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January 14, 2018

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It sounds like that regrets about waiting too long to address this aside (which you have previously written about), the surgery went well and you are receiving excellent care ... huzzah!

Regarding health care in general and nursing in particular, even though I'm more free-market focused than many here, I am in favor of single payor. That aside, there seems to be structural problems in both teaching and nursing leading to "shortages"* that are hard to address, namely opportunities and paths for advancement. For teachers, the only path is administration, but being a good administrator and being a good teacher are two different skill sets.

For nursing, there are PA and NP paths, but from some anecdotal evidence it appears that the job markets for those positions is very competitive and the quality of life (scheduling and number of hours worked) is much more demanding than what an RN is accustomed to (which already can be demanding). I've spoken to more than one PA or NP who regret spending the money or taking out loans for that advanced degree/certification.

As someone who knows a little bit about Japanese political economy, I've been fascinated by Japan's response to its persistent and growing labor shortage. For an outsider, it would appear that economic pressures would eventually lead to an erosion of traditional gender roles in Japan, but I've learned to never underestimate the resiliency of tradition there.


* Some of it may be disinformation, but trying to research the question "Are there shortages of teachers or nurses?" yields contradictory results.

...even though I'm more free-market focused than many here

Free Market economics has a solution for "shortages". Just look at the market for CEO's. Every available opening is filled, and there is no talk of shortages. As for "advancement", there's alway the Senate. :)

Get well, lj

Yes indeed, lj, get well soon and completely. May the force (and every other good thing) be with you.

American medicine can save your life with cutting-edge medical care. And then kill you with some of the worse customer care.

there's a shortage of teachers who want to work long hours for shit pay

lj, glad you're recovering well, hope it continues. I "owe" you an afterthought to your Pinker/Chomsky comment, which was in response to my "words and rules" reference, but I haven't had time.

For now I just want to second this: there is really no way in a civilized society that a health system should be for profit.

I found the Japanse drama series, Doctor X, pretty entertaining.

"Daimon Michiko is a 37-year-old freelance surgeon who is part of a questionable "doctor placement service" that has her wander from hospital to hospital. The harsh environment at the hospitals led many doctors to retire from their positions, forcing hospitals to make use of said program to fill the empty spots at least temporary. However, Michiko doesn't look like a doctor at all with her flashy clothes and eccentric attitude."
Doctor X - Surgeon Michiko Daimon

there's nothing wrong with markets when the conditions for a well functioning market exist, and when the outcomes that a market is likely to produce are what is desirable.

just like anything else.

if money is going to be the basis of allocating health care, then people with money are going to be more likely to get it. it's up to us if that is what we, as a society, want.

assuming we all agree that we participate in a society.

glad to hear you are doing well and are in good hands LJ. take care of yourself (or let others take care of you) and be well.

One area of US medical care where the quality of care is going up and costs are going down are Lasik and cosmetic surgery.

"there's nothing wrong with markets when the conditions for a well functioning market exist, and when the outcomes that a market is likely to produce are what is desirable."

Clearly.

The demand curve for health care for a large portion fo the population goes from zero to infinity randomly.

Then thrown in the supply side challenges which accompany an avoidance of any pretense of "rationing".

That's not even getting into moral issues.

Being a scarce resource, medical care will be rationed in some manner no matter how it's provided.

I think one of the big problems of our modern world is that we don't give blue collar work its due.

As someone noted above, traditions can be incredibly persistent. And that's what is going on here. We still pay as we did when only a tiny fraction of the population went to college or did anything which wasn't blue collar work. Supply way lower than demand, so high pay.

Today, the supply has shifted to few people willing to do blue collar type jobs, at least for the pay on offer. Especially for jobs whose pay scales were created on the assumption that women, no matter how intelligent or educated, had extremely few options.

Get well, LJ.

The aging process sucks. I haven’t had anything serious yet, but am old enough so that it isn’t safe to ignore a funny little chest sensation while jogging. It turned out to be nothing, but it took a few hours in the emergency room and a few followup visits with a cardiologist and various tests and phone calls determining who was suppose to pay to finally reach the conclusion it was nothing. On payment, I ended up not having to pay for much, but I would hate to be a poor person with little to spare navigating this system with an actual medical condition.

My last observation is that there is really no way in a civilized society that a health system should be for profit. Because if it is, there are going to be so many opportunities for someone to cut corners or boost revenues by cutting back on something

An interesting comparison might be law enforcement. Some bits, e.g. security guards, can be privatized. But basic policing? The possibilities for abuse are just way too large. (And we see at least a pale shadow of that in the towns which are dependent on traffic tickets and other fines to fund city government. It ain't pretty, even there.)

The US still has private police forces. North Carolina has quite a few. As of 2015, Duke University had 176 full-time security employees, including 83 non-deputized security officers and 68 deputized private police officers.

And how does that work out, Charles? For the entire population, not just those in a position to impact hiring decisions.

Lasik and cosmetic surgery.

If all any of us needed was Lasik and cosmetic surgery, Bob would indeed be our uncle.

Being a scarce resource

Why is it a scarce resource?

Duke University had 176 full-time security employees

My local mall has some cops, too. Private entity, private cops.

I'd just like to note my appreciation for CharlesWT, who has been around here forever, and who has consistently held and expressed a fairly rigorous libertarian point of view throughout his time here, without copping any kind of attitude whatsoever.

It ain't easy holding a minority point of view. And while I almost invariably disagree with him, but on any given day I learn something from him.

Maybe we need a conservative / libertarian appreciation day here on ObWi. You guys take a licking a keep on ticking.

And how does that work out, Charles? For the entire population, not just those in a position to impact hiring decisions.

I'm not much up on the details of private policing. A mixed bag I would guess. I just know that private police forces have been successful in different times and places. San Francisco's first police force was private and, until recently, it still had a private force in addition to the municipal police.

This article is mostly about individual private police officers rather than private forces:

Private police carry guns and make arrests, and their ranks are swelling


Why is it a scarce resource?

The desire/need/demand for medical care is pretty open-ended. The people, resources and wealth that can and will be allocated to it are very finite.


My local mall has some cops, too. Private entity, private cops.

Are they mostly off-duty public police officers?


I'd just like to note my appreciation for CharlesWT

Thanks, Russell. I appreciate the appreciation.

I'd just like to note my appreciation for CharlesWT

Seconded.
(I actually have a stand of sympathy for the libertarian perspective, just not as a governing political philosophy).

..., just not as a governing political philosophy

Apparently, "Elect us and we'll leave you alone.", is a hard sell. :)

Apparently, "Elect us and we'll leave you alone.", is a hard sell.

The hard sell is the part about leaving alone everybody who is ill-intentioned towards you. Whether deliberately or just thru unwillingness to accept that other people have rights, too.

Beyond might makes right, of course, which seems to be the libertarian default view. At least if it's their might, and not others collectively. Presumable they figure that they, and not others, will always be the ones with the might.

all the best, lj

I'd just like to note my appreciation for CharlesWT.

OK by me. He takes our abuse with remarkable equanimity, to the point I suspect he must be a bot.

Props, too, to Marty and McKinney (when he can tear himself away from the golf course). The get a bit hot blooded at times, but what the hey, it's not as if I never do that (heh).

I do agree. I think it's so important to be able to discuss things (politics, philosophy, music) with people of completely different persuasions, otherwise the bubbles in which we are increasingly living will become prisons, from which we stare at each other uncomprehendingly through the bars.

Hoping you recover soon, lj.

"There is a concept in Japanese called omotenashi, which is poorly translated as hospitality. Japanese like to break it out to explain why they are so nice, but it's a double edged sword, and it can be controlling, telling you how to eat your dish and keeping track of all the minute rules involved with just about every social interaction."

C.S. Lewis talks about this concept in "The Four Loves". The perversion of affection love is in becoming too controlling about how the things you love must not be permitted to change or thinking that because you share something you can demand it from someone.

The interesting thing about omotenashi is that I don't see how it arises out of 'affection' for Japanese. Japanese are famed for doing this for people they don't know from Adam.

Why is it a scarce resource?

"Scarce resource" is actually a term of art in economics. It describes pretty much everything which is not available for free in infinite supply.

As bobbyp points out, the way to get more is to pay more. Want more nurses or teachers? Pay better.

It has always - well, not always, but for a long time - struck me as odd that many who profess to be market believers resist the idea that raising pay scales for some jobs will improve the work force.

There's a limit to how much a pay scale can be raised for a job. At some point, the job becomes not worth doing no matter how skilled or hard working the person doing it.

A major part of medical services being a limited resource is the chokehold the AMA has on the supply of trained medical personnel. Which the claimed motivation of assuring high-quality medical training (which is GOOD), but results in higher prices from limited supply (which is BAD. For most of us).

Maybe there's a better way to strike a balance, but the only simple answers are for simpletons.

There's a limit to how much a pay scale can be raised for a job. At some point, the job becomes not worth doing no matter how skilled or hard working the person doing it.

Well, the near infinite pay for hedge fund managers shoots that hypothesis in the ass.

The idea is if wages for, say teachers, was raised to $400/hr (what law firms charge), more people would (ceteris paribus) want to be teachers. This would alleviate the so-called "shortage". Assuming a fixed working age population,this would draw people from other economic sectors to get the higher income. Those jobs would then be "not worth doing" (whatever the f*ck that means).

One area of US medical care where the quality of care is going up and costs are going down are Lasik and cosmetic surgery.

You mean that there are downwards pressures on costs when consumers are paying for a product out of their own pockets, and can readily choose not to buy it?

Yes.

Or easily choose among practitioners.

(whatever the f*ck that means)

I should have said that beyond some level of compensation, a job isn't worth the cost of paying someone to do it. The job either isn't done or some other means, like automation, is found to accomplish it.

Except for the boss's idiot nephew and some government employees, employees are generally paid no more than the economic value of their jobs. And less if more people are competing for the jobs than there are jobs available.

employees are generally paid no more than the economic value of their jobs. And less if more people are competing for the jobs than there are jobs available.

This is precisely why the larger unit (country/society) has to consider and pay the economic value. If there is some economic value in reducing anxiety about health care or education, then you don't want to be constantly lowballing the economic value.

Hope you recover soon, lj.

This struck me:

My hospital stay after my prostatectomy is ten days to 2 weeks. In the US, it's 24 hours after the surgery

I have no experience with the procedure, so maybe more days is warranted, I had a heart attack in 2004, in Canada, they suggested I would be in the hospital for a month. After six days I checked myself out and returned to the states, where I had a stent put in as day surgery. If you count the original visit, the stent and my bypass many years later I think I was in 12 days total.

There is definitely some cultural difference. When I was told I had to stay in the hospital four weeks, I was angry. It seemed unnecessary and a burden on my wife, a problem at my job, and an unnecessary cost.

Second, i can't imagine how you measure apples and apples and get lower medical costs if the standard hospital stay is weeks longer.

These are observations not criticism.

My admittedly liberal take on this, when hospital days are a main driver of revenue, the obvious choice is to try and cut back there. Unfortunately, this often leads to complications that are even more expensive. This is fine for the hospital, they actually increase their revenue because complications require more and more heroic measures, but not so good for the patient. The insurance company also gets in the act because it wants to reduce costs, so it pushes to reduce those days.

Waiting until some measure of certainty in the outcome is achieved means that more people get back to work, earn salaries to pay taxes. However, if you are always worried about getting by with the cheapest amount to pay because you have little or no insurance, there is a greater chance that you will return before you are really ready to. Or not go until it may be too late.

Post natal hospitalization is a useful place to look at this.
http://www.businessinsider.com/length-hospital-time-after-giving-birth-2016-3

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714454/

The second article gives a good idea of the multiple factors involved for the NHS. Yet, short shrift is given to those concerns if profit is the primary driver of care, which it seems to be in the US.

An approach to reducing hospital days additionally ends up with poorer people using the emergency room, which increases the possibilities of contagion, increased job insecurity, and high pressure on staff, thus costing more money, money that is not accounted for in the 'savings'.

I had emergency surgery for a detached retina 4 years ago. My hospital stay was 3 weeks. In the US, it is usually done on an outpatient basis. If I had lost sight in one of my eyes because the care I received at home was not informed by appropriate medical practice, how much money would the state lose because I would have had a sizable reduction in my earnings? It's not just me losing out, it is my children, my pension contribution, my employer.

I do acknowledge that Japanese medical culture is built on Japanese cultural practices, it would be good if free marketeers would acknowledge that US medical culture is built on US cultural practices and some of those practices have had bad effects on society as a whole and need to be curtailed or at least addressed. The for profit nature of the US medical system has hospitals charging high fees per night, has insurance companies and hospital admins pushing doctors and staff to release patients early (I'm sure every one has seen this
https://www.npr.org/sections/thetwo-way/2018/01/11/577425406/why-was-a-baltimore-patient-discharged-at-a-bus-stop-in-just-a-gown ) It also supports an approach to medicine that results in cookie cutter care and prescriptions rather than more detailed caregiver-patient interaction, which is where the opioid crisis gets started. How much has that cost the US as a society?

I hope I'm not dumping on you here, but if you realize that just as you only needed 12 days on one end of the scale, if the scale is tilted towards your end, the person who needs care on the other end of the scale and needs 48 days is going to come out the loser. You and I don't know who that person is, but I hope that because the person is not you, you don't think there is some divine providence involved.

I found the experience of being confined to the hospital because the doctor wouldn't release me objectionable. I was in no imminent danger, tests and procedures were scheduled for weeks out and I was simply being forced to stay. The prioritization of those tests required me to be in the hospital, otherwise I dropped down the list so it would be months. In the US it was a fee weeks without being confined to the hospital.

I am not sure that my twelve days means that someone who needs 48 won't get it.

Almost all medicine in the US is now cookie cutter, that is how doctors and hospitals reduce their malpractice risk. They follow protocol, often to the detriment of the patient as protocol updates dont tend to keep up with advanced, depending on the area. Emergency protocols take priority in the hospitals I have worked with.

I readily admit US healthcare is built on US cultural practice.

I should have said that beyond some level of compensation, a job isn't worth the cost of paying someone to do it. The job either isn't done or some other means, like automation, is found to accomplish it...

That is likely to become true of an increasingly large proportion of all jobs.
What then ?

There's a limit to how much a pay scale can be raised for a job. At some point, the job becomes not worth doing no matter how skilled or hard working the person doing it.

True enough, but in a highly abstract sense. Wage scales for nurses, to take one example, are determined by a fairly complex system of hospitals, insurers, regulators, etc. The consumer of the service - the patient - has only an attenuated link to what the nurse is paid.

In addition, there are certainly issues, in general, of bargaining power that are outside the simple micro-economic model of wages.

And even leaving all that aside, if someone wants to complain about there not being enough nurses, that same person is ill-placed to argue against pay increases.

"US healthcare is built on US cultural practice"

a significant portion of which is coming from patients, I suspect.

As in "NO, I am not going to stay hospitalized any more, I'm going stir crazy here!"

Well, that's my attitude, and at that of others I know. Others differ.

And US healthcare has very much taken to 'patient-centered decision making' over the past few decades. I don't see that so much as malpractice prevention as a US Culture Of Freedom™. Is there a Doctor in the house that can shed more light on this?

Some years back I was allowed to observe a new piece of instruction the local medical school and biggest nursing program in my state had put together. The soon-to-graduate students were put in a mocked-up emergency room setting, a life-like manikin played the role of the 15-year-old girl who had been in a serious car accident, and an actress played the near-hysterical mother. A prof from the medical school and an aide were "running" the manikin* and observing through one-way glass. The students had been told to provide appropriate care, but had no advance knowledge of the scenario. In this case, that involved diagnosing internal bleeding and that she was pregnant, getting her as stable as possible, getting the resident ER surgeon down, and the patient into the operating room.

It was a disaster for the students. The (male) MD student thought he was God and a dictator, ignored the nursing student who picked up on a couple of key things he missed, and eventually he just totally panicked. All of them ignored the "mother", who grew increasingly hysterical; one of the nurses called security to remove her (an actor, with delayed entrance based on real ER observations). They lost the girl.

The prof told me that I should have seen the group they had the previous day. Doc took charge gracefully, used his team of nurses well, got the diagnosis and had the manikin headed into the ER surgery in 13 minutes.

I spent a little time with the guy from the med school who had spent years getting the initial funding for the project. He'd started when he realized one day that he was terrified about turning out students who had never experienced doing medical care under pressure.

* The manikin could generate all of the appropriate physical characteristics for all of the standard equipment: heartbeat, blood pressure, veins for an IV, etc. She looked realistic enough to be scary.

can readily choose not to buy it?

Which is why most medicine is not Lasik or cosmetic surgery.

Most of the arguments here for why medicine is a scarce resource assume a market model for providing it. There are other models, which we use for lots of other things that we consider to be basic necessities of life.

We do not use a market model for providing (frex) public safety services - cops and firemen. Or (mostly) education.

The reason those things are broadly available, to everyone, is that we decided to make them so. We didn't have to, all of those things could be provided purely on the basis of private transactions between private actors.

But as a society (that word again!) we decided that they were too important to be left to the vagaries of market dynamics.

There are in fact market-based approaches to addressing the scarcity of medical care. We cold lower the barrier to entry - ease licensing requirements for certain categories of care, make it easier for folks trained in other countries to practice. That might help.

But fundamentally I think we should think about what category of good medical care is.

Is it more like cops and firemen, or more like tailors and auto mechanics?

lj, be well quickly. Getting old ain't for sissies.

And I appreciate Charles WT as well, mainly for his cites, which are thought-provoking. They make me think of jumping out a high window. ;)

Low ball this:

https://www.msn.com/en-us/money/other/reading-robots-beat-humans-in-stanford-test/ar-AAuI7Q0

One of the arguments for short hospital stays is the prevalence of infections like C diff, which is what killed my blind, kidney-less diabetic sister when she went in to hospital and had her leg chopped off.

She basically expired from diarrhea and peritonitis after a trained hospital employee (this was in Pittsburgh which has some of the best hospitals in the world) spread feces to the abdominal port used for her peritoneal dialysis.

She would have preferred the choice of having Lasik surgery, maybe a cosmetic nip and a tuck around the eyes and under the chin, or a new pair of shoes, or that other free market miracle that's fairly cheap, having her anus bleached, or some other commodity that's just like every other commodity one CHOOSES to purchase but they kind of had her by the short hairs and what choice there was was between dying of gangrene or sawing the limb off. The last thing she had time for was shopping around for a better price, maybe at Sam's Club, don't they offer cut-rate amputations, or perhaps converting to conservatism and declaring she'd rather just fucking croak than submit to the socialism of having the gummint pay for this "procedure".

Maybe she could read the collected works of Republican White House economist Stephen Moore who said recently Americans don't want to pay for other Americans' healthcare or that other cold-blooded murderer Mick Mulvaney who would have told her she was shit out of luck because as an 11 year old she sat around our shithole house, eating poorly and giving herself Type 1 diabetes, when, in my family, though we by-passed the exemplary trump genotype for native stupidity and assholishness, we were bequeathed, somehow, the genes for childhood diabetes.

It wasn't the first time she had to go to a so-called health center to be infected, but this time she didn't make it.

This was a woman who in the annals of dialysis (she couldn't undergo hemodialysis for some medical reason I can't remember) lived an unheard of 20-plus years (a sizable percentage of dialysis patients either die from infection or give up on the entire thing after a few years for quality of life reasons) while my mother provided in-home peritoneal dialysis four times a day, 365 days a year (my Dad died from kidney failure and stroke in the 1960s before there was dialysis or kidney transplants), that's roughly 32,000 dialysis procedures provided by my mother with maybe ONE or TWO incidences of peritonitis infections in 20 plus years, unheard of, probably because my mother didn't require extensive training, or formal job requirements, or profit sharing, or time and motion efficiency training to enhance shareholder value, or job incentives to WASH her fucking hands each and every time.

We could have sued. But my mother was done and was herself just several years away from developing her dementia and had my sister lived she would have had to go into a Medicaid-paid nursing home, since the rest of the family couldn't care for her because we are FORCED in America to hold down a job in order to eat, and she would have died of heartbreak anyway, even before C diff caught up with her there.

Besides, who wants to be excoriated by republicans for encouraging the medical malpractice lobby, I ask you?

Besides, my sister's passing was a blessing, which I will not elaborate on, because some shithead conservative like Sarah Death Palin might mention death panels.

Look, I know these issues are terribly complicated and the vast majority of medical professionals are honorable, wonderful practitioners, but there is something very wrong culturally, perhaps that corporations are now considered more peoplely than actual flesh and blood people, as illustrated by some of lj's cites, and certainly the case of Epic Systems and their corporate nonsense sabotoging efforts to streamline patient records, with us. (Did I read about that here?)

http://www.motherjones.com/politics/2015/10/epic-systems-judith-faulkner-hitech-ehr-interoperability/

Patient: Hey, Doc, let me ask you something. Why do you cost so much?

Doctor: What do I look like, someone who is in this for his health? This is a business.

Patient: Did you mean my health? But I think you may be on to something. Porn actresses, Mafia hitmen, and people taking a dump call what they do a business too, with exactly the same serious expression on their face. Why izzat?

Doctor: Look, maintaining my lifestyle is what counts. Your good health is merely a happy coincidence of that lifestyle. Now, bend over and relax. My Invisible Hands are busy working overtime thru you on the the way to my yacht payments. Let me refer you to my other pass-through businesses, did I say mine, scratch that, to follow up.

Every American is now a point-of-sale, and nothing more.

Unfair, I expect. But, it's a matter of the values we want to emphasize.

Every American is now a point-of-sale, and nothing more.

This is the best summary of our era and culture that I have ever seen. Thanks, Count.

A brief drive by:

1. Virtually every device and medicine used in modern medicine is the product of free enterprise and the profit motive.

2. While it is true that private insurance covers X days for a given procedure--and this is also true for Medicare and Medicaid--patients are not being thrown out to develop complications. That is called malpractice and the market provides a remedy for that as well. A remedy not available when the unaccountable state controls the process from beginning to end.

3. Medical training puts all medical students in real life situations called rotations. Some can't hack it, most learn and are reasonably competent. The reason many specialize is that there is so much medicine to know, they are not comfortable making life and death decisions with only a generalist's background.

4. But, if someone is making the point that doctors are not fungible and that some are better--often much better--than others, then: point taken. Which is why some are worth more than others.

5. Whether for profit or not, any modern, 1st world healthcare facility is going to be paid for by someone somehow and the amount of money is always, at some point, limited. If not operated for profit, any system must still break even, or eventually it fails.

6. Police and fire departments are not comparable. We do not have police and fire protection on demand. If there are more fires than there are firetrucks, demand exceeds supply and there you go. Police response time is almost universally shitty, which is in part a problem of supply but mainly a lack of accountability.

7. Yes, it is complicated. Very complicated.

Dammit, left this one off:

8. LJ, all the best. Get well soonest.

That is called malpractice and the market provides a remedy for that as well.

a remedy which the GOP has been dedicated to making as toothless as possible.

Virtually every device and medicine used in modern medicine is the product of free enterprise and the profit motive.

I'm gonna go out on a limb and say that this is, straight up, horseshit.

If you really want to get into it, let me know and I'll go drum up the documentary evidence. But I'm happy to put real live money on this one.

Stay tuned for careful parsing of the word "virtually".

FWIW, I'll start with Alexander Fleming and Howard Florey, the guys who brought penicillin to the point of being a practical antibiotic. They declined to seek or hold a patent on the drug.

Neither Salk nor Sabin patented the polio vaccines they developed. Salk's comment on the topic was "Could you patent the sun?".

The Curies declined to patent or make a profit from their discovery of radium.

Anyone else want to chime in? Those were the first three I looked at.

Virtually every device and medicine used in modern medicine is the product of free enterprise and the profit motive.

Just no. To give a thematic example, abiraterone, an important recent development in prostate cancer treatment, was, like many other drugs, developed at the Institute of Cancer Research in London, which is funded by government and charity.

As is usual, big pharma came in to fund the clinical trials, because we've created a system in which no one else can afford to do it. With the result that a drug created using charitable donations, and which is cheap to manufacture, costs thousands a month to buy. This is not an advert for free enterprise and the profit motive.

most of the pioneering work for ultrasound was done in universities and hospitals. commercialization came after medical researchers had already figured out that it could work.

Was the stethoscope patented? And yes, they still are used.

The single largest lifesaving medical innovation was the discovery of blood groups.

Was the stethoscope patented?

Many aspects and improvements have been patented, including several in recent years. The Wikipedia article suggests that improvements invented in the late 1990s made all of the earlier acoustic stethoscopes obsolete.

If you can't personally profit big time solely in the private sector, would you bother making new medical breakthroughs?

No, I'd sleep in or become a bond salesman. What's in it for me?

Ok, how bout if we blow your asses off with megatons of military ordnance?

What do you need? Coming right up. We're all just gummint employees round chere.

https://taskandpurpose.com/10-medical-advancements-from-the-iraq-and-afghanistan-wars/

http://mentalfloss.com/article/31326/5-medical-innovations-civil-war

https://www.theatlantic.com/health/archive/2017/02/world-war-i-medicine/517656/

I'm all for the private sector commercializing whatever they come up with via their research and development and making a reasonable profit and reinvesting it. I make money investing in them.

But, come on! In the real world, it's a partnership. It's not one or the other.

The National Cancer Institute identified the AIDS virus. Not a one of 'em received a stock option over and above their GS rating. I can't think what motivated them.

And they had to do it behind Ronald Reagan's back, because he viciously believed gummint was the problem and his murderous religious base believed THOSE people deserved the punishment of AIDS.

Besides, without the concepts of private health insurance, which many conservatives believe is a problem, because it removes patient choice (What?) and the universal concepts of Medicare and other subsidized government medical schemes, enormous markets for medical innovation would not have been opened up because individuals on their own couldn't afford the ride and they wouldn't have any choice to even be in the market for the advances.

God, the fucking bullshit in this country.

I'll take Jonas Salk over Martin Shkreki all day.

I'm not sure who the rats in power right now would prefer. Salk seems such a know-it-all elitist with his snowflake unpatented vaccine, vaguely smelling of socialism, but Shkreki, now there's a rugged individualist with a house overlooking Galt's Gulch, a place that could use some of those private prisons.

https://comptroller.texas.gov/economy/fiscal-notes/2017/november/federal-funding.php

Lots of medical in there.

Lots of drug companies glom onto traditional medicine and try to patent it. This happened with certain Indian herbal remedies. Bayer had mixed success patenting aspirin, an ancient drug.

One thing's for sure: no medical advance was ever prayed into existence.

Get well soon, lj.

--TP

All medical breakthroughs come via the private sector?

cleek begs to differ.

http://ok-cleek.com/blogs/?p=27371

Here's his bonafides. Some tax money in there. Shepherd's never going to drive a Lamborghini at this snail's pace:

http://shepherdlab.org/wp-content/uploads/2018/01/Shepherd-CV2018.pdf

Just think if he was just like those fed grant whores in the climate change scientific community.

We'd never get to the bottom of THAT either.

I think there's probably some room for private profit-making in drug research and manufacturing. To say that's the only way, or the best way, not so much.

I guess the most aggravating thing about being in the hospital is that I can't be as snarky as I normally would be. My loss, your gain.

I post (with permission) a foreigner living in Japan friend's facebook post who is entering her second year of surviving after pancreatic cancer surgery
Still wrapping my head around everything.
I spent an hour and a half in the bank going over the loan application for son's university. Step by step, it looked like everything was going to be OK, and then, last question at the end of 90 minutes, Have you had any health issues recently.
I bowed my head. I knew it was over. I said I was sick last year and she asked about the nature of the illness. As soon as I said the word, she looked down and I knew it. No way.
I felt like a leper. That's probably what smarted more than not having access to college support.

I went home, took a brisk walk around the block. Cried tears that were not tears of joy for the first time in months.
When I was almost back home, I saw two shadowy figures at the bottom of the driveway.
It was the woman from the bank, and another woman, the chief of the loan section. They had brought me a gift, and offered another kind of loan that didn't require a health background check.

No doubt I'll cry again later when the tear supply has been replenished.
This time, tears of gratitude.

How on earth did they ever find this house, tucked away on the hill up a street that doesn't even look like a street?

This is not to make some point about Japanese omotenashi but to tease out a more subtle point which is that because the state provides advanced healthcare, it allows a bank (whose raison d'etre is what essentially the biblical sin of usury) to also support and help. Helping helps others to step up as well. I'm not sure why this is such a difficult concept to grok, but when I see things like Virtually every device and medicine used in modern medicine is the product of free enterprise and the profit motive. I wonder if I'm writing in Kiswahilli.

I am extremely conscious that this story happens in some way because the person (a white foreign woman) 'assimilates' into this culture, takes on the cultural characteristics and patterns and is more likely to be treated with omotenashi (which is why Trump's licensing of racism is so pernicious). I do wonder if we changed it to a black man, or a Korean or Chinese, and held everything else the same would we get the same outcome. Yet, as this Mother Jones article points out, the way things are going in America, it is demonstrating the same self-selection biases that people so bitterly complain about with Japan. Pick your poison.

But a society that makes its healthcare as a for-profit enterprise is basically telling its citizens (some of them more loudly than others) that 'we don't give a shit about your health, so you are on your own'. Who wants to live in a shithole like that?

There's a growing number of doctors who are opting out of insurance-based healthcare.

One approach is to provide basic healthcare for a monthly subscription fee plus fees for various test and procedures.

Another is cash up front for various surgical procedures.

Just to gild the lily, there is this

http://www.businessinsider.com/statistics-about-the-health-care-industry-2011-2?op=1/#recent-study-found-that-medical-bills-are-the-root-cause-behind-more-than-60-percent-of-all-personal-bankruptcies-in-the-united-states-each-year-1

though be aware that the first line says

Do not read this article if you do not want to get angry.

I'll take Jonas Salk over Martin Shkreki all day.

amen.

the inability to recognize the fact that everything is not about freaking money is going to cripple this nation.

i'd actually put that in the present tense.

Every American is now a point-of-sale, and nothing more.

i wish that was hyperbole.

Others have, quite rightly, dumped all over the first fallacy of McKinney's "drive-by."

May I also call attention to his fifth? Whether for profit or not, any modern, 1st world healthcare facility is going to be paid for by someone somehow and the amount of money is always, at some point, limited. If not operated for profit, any system must still break even, or eventually it fails.

IOW, the fact that most of the "modern, 1st world healthcare facilities" in the (First) World are NOT operated for profit, and have NOT failed, is discounted ab initio. Who are you going to believe, McKinney T or your own lying eyes?

I wanted to hit on that but hospitalization saps the energy for fisking, fortunately or unfortunately. What is interesting is that just before my surgery, I took my seminar students to Busan by ferry and at the Busan ferry port, there were some big ads and I think an office for 'Medical Tourism'. The female Korean doctor in the Avengers seemed competent.

National health systems should be designed to run at a break even point, not a for profit point. Education systems to educate doctors and health care professionals should be considered part of that system. Why is that so problematic?

"Why is that so problematic?"

Because in these discussions there is never a mention of those break even systems actually struggling, or the seeming huge number of doctors who want to be trained in the US, or any other fact that points out that those modern, first world break even 0 facilities have their own set of challenges is ignored.

This topic, like many other of these discussions, is discussed based on pointing out anything that might be wrong with the US system while assuming the others work perfectly. Which they dont.

Let's start with 10 days in the hospital is the right amount, underlying this discussion is the assumption of that as fact. As if 10 days provides better outcomes for all sets of patients.

While picking and choosing outcomes place the US in varying ranked positions, are the outcome stats bad in the US? While we talk about having the most expensive healthcare do we ever compare all the costs of those other systems with ours? My bill for a hospital room in Canada was every bit as expensive as one in the US, why is it "cheaper" when the government pays instead of me?

So the discussions are not productive because the starting point is "It shouldn't be that way", by definition.

This topic, like many other of these discussions, is discussed based on pointing out anything that might be wrong with the US system while assuming the others work perfectly. Which they dont.

To put it pungently, bullshit. I'm not making any claims that the Japanese system works perfectly and I am more than prepared to discuss problems.

While picking and choosing outcomes place the US in varying ranked positions, are the outcome stats bad in the US?

Because it is on the national level that US health care is failing and that is the level that we have to discuss issues on.

While we talk about having the most expensive healthcare do we ever compare all the costs of those other systems with ours?

In the OP, I tried to point out that is wasn't simply costs, it was a range of inputs and influences, such as how the medical education system is structured, how the gendered structure of Japanese society makes nursing very attractive for young women and provides a steady supply of labor. Did you read what I posted?

My bill for a hospital room in Canada was every bit as expensive as one in the US, why is it "cheaper" when the government pays instead of me?

I think that might be because, as far as I can tell, you aren't a Canadian citizen? Or should a hospital room for you be the same as it is for a Canuck because you are American? I really don't think that is the way it works.

So the discussions are not productive because the starting point is "It shouldn't be that way", by definition.

I did say that the US health system or any national health system should not be for profit. I'm prepared to defend that position. I realize it was McKinney that said "Virtually every device and medicine used in modern medicine is the product of free enterprise and the profit motive", but if you want to start off with 'The US health care system, unlike the health care systems of all the other developed countries, must remain for profit because...', you could avoid your definitional problems. I just don't think you'd like the way the conversation would go though.

Yes, just had one tube pulled out today and the other in a few days, so I am feeling better.

Glad to hear you're feeling better, I can relate to tubes coming out. I hope recovery continues smoithly.

In the UK, the NHS, almost free at the point of use, has plenty of problems. Mostly with funding - the budget struggles to keep up with medical advances and the resulting ageing population.

However, despite our spending less than half as much as the USA per capita on healthcare, life expectancy here is a couple of years longer. To be fair, that may be more to do with much lower mortality from homicide, road traffic accidents, and suicide.

freedom's just another word for dying young and poor

why is it "cheaper" when the government pays instead of me?

it might not, but the cost is shared across the whole popultion, so the cost per person is more affordable.

the starting point is "It shouldn't be that way"

the US pays more per capita for health services than any similar nation, and on the whole our outcomes are at best middling.

"it shouldn't be that way" seems like a perfectly reasonable starting point.

"is discussed based on pointing out anything that might be wrong with the US system while assuming the others work perfectly."

Actually, the starting point for these discussions is the ambient, background soundtrack and push back of conservative America that assumes, with a great deal of nationalistic umbrage that anyone could suggest that any other nation or culture could possibly come up with something better in any segment of business or society, even in the smallest detail, than the indispensable Nation, America, that everything we touch is unquestionably exceptional.

So, we argue for something better, slightly superior arrangement, if only in part, against the conservative argument that if it was good enough for my pappy, it's good enough for you, and you'll like it, sonny.

Where, I ask you, does it say "subsidized catheter" in the Constitution? Case closed.

I don't believe Toyota automobiles are perfect. But I've owned nothing but over the years because until maybe the last decade or so American-designed and manufactured vehicles uniformly sucked.

And don't get me started on the Triumph Spitfire!

What, made in America ain't good enuf for ya? You onea them cosmopolitan types? Mebbe a communist? The man says the aspirin costs nine dollars from the hospital dispensary, who are you to think different? Hanh? What, you think some way of doing things thought up by a frog is poifect?

So, it just seems to conservatives that some here are giving the impression that we believe other systems are perfect, when really, if I lived in France, I'd be kicked in the balls there too by the conservative, nationalistic Le Pens for suggesting, ya know, in America, they do these few things that are better than you guys manage.

"Quelle, mon ami?", they would ask, while asking for my papers.

"Let me see the money first." I would say, being 3/5ths American.

Here's an American conservative" "We want Norwegians to immigrate to our country, not dos utta shithole countries. The former are not so, I don't know, melanin influenced, ya know what i'm sayin? Yeah, you know what I'm sayin."

Me: "How bout if they bring their universal healthcare system with em?"

Them: "No, no, hold on there, Nelly. As we pointed out during our resistance to all things Obamacare, we want a healthcare system where a guy can go to the doctor bearing a freshly slaughtered chicken and exchange that poultry product for, say, surgery to repair his ruptured aorta. The way things used to be in America, back before you pinkos created the Federal Reserve and took away the true American currency, plucked livestock."

Me: "Were those chickens free of antibiotics? Never mind. More to the point, you do know that the system you describe is how things are done in those shit hole African countries and certainly that dump, Haiti. Sick people bearing chickens to the witch doctor. Your words, mind you. I like Norway's system better. What say you?'

Them: "Let me see your birth certificate."

Me: "So, how do you want things arranged?"

Them: "We got 50 states, amiright? 50 ways of losing your lover, 50 of those watchyamacallit laboratories of democracy. We experiment.

Me: Like science?

Them: "No, not science! There will be no scienceing. Jesus, what are you, one of them eggheads with tenure?"

Me: "Go on".

Them: "So, in one state, right next to the state line, say, of Alabama on the other side of the imaginary line, you subsidize the entire population's health insurance, your commie way, so as you say, everyone can enjoy the fruits of the gigantic free market innovations in medical science. We take a guy having a massive coronary right on his side of the state line and we see what happens.

Me: "What about Alabama?"

Them: "I was getting to that. Alabama does things the American way. You get two bootstraps at birth and you are on your own, like Jesus stipulated. You can't afford health insurance, but you manage to swipe a chicken and you present it to the doctor, who measures that payment against his overhead, what we call pro bono. That guy has a similar massive coronary on his side of the state line, not too close, we don't want him crawling across the line into the subsidized state and fucking up our hypothesis. Then we see the relative outcomes."

Me: "What is your expectation?"

Them: "Doesn't matter. The guy in Alabama does it the American way. The other guy in the snowflake state does it the foreign way. What more do we need to know? That one is dead and one is alive is not the point. Plus, if someone comes along and finds the body of the dead guy without health insurance, Alabama's doctors are up one dead chicken. You could run for Congress on that platform."

Speaking of tubes, in or out, and the sooner the better..... Carlin:

"Down the tubes. Hear that one a lot, the people say "Ahhh the country is goin down the tubes" .....What tubes? Have you seen any tubes? Where are these tubes? And where do they go? And how come theres more then one tube? It would seem to me, one country, one tube. What, does every state have to have its own tube now? One tube is all ya need. But a tube that big, somebody would have seen it by now. "somebody would of been like "hey, Joey, joey, look at the fuckin' tube" Big ass fuckin' tube ova here. Ya never hear that. Ya know why? No tubes. We don't have tube 1. We are essentially, tubeless."

"In the UK, the NHS, almost free at the point of use, has plenty of problems. Mostly with funding - the budget struggles to keep up with medical advances and the resulting ageing population."

So many imperfections, many by choice:

https://www.theguardian.com/society/2014/oct/05/nhs-finances-crisis-rising-demand-budget-cuts-30-billion-pound-deficit-2020

Those billions of pounds promised by the British right-wing to the NHS to flow in from the end of Brexit are coming soon, amirite?

"Doctor, I can't breathe waiting for the savings from Brexit."

"Stop holding your breath."

And don't get me started on the Triumph Spitfire!

"Started" and "Triumph Spitfire" are phrases that are not always found together.

Electronics by Lucas, Lord of Darkness.

"There's a growing number of doctors who are opting out of insurance-based healthcare.

One approach is to provide basic healthcare for a monthly subscription fee plus fees for various test and procedures.

Another is cash up front for various surgical procedures."

So .. insurance by any other name, without the middleman. What's the small print on preexisting conditions? I suspect a very tiny "no".

Monthly subscription fee? Ya mean, a premium?

Cash upfront? You mean co-payments and deductibles, just like conservative think tanks claimed would make the "healthcare consumer" a choosier, more rational, and cheaper recipient, but when put into operation by Obamacare, was claimed by the same think tanks (too bad think tanks don't have dunk tanks in their lobbies) to be unaffordable for your average chicken.

we want a healthcare system where a guy can go to the doctor bearing a freshly slaughtered chicken

a story, because everybody likes stories.

when my dad was a kid, he was kicked in the face by a mule. the local sawbones came over and sewed him up. i don't know the details, but i'd be unsurprised if payment in kind was at least part of the deal. my dad's family had very little money at that point, but they did have chickens.

when my dad was a kid, the US population was about 120 million people. about half the population lived in rural areas.

we no longer live in that world.

if I paid my doc in chickens, I don't know where he would even keep them.

sometimes I think current day conservatism is, precisely, nostalgia for the 1920's. or maybe 1880's.

it's a losing game.

when my dad was a kid, the US population was about 120 million people. about half the population lived in rural areas.

we no longer live in that world.

which is what galls me about the recent plea for big city Dems to drop their 'elitist' ways and embrace the real American deplorables in the 'heartland'.

80% of something isn't elite. it's standard, common.

Whether the 1920s or 1880s, it's social Darwinism, with a few economists putting a little lipstick on it.

freedom's just another word for dying young and poor

Did you purposely word this to be sung just as the line from Bobby McGee is, or was it coincidence?

sounding good was good enough for me

There's a growing number of doctors who are opting out of insurance-based healthcare.

One approach is to provide basic healthcare for a monthly subscription fee plus fees for various test and procedures.

This is, in fact, pretty much the model that Kaiser has been using for years. (Since Hoover Dam was built in the 1930s actually.) Except that they still call it "insurance" -- and it's one of the options offered by the ACA.

(which is to say: yes, with full intent)

So many imperfections, many by choice

The story the Count cites about budget cuts at Addenbrookes is somewhat disingenuous. If you read far enough down the article, you'll see that spending is in fact increasing slightly in real terms. The problem is that larger increases are needed to meet increasing demand, and hospitals are asked to make good the shortfall by cutting costs by more than is practicable.

Providing enough extra money is particularly problematic when healthcare is funded out of general taxation. I'm increasingly thinking that something more like the French model would work better.

If you're ever treated at Addenbrookes you're likely to receive excellent care. Please visit the Jubilee Garden and enjoy the paperbark maple planted in memory of my late wife, who was a doctor there.

Please visit the Jubilee Garden and enjoy the paperbark maple planted in memory of my late wife, who was a doctor there.

Very moving suggestion. I wish I were in a position to do just that. Thank you.

"Providing enough extra money is particularly problematic when healthcare is funded out of general taxation."

Yet another otherwise intelligent person in thrall to the antique notion that "money" is a pile of shiny metal that is bounded in quantity. Clue: the economic bowling alley will NEVER run out of 'points'.

Me, I'm waiting for WeimarII, when we need to haul wheelbarrows full of disk drives loaded with digital bank balance bits to buy a loaf of bread. But at least the cabarets will be entertaining.

The GOP just cut taxes to crank up the 'deficit' by ANOTHER $1T to bribe their 1% base. How much healthcare would that buy? Probably more than the extra that's needed.

in other health related news, the president can recognize a rhinoceros and draw a clock.

for which, i suppose, we should be grateful.

...another otherwise intelligent person in thrall to the antique notion...

Let's leave the economic debate for another time. I think I was clear enough that I was talking about a political problem.

I've never had to be treated at Addenbrookes, Pro Bono, but if I'm ever around there, on my infrequent visits to Cambridge, I'll do as you suggest. I've been moved by your references to your late wife in the past, and would like to see her tree.

Best wishes for a quick recovery, LJ. And it sure looks like the care yu are getting is a quantum jump ahead of what you would get here.

Thank you GftNC. I'd be glad to show you myself, if you choose to get in touch.

Certainly I would so choose; meeting sympatico ObWi participants IRL is a very appealing prospect. But I am very rarely in Cambridge, if that is where you live, although likely to be down south a lot more in the future.

[myusername][email protected]

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