And also the most profitable of all corporations -

Post #40,781 by Ashton 5/31/02 7:09:25 PM Reply	And also the most profitable of all corporations - If a friend's undocumented source for this stat factoid proves correct. Yup: Yer Money or Yer Life! Where did we hear that used, first? (before Corp-Med, that is) [Well - it could be easily: your money AND your life, given the 3-minute exam before, Next! is called] But then, maybe all the other rich countries who managed universal care are just smarter and less mean than we be.. in its original sense, Mr. Scrooge
Post #40,793 by mmoffitt 5/31/02 9:19:28 PM Reply	This is tricky. I worked for HMO's for about 7 years. The HMO industry is fundamentally flawed because it is an application of, essentially, a greed driven model (Murican bizness) to an, essentially, altruistic activity (the delivery of healthcare). However, it is equally true that most Muricans want to eat McDonalds grease, sit in front or their TV's and/or PC's and live forever. They want allopathic medicine to make up for their pathetic lifestyles. So, damn the HMO's if you wish, but also consider the idiots who think they can "have fries with that" and not have heart trouble.
Post #40,808 by Brandioch 5/31/02 11:03:34 PM Reply	And, in that regard, a national system would be as bad. You're right, the problem (poor health) starts with the individual. Now, if you have a fat, smoking idiot looking for a quad bypass.... There is no magic for poor living. Not to mention the problems that drove us to HMO's in the first place. Things like massive malpractice awards. There are a number of faults in our system that manifest themselves in various ways. The trick is to design a system that will reward those who take care of their bodies (without punishing those who do not). Hopefully, the system would tend, over time, to make more people take care of themselves. While still being able to provide health services to every child in the country. possible?
Post #40,842 by ben_tilly 6/1/02 7:03:13 AM Reply	Healthy people eventually cost more Sure, smoking and grease help kill you. But you are going to die anyways, and from the point of view of the health care system it is hard to find a cheaper way for someone to die than to just keel over in a heart attack. The result is that people who actually watch after their health and try to live long and happy lives tend to cost the system more when they die. Cheers, Ben "... I couldn't see how anyone could be educated by this self-propagating system in which people pass exams, teach others to pass exams, but nobody knows anything." --Richard Feynman
Post #40,846 by Brandioch 6/1/02 11:20:21 AM Reply	Logan's Run :) Option #2, encourage death sports amongst the vegetarian crowd. Option #3, advertise Canada as the retirement dream land.
Post #40,858 by mmoffitt 6/1/02 4:29:17 PM Reply	Remember Governor Lamb? Of Colorado, I think. He made big news in the 1980's when he said, "Old people have a duty to die and get out of the way of the next generation." What I dislike most about Murican society is that we always sacrifice our youth for the sake of our aged. It makes no sense to me. Look at Social Security. The average retiree gets everything he put into it back (+ interest) in two and one-half years. Yet they collect for up to 20 years or more. Pass 65? No problem, we've got this healthcare package called "Medicare" that you are entitled to. But, be a poor working mother with a child and unless you are absolutely without any kind of funds at all (i.e. don't work at McDonald's) you get bumpkis. So, how the hell come we can make sure all our old farts have some medical coverage, yet we can't seem to do that for our children? My answer: because we are a nation of idiots sacrificing our future for the sake of our past.
Post #40,864 by Ashton 6/1/02 5:06:28 PM Reply	Corollary The purpose of young people (always created by older people - for those who need help with the math) is to assist older people for as long as they bloody well Want assistance. (And Not longer either - just because your infirmary makes big bucks keeping vegetables sorta alive at $1000/hr.). In past, this process was furthered by having a round dozen of young parasites - counting on 3-5 surviving long enough to fulfill their destiny, their sole raison d'etre: being of use to their Creator. Of course, moving up to the scale of Overview: Water invented homo-sap as a means for carrying Itself around. As Water has prolly seen just about enough.. by now: the purpose of the species is also - just about running out. (As we see by the symptoms of disintegration all around, despite all the techno-crutches and banal diversions; those which merely mask the pointlessness of most homo-sap activity.. (Save that of carrying Water around, of course.)) :-\ufffd Smoke That, Sonny..
Post #40,888 by mmoffitt 6/1/02 11:58:10 PM Reply	Um, that's backwards. I take your point is that because we used to reproduce to have some one around to care for us, that this is what we ought to continue to do? That is nonsense. I chose to have two daughters, when I had the time and money to care for them. I chose to have them, they didn't choose to have me. They owe me nothing, I owe them everything I am capable of providing. My productive life is coming rapidly to a close. At nearly 43, I have very nearly nothing left to offer. At 10 and 12, they have at least 30 years of meaningful contributions to make. Why should they, or society in general, afford me anything that is not doubled for them? If I were genuinely convinced that my daughters would be better off if I stepped in front of a bus, no one could prevent me from doing so. It is such a pity that more parents do not feel the same.
Post #40,960 by boxley 6/3/02 12:14:05 PM Reply	Say what!!!!!!!!!! Your 43 and have nothing left to offer? I am 46 and have the same drives, wants and needs as I did at 16 but with the experience to temper judgement and cunning to swerve the younguns. How much longer can I go I dont know but dont sit around brooding about it. thanx, bill TAM ARIS QUAM ARMIPOTENS
Post #41,222 by mmoffitt 6/5/02 12:00:37 AM Reply	I'm not brooding! I just recognize the fact that the real contributions we make almost always are made before we reach 45. Best example is probably Einstein. Look at his contributions 18-35 and compare them to 35-the rest of his life. Obviously we can't all contribute what Einstein did, but I think its folly to believe that at age 43 we have the same potential for contributions that we did at 23. I'm not lamenting it, it is simply a consequence of life.
Post #41,229 by Ashton 6/5/02 12:45:02 AM Reply	Possibly you are forgetting that certain kinds of contributions are most unlikely to be made until.. after '40s, maybe well-after. But if you mean contrib. of the ilk of AE or of Alan Turing -- well, yes: a new mind is focussed entirely on Problem 1, undistracted by the Rest of life. Later on, other concerns and interests seem not to lend themselves to 'grading', though art / literature also gets a round with the Nobels and Pulitzers. For those who think that matters a lot. Loved Feynman's response to the Nobel and to 'Sci. Societies' in general: Awards is epaulets! So next.. you get to synthesize whatever passes for any Wisdom: gleaned through all those mistrakes.. :-) Never mind the Unified-Field-DNA-Bach medal. Ashton
Post #41,893 by mmoffitt 6/10/02 11:46:33 PM Reply	I am not without hope, but, ... the older I get, the less I understand... Perhaps, just perhaps, that's because I am becoming wiser ;-)
Post #41,911 by Ashton 6/11/02 3:36:25 AM Reply	More than one Sage has observed that, Confusion is a High state.. (Actually - that's verbatim, but one has to know that High doesn't mean stoned, though there might be superficial similarities, y'know?) Corollary - 'most of the stuff we know is wrong' only seems to be hyperbole: til one sees how much in our collected factoids is - utter tripe. So it is hardly a Bad thing to imagine you 'know less and less' - as you get older. (So much for zero-sum games) Ashton who hopes to reach 0, just before I turn out the lights on the dream I have somehow (!?) created, populated and called 'here'. [\ufffd-cackle]
Post #41,947 by boxley 6/11/02 12:05:15 PM Reply	contributions? Teach a 4 yearold how to sing "Great big gobs of greasy grimy gopher guts" and watch the joy slide accross their face. Dop a cooler of ice cold beer and sandwiches off to a homeless guy on a hot day. Watch a beetle move accross a garden with a small child. There are more individual contributions that make up a saner world than a single contribution that advances mankind into the darkness of self destruction. Be a micro contributor, remember confucious and the butcher. Be the best at what you do. thanx, bill TAM ARIS QUAM ARMIPOTENS
Post #42,156 by mmoffitt 6/12/02 10:35:43 PM Reply	Well put. And I concur completely. Those contributions are, believe it or not, what I personally value most. My measure of success is whether or not my children will come visit me when I'm old - because they want to. Still, recognizing that most of us can contribute to only a handful of people does not, for me, give rise to the notion that the entire future generation should keep all of us old farts up. The ruling classes have most of the private wealth (iirc, top 1% owns 12%+ of all privately held wealth - dramatically up from the 70's when they held 7%). That being the case, the great unwashed of us have less to spend on themselves and their elders. I see no revolution coming, which means that some largish segment of the unwashed has to lose. IMHO, it should be the outgoing generation, not the incoming one, that sacrifices most. Quick example: all the talk about a "prescription benefit for Medicare" is out of place, imo, when 1 in 4 kids live in poverty, many millions of them with no healthcare at all. Give them healthcare first, before throwing yet more money out of the pockets of the next generation and into the elderly's. Again, sacrificing the future for the sake of the past - I just don't "get it".
Post #42,167 by Ashton 6/13/02 5:42:16 AM Reply	Interesting triage. And hard to argue with the fait accompli of the [never mind the mere 1%] 3-5%, where something over half of everything gets squirreled away: to keep the hegemony going and the illusion of Elite sustained. Nope, no revolution on any horizon I see. Of course the whole idea of inheritance is the mercantile mind's response to Life, the Universe and Everything\ufffd. This even though we know the effect upon children of their being early-on, "set for life" !! Would the desire to buy 'immortality' vicariously through offspring, be as Big a deal if.. fearfulness of death (increasing with age) were not nearly So Big a deal? (ie we're s'posed to acquire some inklings of wisdom - that used to be called maturity - thus Less fear! of a perfectly natural process involving 'bodies'. Instead: we will spend any amount available to buy 5 minutes more.) Trouble with your triage suggestion is - none of the above fits into the idea of 'rationality' (certainly not logic), since maturity has become increasingly rare in especially wealthy culture(s) and: Cosmic Joke? it appears that the more wealth accumulated - the less likely it is for that one to achieve maturity! The Xian bible's homily re "a rich man passing through the eye of a needle" suggests that the wealth aspect - has always negatively affected homo-sap's chances for er Enlightenment or at least adulthood? (Not just a Xian observation, natch) Of course there are the exceptions.. in an early stage of vulture capitalism: Astor and other moguls went down with the Titanic, with quiet dignity, it is said. (We can't know how much of that aplomb was from.. peer pressure?) Still, when pursuit of $$ is one's actual religion - I can't see that there are many (both old AND fearful) folk who could maintain the mindset which you suggest, for above reasons. (I agree it seems a much saner approach than the usual, just don't believe that many are capable of fulfilling it) Ashton
Post #42,819 by mmoffitt 6/18/02 7:03:19 PM Reply	Think there are any? Talk to some 70ish people who have the good fortune of having a net worth >=500,00 about maybe, just well, maybe they don't need that SS check and maybe since Washington takes care of those who vote and keep them on the gravy train (hence are unlikely to stop subsidizing them), maybe the 70ish person should put their entire SS check into a 529 or similar plan for their grandkids. Mind you, if you do ask such people, by all means, do not do so unarmed.
Post #40,869 by Brandioch 6/1/02 7:22:24 PM Reply	Times change. Social Security used to be for the few who had no other options. Everyone else was provided for by their families or pensions. As our technology improves... And our fear of death increases..... We will demand that our government spend tons of money on us to keep us "alive" a couple more years. Even if "alive" means hooked to a bank of machines. In the old days, granpa would be dead and cold by the time the doctor got to the farm. Now, we can check granpa into the hospital and they'll keep him going as long as their tech can. If it were paid for by the family (a problem with the nuclear family, there might not be anyone near who cares), the family would have to determine how much money to spend to keep him alive. The family's coffers are not bottemless. It's a hard decision. But when the money comes from the government, the decision is much easier. Keep him alive. Changing this will require a fundamental change of attitude/beliefs/etc.
Post #40,889 by mmoffitt 6/2/02 12:06:34 AM Reply	Social Security was never meant to be collected. Check out (at the time Social Security was crafted) the age at which one became eligible for benefits. Then, check out average life expectancies at that time. It was a general purpose tax in sheep's clothing. The problem is that as life expectancy increased, the age of eligibility did not keep up. No one (well, okay the few on the right side of the Bell Curve) was supposed to get anything back. On the cost of medical care, the overwhelming majority of all monies spent on healthcare for an individual come in the last five years of life. Is that money well spent? I don't think so. WHen you get old, you die. Can throwing the family's total assets at the problem of dying extend life? Sure, for a time. Can it change the outcome? No. Take the money we spend keeping aged vegetables on ventilators and use it to bring our childhood immunization rates up to, say, at least Guatemala's. Or shoot the moon! Try to get our infant mortality rate down to the lowest in the Western Hemisphere. But will we do that? Of course not. We have to keep our least productive elements klinging to life on our best equipment for as long as possible. It is madness.
Post #40,895 by Another Scott 6/2/02 9:15:19 AM Reply	Yup. Automatic COLAs started in 1975, further worsened it. As you say, an insurance program that starts payments at 65 when average life expectancey is 46 (IIRC) only helps a very few. Of course, SS had other programs as well (survivor benefits, etc.) that did and does help many people. The finances of it started to get strongly out of whack in 1972 when Congress passed legislation mandating automatic [link\|http://www.ssa.gov/cola/automatic-cola.htm\|Cost of Living Adjustments]that became effective in 1975. People in the US are living longer, and the average age of retirement hasn't changed much (though some of us won't be able to get full SS benefits until we're 67+ now - if ever). It's a system that can't go on as it is without bankruptcy. Medicare is in a similar situation, but Congress hasn't learned from the SS debacle and will likely add some expensive "prescription drug benefit" to it - a program that will only get much more expensive over time. Solutions (as we all know): 1) Keep the SS system the same but (over time) raise the age for SS to (something like) 75+ (to nearly match average life expectancy), or; 2) Make SS an insurance-like program that people have to qualify for and exclude those of incomes above some threshold (say, e.g. $35k), or; 3) Raise SS taxes dramatically. I expect some combination of the three. On medical spending - you and Ben and others have a good point. But something else to consider is that medical professionals in the US have much higher status than they do in many other countries. E.g. in Iran it used to be that Engineers were at the top of the status chain - a position held by physicians and lawyers in the US. Why is that? The training is similar in both places. Why the difference? Part of it, IMO, is the AMA and state boards restrict the number of people who can be physicians and medical workers. Supply and demand and some cartel-like activity means that physicians are expensive. And specialized physicians are very expensive. Similarly with drugs. As long as the situation remains as it is - specialites are worth much more than general practice, new drugs are expensive to develop but come with patent protection (and the hope for huge profits to cover expensive drug research and expensive legal and regulatory paperwork), etc., then medical care will be ever more expensive. And note that the medical system is spending vast sums on treating very expensive illnesses and conditions in infants as well. It's not just the old that are driving the system. Finally, as long as the system doesn't let people choose an alternative to treatment of disease or aging, then the money will get spent. As a side issue, last week's (May 25-31) Economist has an interesting article on brain research. They make the point that there's almost no control on research done on brains while the press and Congress is focused on the dangers of cloning and genetics research. From the "Leader" (editorial section): In an attempt to treat depression, neuroscientists once carried out a simple experiment. Using electrodes, they stimulated the brains of women in ways that caused pleasurable feelings. The subjects came to no harm -- indeed their symptoms appeared to evaporate, at least temporarily -- but they quickly fell in love with their experimenters. Such a procedure (and there have been far worse in the history of neuroscience) poses far more of a threat to human dignity and autonomy than does cloning. Cloning is the subject of fierce debate, with proposals for wholesale bans. Yet when it comes to neuroscience, no government or treaty stops anything. For decades, admittedly, no neuroscientist has been known to repeat the love experiment. A scientist who used a similar technique to create remote-controlled rats seemed not even to have entertained the possibility. "Humans? Who said anything about humans?" he said, in genuine shock, when questioned. "We work on rats." [...] Yet [in comparison with geneticists and cloning researchers] neuroscientists have been left largely to their own devices, restrained only by standard codes of medical ethics and experimentation. This relative lack of regulation and oversight has produced a curious result. When it comes to the brain, society now regards the distinction between treatment and enhancement as essentially meaningless. Taking a drug such as Prozac when you are not clinically depressed used to be called cosmetic, or non-essential, and was therefore considered an improper use of medical technology. Now it is regarded as just about as cosmetic, and as non-essential, as birth control or othodontics. American legislators are weighing the so-called parity issue -- the argument that mental treatments deserve the same coverage in health-insurance plans as any other sort of drug. Where drugs to change personailty traits were once seen as medicinal flipperies, or enhancements, they are now seen as entitlements. This flexible attitude towards neurotechnology -- use it if it might work, demand it if it does -- is likely to extend to all sorts of other technologies that affect health and behaviour, both genetic and otherwise. Rather than resisting their advent, people are likely to begin clamouring for those that make themselves and their children healthier and happier. This might be bad or it might be good. It is a question that public discussion ought to try to settle, perhaps with the help of a regulatory body such as the Human Fertilization and Embryology Authority, which oversees embryo research in Britian. History teaches that worrying overmuch about technological change rarely stops it. Those who seek to halt genetics in its tracks may soon learn that lesson anew, as rogue scientists perform experiments in defiance of well-intentioned bans. But, if society is concerned about the pace and ethics of scientific advance, it should at least form a clearer picture of what is worth worrying about, and why. A longer story on the issue is on pages 77-79. It's available on Economist.com, but you have to pay. :-( It's a good read. Cheers, Scott.
Post #40,908 by mmoffitt 6/2/02 5:03:14 PM Reply	Modification to your solutions. : 1) Keep the SS system the same but (over time) raise the age for SS to (something like) 75+ (to nearly match average life expectancy), or; 2) Make SS an insurance-like program that people have to qualify for and exclude those of incomes above some threshold (say, e.g. $35k), or; 3) Raise SS taxes dramatically. As much as I am all for the redistribution of wealth by the government (to make up for the vast inequities in wealth distribution that comes from having a capitalist economic system) I would not propose that the wealthiest receive nothing in SS benefits. Rather, I'd propose the following: 1) Everyone gets back what they paid in, including interest. 2) A needs analysis is done. If you don't need it, you don't get it. Yes, this still runs a deficit, but not near the deficit generated by current policies. Despite my retort to Ashton, I do think the next generation owes something to the previous, especially in a capitalist society. Still, it pains me greatly that 16% of my income goes to SS taxes and I know that my mother-in-law has already "earned" more from SS than she did, adjusted for real dollars, in her entire working life - GROSS! That, coupled with the knowledge that my mother-in-law and father-in-law are well enough off that they do not need it, burns my, er, ... well, you know what ;0)
Post #40,909 by Ashton 6/2/02 5:07:50 PM Reply	Provocative article.. Thanks for the excerpts - which are enough to see the Next techno- unintended consequence: Happy Surgery! (or 'treatment' via natch, Expen$ive New Pharm-Chem -- needing frequent .nyet-style 'maintenance dosage' ... Inevitable!) Honey, did you forget to pay the rent again? No, Sweetums.. but I was feeling a little well... less than ecstatic about life n'stuff yesterday - so I Needed a little boost in my Soma-injector fanny-pack. Not to worry though {worry is a Negative thing, Sweetums} I've already filled the UAV's 30 gallon tank on the CC, and that will keep us moving for at least 3 days... (OK small exaggeration - the 30 gallons might not go much over 2 days - it's a new Navigator, after all... on 72-month lease) Nothing unexpected in the above, though it is a jarring reminder of the fragility of such visceral matters as "feeling In-love\ufffd" (?) and other stuff which we would really Not Like to think deeply about. Ever. {sigh} When I hear 'progress reports' of this ilk, my association naturally goes ---> the Myth of Atlantis, the self-perpetuating denouement where random techno change for mere "thoughtless instant profit", is said to lead. profit? - maybe also amusement? instant gratification because You Can? There may be other qualifiers re the Atlantis 'conditions'. Once started (this inexorable process?) - I know of no counter-myth which provides for a wise "backing-out with grace" ... ... for a few decades of contemplation re, quo vadis. (And I ain't smart enough to invent one, I see.) Ashton
Post #40,899 by bepatient 6/2/02 3:01:09 PM Reply	But... ...we're not allowed to let them die. Not until after the last battery of tests are done and we've paid our thousand a night in the med hotel. And Social Security shouldn't be collected. One of those >great ideas< that cost everyone billions and won't satisy anyones actual >need<. Shining example of the forethought that will bankrupt our government. You were born...and so you're free...so Happy Birthday! _{Laurie Anderson} [link\|mailto:bepatient@aol.com\|BePatient]
Post #40,910 by mmoffitt 6/2/02 5:10:22 PM Reply	As usual, wrong. One of those >great ideas< that cost everyone billions and won't satisy anyones actual >need<. Shining example of the forethought that will bankrupt our government. Easy counter-example. My grandmother, rest her soul, worked two jobs very hard because my shit-heel grandfather bailed when my dad was a toddler, one aunt a toddler and 2 more were in diapers. She worked for G.C. Murphy for 29+ years. Exemplary employee. Retirement required 30 years of service. But then some of your "entrepreneural" buddies decide to raid the retirement funds. Laid off hundreds, closed the "inefficient" stores, etc. in short, generated revenue for themselves and some shareholders. My grandmother took a job 60 miles away (which was a trick because she never learned to drive a car in her life). That took her up to several months before the "required 30". Then, guess what? Bankruptcy - YAN neat corporate capitalist trick. The result for grandma? She had nothing, the pensions were raided. Oh well, at least the business exec's made some money - (which is as it should be, right, Beep? Social Darwinism at its finest). W/out SS people like my grandmother would have literally starved. So it is necessary, because our socio-econ system is fundamentally unfair.
Post #40,926 by Ashton 6/3/02 2:01:46 AM Reply	PS: Cost benefit of "an extra year of life" - on NPR I caught the tail-end of such a discussion on NPR. Compared the cost of a $60K heart (bypass?) operation VS the "value" of just one 'extra' year, est. at "$150K". No, didn't hear the ingredients of the 150K. Nor how the 60K was apportioned among HMO execs, Insurance execs, Hosp. admins or Home Security detail (Oh: and then the plebes who just work 3 hours for Min-AMA wage, doing the plumbing.) The mere fact that the Econ-besotted mind Will cheerfully attempt to postulate an ROI.. on "a year of life" at any age - may indicate the disconnect of our $-obsessed consumer ersatz-'life' VS any formerly human concept of a life worth Living. Econ-2002: The Velocity of Blarney? Next we shall weigh the cost of a medium-sized nuke VS the outcome for a 5 year GNP projection [IF USED/IF-NOT USED] with a straight Econ-face: and with graphs and PowerPoint slides to demonstrate the rigor of the calculations. (A rigorous crc check shall be sufficient proof of the correctness of the calculation.) (I still think the mythical-Atlanteans have much to teach us re the consequences of the reduction of Mystery into nice delimited columns of number-symbols... not that many are apt to want to learn what that might be.) Ashton The inmates are in the asylum to protect them from us. Cost-effectively. (That isn't working, either.) PPS - as to tradeoffs in $/unit/yr. of childhood %Grossest National Product VS $/unit/yr. as the age rises -- this could only be a thread in the Metaphysics forum, methinks. Or maybe Oh Pun?
Post #40,921 by kmself 6/2/02 11:59:38 PM Reply	Heart disease Those fatal infarcts are pretty effective streetsweepers. The problem, from a health-care finance perspective, is that they're also relatively infrequent, compared to heart and circulatory disorders of a chronic nature. Long-term care in these cases -- multiple CABGs, oxygen, drugs, ambulance transports, and hospital stays, are where the costs start adding up. By contrast, lung cancer (frequently fatal in weeks or months) is relatively inexpensive. Healthy people who die suddenly (pneumonia (the "old man's friend") or falling out of trees (GB Shaw)) are relatively inexpensive. Or, as the old saw goes, it's not the death, it's the dying. `-- Karsten M. Self [link\|mailto:kmself@ix.netcom.com\|kmself@ix.netcom.com] [link\|http://kmself.home.netcom.com/\|[link\|http://kmself.home.netcom.com/\|http://kmself.home.netcom.com/]] What part of "gestalt" don't you understand? Keep software free. Oppose the CBDTPA. Kill S.2048 dead. [link\|http://www.eff.org/alerts/20020322_eff_cbdtpa_alert.html\|[link\|http://www.eff.org/alerts/20020322_eff_cbdtpa_alert.html\|http://www.eff.org/...a_alert.html]]`

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