we won. The goddamn insurance company still tried, after the surgery, to stick me with the full bill, but I just reminded them of their approval of the surgery and that problem went away.
By the time my right hip was worn out in 2006 in March of that year the local surgeons were using the more advanced materials. This time, in network, one of the orthopaedic surgeons where my wife works, did the job. I went with the new alumina ceramic material this time, which was just a durable.
One of my fears about socialized medicine, besides the inevitable rationing and the harm this is going to do to people, is the fact that it will likely lead to much less R&D in the field.
Obonga and his minions are just going to plow ahead and ram this down our throats, when they really have no idea of how to make this work well. In fact, anyone who thinks the government can run health care well is certifiably insane.
Liberalism is a mental disorder.
Uncle Bill-
My mom ran into a similar problem after her knee operation where she had a blood clot– but didn’t complain of enough pain (over the phone) so they didn’t figure out that’s what it was for three days. It took getting a nurse who knows my mom, and knows that when she says “it’s really hurting” she means “on a scale of broken leg to that time I walked twelve miles with a shattered shoulder collar, it’s closer to the shoulder level of pain.”
I do think a lot of the over-demand on ERs and some doctors could be filled by making it easier to have “walk-in clinics”. I love these things– I got a throat infection and, being a very healthy twenty-something with only catastrophic insurance, was able to get checked, diagnosed and get an antibiotic script in less than an hour.
The other folks in the room were some folks coming back for check ups on broken bones– not something that requires the emergency room, but not something you can schedule a week in advance.
OT
Neo:
http://roflrazzi.com/2009/03/09/celebrity-pictures-lohan-richie-anorexia-healthy/
Thought this might amuse you.
We can argue until the end of days over sound rational ideas – yet there is nothing we can not argue that does not invalidate one single thing: Obama has overcome every obstacle put in front of him up to the highest office/position in the free world simply by being Obama.
Now, think on that a moment – really. Were you truly in his shoes what would *you* think?
How did this occur – some level of brilliance (I know many who think so and are waiting for it to occur, some starting to become disappointed as he is too “populist”)? Well, not really – how many of his endeavors were a success if we look at what they set out to achieve? None – however they were all HUGE successes if you consider a personal promotion for Obama to be the test and that is what his supporters focus on. I think Obama is truly smart enough to realize this – we only have to look at how he downplayed his experiences in any other way than how it helped him get to his next level.
Is it luck – again, not really. Too many lucky strikes there for it to simply be that. At worst he had to have the intelligence and drive to take advantage of those lucky points to their fullest – no one else ever has. Indeed, there have been few people we know of in history that has done as well as he has in this respect, especially when you take age into account.
So, what it boils down too is that Obama Solves Things – and there is no reason for him to believe otherwise. At some point that train wreck is going to happen – in his other positions it happened after he left and was, therefore, the other guys fault (basically the other guy wasn’t Obama and didn’t have that near perfect mix to mesmerize everyone and failure was seen as failure).
That the fall hasn’t occurred yet is some testament to simply being Obama: that particular mix of white, black, other, educated, uneducated, poor, rich, American, Foreign, and simply luck along with a great oratory ability that allows everyone who wants too to paint him in the image they want (along with the time period having a great deal with the wish to identify with that non-person person) has carried him a LONG way.
Were I not a US citizen I would be enjoying watching and betting when the train wreck will occur and Obama’s simply being Obama isn’t going to solve the problem (as a promotion is no longer there and you have to *do* something). As far as I can tell most of the experienced world leaders are making fun of him as is and manipulating him for their own goals (see the snubbing of England for the d-day event with France). When we finally wake up to that dunno what is going to happen.
Just a few more points from me, a doc:
In medicine, as in life, no one bats 1000. I don’t know if that’s consoling, Thomass, but despite my best efforts I have struck out more than several times, though in only one case to my knowledge did death result from failure to make a difficult and unlikely diagnosis timely.
PCPs are like traffic cops. I don’t know why anyone with the stomach for the 8 year grind to the MD degree would choose it. I did general internal medicine for two years in the early ’70s during the romance of decentralization-rural healthcare delivery (I also voted for McGovern !?!) and fled for specialty training as I came to my senses on a number of issues, including politics.
The AMA is not the voice of American medicine, though it styles itself as such, any more than the GOP is the voice of conservatives. Their public policy positions today should be regarded with suspicion and cynicism.
Pain can be (and has been) almost unbearable. Life threatening illness, frightening, especially if you’re not done yet. I suppose we should all borrow a statement from Dustin Hoffman and have it placed on our grave stones: “I knew this was going to happen.” That, and taxes.
Mr. Frank and March Hare are right- it’s a supply and demand issue, no matter who pays. Government intervention will not change the fundamental equation that doctors are in short supply. Further, it will take decades to start to alter the balance- training a doc isn’t like building widgets.
Face it- the AMA has done a marvelous job of featherbedding to the detriment of us all.
The truth is that we ration under the present system- the mechanism is the ability (or inability) to pay. Under Obamacare, rationing will shift to a first come-first serve mechanism, irrespective of cash (except for inevitable black markets.)
Both systems ration. But Obamacare will morph into a hellish DMV line- take a number and wait your turn, with little incentive toward speedy, competent care.
Neo–a very good post, as usual. I’m a physician, still in primary care but shuffling toward retirement. I wish it all was as easy as the “experts” advising Obama would have us believe. Making the right diagnosis can be as hard as hell; recommending a treatment that works is harder still. The idea that medicine can be reduced to a simple cookbook makes me want to vomit, but that is where we are heading.
Dan,
what you say is premised on a false idea. that he wants or cares if it actually improves.
medicine CAN be reduced to a simple cookbook if you dont care what the outcome is, and or you want darwin to solve the problem of the weak and infirm in the population (eventually everyone WILL fit the book as the book becomes a selective pressure).
people are so afraid of being labled a nazi if they think as to genetic conclusions. rather than realize that the problem is in the solution and the idea of manipulating to an end by the few over others, and not the inforamtion itself.
as an extreme example, you find out that a person has downs syndrome, you can shoot them, or you can educate them and put them in society.
those who are progressive, modern and foward thinking will shoot them, because they are actually regressive, backwards, and archaic.
those who are conservative (like the hoyts) will value the person and know that we all dont ahve to be the same to have a meaningful viable, and productive and happy life. that earning a living pushing a shopping cart and helping people can be fulfilling and meaning (and not just to downs syndrome).
unliek the progressives,modern, forward thinkiers they realize that luxury and such desipised things means that one no longer requires the same level of efficiency. that is why these things are throwbacks, and not forward thinking. they are still thrown back to our primitive era where the marginal existence IS seriously impacted by the actual makeup of the population writ large.
but when populations are 300 million, that concept breaks down. just as pollution breaks down the minute you realize that the whole contenent will be folded under and meleted down in the future. that invasive species are the engine of darwin, and trying to keep every proportion static, and blances is a waste (and relies on some really bizare logic)
so ultimately the things that our elite are doing are ending up creating a genetic outcome.
they are and have created a mass breeding program. rather than old age being the mark (and the species getting to be older and olcer), they will create an artificial mark, and so increase the fitness elow that mark.
they are shorting the syustem so that the able and prodictive are being bred out of the population, while the stupid and others are being promoted on the dime of the able to over breed. both ends, elite and poor are overbreeding away the middle, and that is an engine of speciation (welcome to morlocks and eloi)
this is the concept of achieving an END by another means in a population that has lost the mental capacity to see physical ends as absolute and equivalent no matter what the label is
their failure is a given, and is proven
that means that their actions desire the end that failure gives, while they use the fact that such failures cant be stopped by a general population that cant reason any more.
and here is what i said it was all along given all their political writings and movements:
Murder by Bureaucracy
spectator.org/archives/2009/06/10/murder-by-bureaucracy/print
A hundred years ago, your doctor couldn’t do much for you: set a bone, tell you whether your heart was good enough to go in the army, tell you to stop drinking, tell you whether something was going to kill you or not, give you some medicine for various digestive problems. That was it.
Magic is expensive, just like it was in the Middle Ages. We can do magic now, and it’s expensive.
Unfortunately, it is also expensive to determine if we currently have the proper expensive magic to help you.
This is what drives health care costs and will continue to drive them. We can sometimes do amazing stuff. We can cut back percentages of that with efficiencies and wisdom, but the essential underlying costs are not going to change. New technology, new medicines, new techniques – all very expensive.
We know this intellectually, but switch to a different mind-set when we discuss actual patients. A new medicine exists – we think everyone should be able to get it. You’ve got that MRI machine right there, doc, and it would tell us what we need to know – set me up.
interesting article here:
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
Yesterday, I spoke with a Department of State representative about a passport issue and learned that the solution would require an appointment in person at a Regional Passport Center. I called the number given to me for that purpose by the representative — the same number provided by the Passport Center’s website. Then, I waited on the phone through extended irrelevant recorded messages about general passport-application procedures, directions to select from a menu which did not include a choice for making appointments or an “everything else” option, endless periods of silent hold, transfers to various persons, each of whom required a new explanation of my problem, each of whom helpfully advised me that I would need to make an appointment, and none of whom knew how such appointments are made. Eventually, somebody provided me with the direct number for the automated appointment line (a deep secret for some reason). Once I got myself properly connected, making the actual appointment turned out to be a simple, startlingly efficient process that took only a minute or two.
Now, every live person I spoke with as I wended my way through the voicemail catacombs was pleasant and patient. But the time and frustration it took to reach them was unbelievable, and completely disproportionate to my extremely simple purpose. All that time, I kept thinking of what fun it’s going to be when I’m on the phone with a government bureaucracy sometime in the near future, trying to get an appointment with my doctor.
We need free passportcare for everybody 🙂
FredHjr Says:
“I understand that some PCP’s do take their gatekeeping function more seriously than they do the Hippocratic Oath. ”
They often get a bonus for doing so…. even in the UK / in public care!
Tom Says:
June 10th, 2009 at 1:44 am
“Just a few more points from me, a doc:
In medicine, as in life, no one bats 1000. I don’t know if that’s consoling, Thomass, but despite my best efforts I have struck out more than several times, though in only one case to my knowledge did death result from failure to make a difficult and unlikely diagnosis timely. ”
I hear you and if it was a totally off the wall situation I’d agree it applies in my case…. but its not. I came in five times over six months with symptoms that said possible heart problems. He just blew it off and played gate keeper (its a virus, we don’t have anything for that, blaw blaw blaw). Everyone else (nurse friends and such) were saying… hmmm, might be your heart…
yeah, well..
i just heard how man CZARS our populist has created.
now we have more CZARS than the romanov had during their 300 year dynasty…
Can the government deliver quality health care at an affordable price? The Obama administration says “Yes, we can!” I say “No, you haven’t.” Medicare/Medicaid has been kept going only by mandating price controls. If private patients are brought under government programs, where do you think we will get our new physicians? Why would anyone be willing to spend four extra years in school, plus another four or so as an intern/resident, just to join the civil service? The places with the highest incidence of government health coverage are the ones where you can’t find a pediatrician or OB-GYN. When the whole country is under that kind of price control, promising students will find something else to do with their lives. Maybe they’ll go to law school and sue the few remaining doctors.
let me state my math point, perhaps in simpler terms, and then show examples where its a problem all over.
and one that we cant get around..
Here is one of several fundemental problems…
The universe has infinite decimals, and their math models use rounded numbers
As you use the prior state of the model as input to compute the next prior state, you introduce more and more errors till the numbers are so far from reality they are USELESS..
one can then apply this to economic models for central planners, global warming models, and even things like this “Earth may collide with Venus” -www.straitstimes.com/print/Breaking%2BNews/Tech%2Band%2BScience/Story/STIStory_388456.html
the point is that even if central planners could choose the right number or columns, create curve fitting formuleas to be applied when reversing the task (from sumary to reality), that is EVEN IF THEY HAD ALL THE STATE INPUTS CORRECT TO START THE SIMULATION THE SIMULATION CAN NOT WORK MORE THAN A SHORT TIME.
even curiouser
if they do get a model to start a thousand years ago, and the model works great up to today, and the model then is used in the future, then all they did was get an invalid model to converge on a current value before careening off again.
the reason is that they do not tell you how they correct for this mathematical problem between reality and machine models.
without rounding the problems become so intractible and so large that putting two number together becomes impossible. go ahead, add the value of pi to itself and let me know the final decimal value
about the only pretend way to avoid this in hard models of reality may be to take the decimal points beyond the nyquist limit of the plank time – this would be to take ALL the calculations to beyond the 44th decimal place. and that wouldnt avoid it, just push it off for a while… (since the smallest values in reality do not limit the calculated outcomes in reality – that is the interaction of several plank units not in the exact same alignment will yeild values that are smaller than plank units)
now. today the smallest unit of time is the atto second… that is measurable time. and taht is only to the 18th decimal place. this would be about 10 to the 26th plank times off.
and by the way, once you start measuring things at the ATOMIC level which is WAY WAY WAY larger by such an extreme one cant mentally grasp it, the measurments affect the system.
want to know how sensitive reality is to conditiions?
to greater than the 44th decimal place counts.
Why would anyone be willing to spend four extra years in school, plus another four or so as an intern/resident, just to join the civil service?
beacuse when they were tested as children the planners said that this one would beome a doctor, and so on.
duh… doesnt any one actually remember HOW SOVIETS LIVED? [heck controversy still goes on that some of the athletes were not the sex everyone thought they were, like the chinese girls of indeterminate age]
he and his freinds are stalinists, so if you want to know their ideas of how to solve the economic crisis at each step, you just ahve to examine history of teh same steps.
http://www.clarkhumanities.org/oralhistory/2006/9612_1.htm
some excerpts:
My husband was also an engineer. We made very little money, because the engineer salary was little, and it wasn’t enough so we were forced to do secret sewing work at home.
But we did it with fear, because it was forbidden to have private jobs. In the Soviet Union everyone worked for the government, because all the factories and stores, everything was owned by the government. People worked for the government and got paid. And because of that nobody could work at home, it wasn’t allowed. If they caught you they would penalize and take you to jail.
There was no democracy during the Soviet Union. There were elections, because they would elect a government leader, but the leader was already chosen by the government. The Communist party was controlling the Soviet Union and the Communist party secretary was the leader of the country. The Soviet Union leader, Communist Party leader was the first secretary
Armenia had their own leader, again Communist, and the other republics had one too. And all those secretaries of the republics were reporting to the Communist Party in Moscow, the first secretary Brejnev. Before Brejnev were different people, Khroushov, Brejnev, and then it became Garbachova.
They had death Penalties in Russia. They said they would shoot them. That was the death penalty. In reality, they made them work in Siberia. The coldest parts of Siberia…unbelievably cold. It was better for the government. They would benefit and eventually the people would die.
so if you want to know where this will all end up if it doesnt stop, then read what happened in other palces when they didnt stop addig bandages on top of bandages and refused to reverse course.
All of the newspapers were written with articles filled with good things about the communist party. Nobody had the right to write their own newspaper. And if you said anything against the government KGB would catch you. No one had the right to say anything bad.
all ya have to do is talk to those with EXPERIENCE and stop listening to those who only have baseless OPINION.
We decided to move to America because we were living in fear, during the Soviet Union. The engineer salary was low. Mine was low, your grandfathers was low. Since our salary was low we did secret work at home in the basement. We put an electric motor and started sewing. But when they would knock on the door, we would turn off the motor because we were afraid of them catching us. We would take it to stores secretly, sell them and live off the money. We thought to ourselves how long we could live like this. It would be better to go to America. During those times there was an ovir, where the man would make us papers saying its ok to go to America.
You had to have a relative there to be able to go. We had a friend, and our friend made our papers saying that your grandfather has a brother that went to America during the war. He made a paper with that mans friend who was our close friend. He made a paper that he was your grandfather’s brother and we took those papers to the ovir. We turned in the papers. They could have denied us, but they didn’t because the person knew us and we gave him money so he would let us come to America.
We came, we rented a house. I looked after your great-grandmother. I earned money for looking after her. There was your great-grandmother’s pension. The rent at that time was pretty cheap. The rent was $450 dollars the same as your great-grandmother’s pension and to that we would add the money that I would make looking after her until your mother and I started working. Little by little the circumstances got better. Now were old and we get a pension.
http://www.clarkhumanities.org/governments.htm
Page down and find Soviet Union…. Then you can read and find out what its like to live under central planning!!!
Some of them are very interesting, most are from the southern areas. but you can find similar stories from latvians, poles, czechs, slovaks, etc…
A Woman of the 60s Trying to Get Through Life
http://www.clarkhumanities.org/oralhistory/2006/8450.htm
All businesses were the governments. No man was allowed it have their own business. We had no freedom. We couldn’t everything was the governments. But there were much greater things: no funds for attending school, learning was free.
Soviet Union controlled fifteen different countries.
You know how all police here have the same value and nearly same job. But in the Soviet Union it wasn’t like that. See whoever was the highway officer was the only one to be able to give a ticket. But the city officers had no right to give out a ticket; they had no business with another’s business. For example city cops would give you a ticket if the rate were written thirty-five and you drove fifty, of course you would receive a ticket.
as you read them you will start recognizing the stuff that doesnt make sense to you!!!!!!!!!!!! it still wont make sense, but you will know where it comes from!
All the strong and powerful took over the lower class people. And that’s why people left to come to America. That’s why the strong and powerful are eating the weak and poor in our country.
They came to this oppressive center of capitalism to get away from capitalism?
from another:
I was very young so I have some vague memories while I was in Bulgaria the president at the time was Todor Zhivkov. The neighborhood that I lived in was pretty quite and most people are very well mannered and highly educated, but due to the communist regime a lot of people were very fearful of being abnormal. I think that their was a lot of mistrust among people in my neighborhood and because communism relies on sort of spying you never knew if your neighbor was watching you to see if you might say something anti government.
One other flaw that was about my neighborhood was that if somebody was a little bit more wealthy then anybody else it would be very noticeable and people would start watching and they would become very jealous. I remember when I was five I had a pair of brand new roller skates and I was playing with some friends and I just happened to walk away from the skates and they were in the lobby of our building and maybe a half hour later when I came back they were all gone. And it wasn’t uncommon for neighbors to steal from each other when one wasn’t looking because there was an extreme neediness because people live with the bear bear minimum, but their was stuff lacking.
Their was so many things that were lacking and when it comes to you know going to the super market you take here for granted such as the meats, and vegetables that you can buy but when you live in a country where there is just a limited amount of everything and there is some thing that do not even get your country. And that then creates a huge desire in people so if someone has something that they don’t have of course there’s going to be some stealing and that’s how some of the laws were broken but of course you know it was done in a way that you know you can’t point fingers because if you point fingers then somebody’s going to point a finger at you.
In Bulgaria freedom of speech was very very limited so in um in a communist society you basically um limited to accepting communism and anybody who accepts communism is given um the more loyal you are to the communist the more freedoms you have. If you go to communist party meetings then at your job you get certain like benefits are given to you because you are one of them, so um freedom of speech was extremely limited. Basically there was a lot of like limitation of what information comes out of Bulgaria of what’s going on around the world. So everybody knew that you know that in America things were totally different in everybody’s mind you know America was like the big dream where everything was just wonderful. There was all this freedom but you didn’t hear much about what was going on and information and information on what was going on in Bulgaria wasn’t coming out either so the newspapers were very very limited on what they could print.
People tried many different ways of escaping from Bulgaria and some people ended up going to France or to Germany or to Italy. It was under the pretense that they were visiting relatives or going on a vacation and they never cam back. But when they left they left pretty much everything they own, all their relatives behind so you may like for an example to brothers they leave their Parents their um Cousins, Aunts, and Uncles but together they somehow manage to get across the border and they might make up reasons like they’re going to get across for a couple of weeks to do work they might go to Greece and they don’t come back. This was going on for decades since communism was uh started and even after communism fell like in the nineties when I visited in nineteen — ninety-four and things were a little bit more free but again financially the whole country was almost in a collapse I mean so many people were desperate for work. Bulgaria is not very economically in debt but that’s what the country’s are like in present day two thousand and fives’ countries.
Everyone had jobs. The government gave everyone their jobs. People always had something to do. There were a lot of factories and many worked there. But the pay was very low. In America the boss receives more pay than the employees but in the Soviet Union the employer received less than the employee and that caused a lot of corruption.
were no laws tied with business management and that’s why there was a lot of corruption. If you wanted to do something u had to pay money to do it and it had to be done secretly.
[the chicago way]
Whatever your boss said you had to do it, for example the journalists. They could not write what they wanted. They could only write in the newspapers what their bosses told them to write. The journalists that had interviews with people could not ask anything they wanted as well. Their boss would give them the questions and they would have to ask them. You could never speak your mind.
does this sound familar?
There were people that would gather and talk about Stalin privately but you could not publicly. If someone reported you, you would be jailed immediately. People hated him but when he first ruled the Soviet Union people liked him for he wasn’t strict. Then he took away freedoms so he was hated.
and another telling about the press..
During Soviet Union you didn’t have the 100% right to say anything that you wanted. The Communist system didn’t let you say everything openly. They didn’t care about what I had to say and they wouldn’t count what I had to say. There was no freedom. The Communist government didn’t let whatever the person wanted to write in the newspapers. Ahh…Most of the time they forced the people to write whatever the government wanted for the good of the government.
Soviet, most of the time was a Communist system and said equality, but there were no equality, most of the people were poor, and there were rich people and they were small amount, but there were, it wasn’t equal. The rich people didn’t help the poor and you stayed poor.
we all new that when you grew up you shouldn’t say anything against the government, that’s definitely everybody knows from day they are born.
we used to live in a socialistic system, um; it’s much different system than we have here in United States. So, every child in school, we had obligation to be in young political groups, starting from the second grade probably, we have to be from the start, we have a symbol, it’s a like a star.
On all levels of education, we had political science subjects, and we had to believe, like we here, we believe in god, we have to believe in our leaders, party leaders, and whatever their idea are.
when we want to talk to somebody in our apartment about our paperwork, about stuff, what we have to take, we had even to cover the telephone unit so they wouldn’t listen us, they wouldn’t hear us. Because every telephone they could hear you, they tapped the phones, everything; they send people to know what you are talking about.
they could tell you whatever they want to tell you, they would put you in jail for any reason they wanted, and you cannot say that you right.
Over there we were categorized by nationality, and we have to show on our documents, which is for example passport. So when they open the passport, they see Jew and they say oh no, we don’t have the opening for you.
[explaining obamas hate of isreal?]
a lot of people who were talking freely, they have to go to concentration camps in Russia, they have to go to prison, only because they speak freely.
how do you get people to read the testimony of literally millions?
doesnt this ound like what people are like with obama?
They were brain washed. People in our country, even after Stalin, even the time when we were leaving country, even some people now, here, they brainwashed that much, they couldn’t believe that it would be something different. So its actually was brainwash, whole country. I do remember when I was five or six years old when Stalin passed away, and I remember my mother, my grandmother, and my father was at work, they were crying and they were saying, oh, our father died, so how much they were brainwashed. Then on my mother’s side, I have an uncle who spent many years in concentration camp, he came, thank god, alive from concentration camp, and anyway, he didn’t believe that it was Stalin’s fault. They accuse everybody else, but not him. He was like a god for people. People were brainwashed, brainwashed from the day you’re born. After he passed away, when it was Khrushchev in Power, well, then they start to uncover some truth about Stalin, and then you start to know even more and more and more. But even today I know some people who honestly believe Stalin was ideal. He was the perfect person, almost like a god, even today. Most of their politics were concentrated of brainwash people. It’s happened in the world here, there, somewhere.
I could tell you one thing. The soviet country was a big prison. In prison the people live the same way right? They eat. They sleep. They can see movies and read books but they can’t get out.
However the government set the laws and they had to accept it, even in the schools teachers were teaching “maxizm”, “Leninism.” How can I explain their prevailing ideas? The ideas that the innocent children would learn. The schools were not payable, it was free, since the year that kids were bom they would send them to school, they would send them to school that was called “mankamsur.” It was beneficial for the government to take care of children, because in the future they would be their supporters. If they let them to stay with their parents for a long time it wouldn’t be good for government, because parents would always complain. They did not have food and what could kids say or think about it? At school teachers would ask what did their parents talked and kids would innocently tell their parent’s appeals. The next day they would not see their mom or dad anymore.
Freedom is a very intangible concept, for a criminal freedom is freedom to kill, for a good man freedom is to create, to help others, to do something. Freedom is a very interesting concept it is all up in your head, it all depends how you understand, what you understand with that word freedom. Freedom doesn’t mean that you are free to come and do all kinds of criminal stuff. No. Freedom means you are free to create, to help others, to learn to study, to get promotions.
During communism in any republic in Soviet Union there was no such a thing as freedom of press or freedom of speech. It was mandated from the top from the government, they would decide what could be said and what you can say what you are aloud to say, and uh you just couldn’t uh say what you wanted or you could not print a journalist could not print anything he wanted in any newspaper or uh or speak loudly publicly. There was no freedom of religion there is one semi oppressed religion which was Christianity of course. People did it like under table you know, but it was not completely open. — Mr. Nersesian
http://www.clarkhumanities.org/oralhistory/2006/9107.htm
there is a reason that some of the most ardent patriots of the US are the ones that risked their lives and such to get here…
like my family…
Artfldgr:
If God were a rancher, he wouldn’t allow, much less encourage, the random, vigorous breeding of the least desirable animals in his herd.
But God is not the rancher. Who’s running this ranch?
More than Canada
Canada, being next to the US, is automatically in an unusual position.
If you’re going to look overseas, and you should, look at the more successful systems in Israel, Norway, France, and Germany.
US statistics are skewed with comparison to Europe’s because of our racial history and the large number of illegal immigrants in the system. Different social problems produce different distortions.
Medical economics is actually quite complex. The US currently rations care by cost, which doesn’t produce a political uproar. The same decisions by a “Heartless bureaucracy” would be front page news.
Rationing by cost is invisible and is legitimate because it is seen as “Individual choice”. Public decisions become political, fodder for the news shows. And then it becomes rational to try and raise a stink if you don’t get what you want. It helps to have a cute blond child in the picture.
The cheapest solution, by the way, would be to kill people who get too sick.
Our statistics are also skewed because we’re more honest in our reporting– infant deaths here.
You want information on nationalized health care, try Mr. Smith’s blog–he does bio-ethics.
Artfldgr,
It must be disheartening for you, a Russian immigrant, to see this country heading for socialism. You fled socialism.
Right now, maybe it’s the kind of day I’m having (a tad sleep deprived because of pain and a certain condition), but I’m feeling discouraged and a tad depressed about what is going on. It really is happening: I am living in the days of the decline of Western Civilization.
fredhjr..
it IS disheartning, but not becauyse i am a russian immigrant.
its beause i am the son of a refugee latvian.
latvia is not russian, it was occupied, and thats the beef that russia is having. russia wants to be celebrated like america was loved by the french after the war (and still is by the old french that remember)..
whats left of my family is just my parents, my sister, my son. a few cousins… and their kids…
thats it… it was so odd growing up. you would visit your grandmother and family… and there would be photo books but you would look… and they would tell you about this person, or that person, and your a kid so you ask questions.
later you learn not to ask questions. you go to cultural events like johns day. the old men get drunk and start talking about the old days.
eventually as you get older thy start saying that your old enough to know. every latvian i know has a copy of the gulag archepeligo. they tell you of how they lived, how it changed. what to look for. they tell you to read the ideology, just incase it happens.
i have so many skills beause those with skills could survive under the radar.
unlike the people here today, unlike their grandparents.
its not that i fled socialism… its that it followed us to finish the job it couldnt finish last century.
i can live in any of these systems as long as i am not singled out as a direct target. i ultimately really dont care for me, but realize what will happen to everyone else.
to see the photos of the checka rooms. to realize that the black tarps on the walls and the grooves in the floor and drains were not hollyweird props.
to see the photos the family no one would ever meet.
to watch a documentary about stalin and hitler and they show things in the area where you family lived. and you wonder how many of my family is in that mass grave? are they somepalce else?
you see the castle and propery and awards that your family accrued over centuries living in the same place… never to have them because all was lost when they fled.
and the stories… so horrible.. and you knew they were cleaned up..