On Thu, Nov 8, 2012 at 11:51 PM, Paul Tanner <email@example.com> wrote:
<< snip >>
> > Your whole reply above is an example of what I was talking about. > > If you think "toilet paper" is infantile as a metaphor for what we > need and which needs to get paid for if we're going to get it (unless > you're lucky enough enough to get every doctor and so on you'll ever > need to do it all on a volunteer basis), then let's try "health care". > > And so let's get real, and confront the facts with respect to health > care, shall we? > > Would you kill Medicare? >
To review, I've been arguing that people who think quite strictly in terms of budgets and money (as in "should we kill this or spend more on that?") are not really conceptually grappling with designing and/or planning for the delivery of services to needy populations.
Nor are the purely money-minded interested in zoning for the growth of cities or doing land use planning of any kind.
They're looking at a column of numbers and saying "do we up this or lower that or what?"
It's not clear to me that people who think purely in monetary terms have much if anything to do with the engineering work it takes to design and build much of anything.
The money-oriented tend to be the least conscious and aware of all the variables in play, the options provided by current and expected technology.
They've narrowed the world to some numbers and now they insist that reality follow them down that rabbit hole and be manageable in those terms.
How do you spell "rubber room" (as in straitjacketing thinking)? Such is economics, at least half the time (GST is bringing fresh perspectives).
Economics is a form of mental retardation, for the most part (true of many academic subjects, which doesn't mean they can't feature tough puzzles and/or "higher math"). FYI: I've just been perusing some early MAD -- 1950s -- re "how to look smart" (pretty funny). I found this Tom Lehrer contribution in issue 35:
> > Would you do the conservatives' thing and make it so that old people > either pay more and more in terms of the total of premiums, > deductibles, and copays or they get no health care, statistically > guaranteeing that more and more old people with all those already > existing conditions will not be able to have health care via not being > able to afford it? Yes? No?
It's not just about "old people". People at all ages tend to need health care, many times for congenital conditions.
What's true today is some retirees flee the USA jurisdiction and set up with their savings in Mexico or the Philippines, where their dollar goes much further and health care is much more affordable.
Others stay where they are but mail order their drugs from Canada, although the Wal*Mart strategy of going $4 on generics (to iTunes the meds business) has helped alter those distribution patterns.
Huge numbers of health care workers, including for longer term care facilities (it's not just about hospitals) migrate to North America in response to vacancies and remit some of their earnings to families elsewhere around the globe.
Point: it's a global operation already, and like the electrical grids, the health care networks are tending to hook up and integrate on many levels.
What would I like to see?
More floating hospitals, an industry as big as the cruise ship industry, with lifestyles to go with, and these put in to port for non-trivial amounts of time. Some park there for the duration, pretty much. It's a way to build something state of the art and float it to where it needs to go.
Who would pay for these?
Based on current projections, probably not the USAers. Their role is more to put people into these hospitals, by upping violence levels in various parts of the world. This has been their role recently (we can run some numbers if you like) and they seem eager to "hold the course".
The Russians? Lets talk about long range plans for an eye care facility / hospital / complex in Siberia. It's under some big domes and is warm and cozy 24/7 and has resort hotel aspects. People fly in from all over the globe because the eye care is good and affordable here.
Extrapolating from existing trends, health care will be more of a global enterprise than it is even today. South Africa is likely to be a player (already is).
However do we want to do all our accounting in terms of sovereign nations? If I'm Ford, looking at Ford around the world, then it may really confuse me to try thinking in terms of Ford / USA versus Ford / Germany and Ford / Mexico. We're talking about integrated operations and a bottom line. These political demarcations are interesting but certainly not the whole story.
Health care planners who think in purely nationalistic terms may not have had the best educations money can buy, eh?
When you study an airplane's schematics in CAD and want to look at the electrical system, you don't just look at controls in the passenger seats or the coffee making circuitry in the galleys.
Likewise, when looking at health care planning, you may choose to think just in terms of some "USA" and its budget. You may simply brand yourself an "an economist". You may get a cubicle in DC and get to write papers for politicians to base speeches on. You may be considered successful in your line of work, and have the Nissan Leaf to prove it.
> > > Would you do the conservatives' thing and make it so that Medicare > covers less and less, statistically guaranteeing that more and more > old people with all those already existing conditions will not be able > to have health care that they need? Yes? No? >
Health care that takes you outside the USA jurisdiction for many of your elective health care needs?
Heart surgery in South Africa?
Eye care in Siberia?
In some cases, that might be your best route, in terms of both patient experience and outcome.
Likewise, the ability to offer lots of dental care may depend on relief teams coming in, some of them religiously based, whatever ideologies.
A lot of people around the world depend on charitable organizations, funded behind the scenes by various private beneficiaries.
My goal with CSN is to have charitable giving be more a part of the everyday experience for ordinary folks, starting from a young age, no need to be some gazillionaire. There's a game playing aspect. We're talking hours a day.
A China-based set of charities wanting to provide dental care in Detroit would be part of a wider foreign aid effort. As most people know, many USAers live in dire poverty, with terrible living conditions, little access to services.
Many idealistic health care workers will do some service in North America out of a sense of compassion for the impoverished in that area. Slowly but surely, the hope is to raise living standards, even for these malnourished and undefended.
> > What about all those 50 million below age 65 that have nothing now, > and what about those many more tens of millions that are what they > call under-insured? > > Where would you get the money to pay for it? >
You certainly need people with an appetite to become health care providers. That means you need attractive lifestyles, sometimes serving aboard health care ships.
All the money in the world can't make up for too few people with the knowledge, skills and sense of compassion (cultivated through meditation and tending to mental attitude -- dharma / curriculum stuff).
There's this tendency among the money-thinkers to forget that it's part of the planning responsibility to attract and recruit.
Making the job of health care professional more global by definition, offering more opportunities not just for "travel" (in the sense of idle tourism) for learning skills and encountering many more career relevant situations in one life time, is going to bring more talented people into the health care professions.
These are people who might have otherwise squandered their talents as demolition engineers and explosives experts in the business of maiming, actually *undoing* the work of health care workers (fighting doctors).
So I'd say the long range plan is to counter-recruit against the murder and mayhem crowd (lower skill levels on average) in part by upgrading the STEM curriculum, the work / study scenarios.
We may gradually convert some of the facilities (e.g. Okinawa) into more health care related and relief operations as well.
The doctor-fighting USA (the DC centric version of it) is likely to counter these developments though, as a nation with a track record of militating against health and health care, even for themselves (just look how they eat, so many of them! -- suicidal obesity is a norm in the US, and not just in Texas).
> You complain about debts and deficits but offer no suggestions as to > what our government should actually do in terms of these very real > questions of revenues and spending..
If you're talking about Washington DC, then I'm not really interested in reading their "white papers". So many of these people come straight from college, where they received a warped view of reality, after years and years of heavily fictionalized "unreality TV" and now they have cubicle jobs writing "policy proposals".
Sorry, but that's not a city I look to for real leadership as a rule of thumb.
I think Obama's effectiveness in his 2nd term will have a lot to do with how much time he spends outside of DC. He's got all the telecommunications he needs. He should travel more. DC gives any president a less intelligent perspective on many issues.
I think the equivalent of a White House on the west side, where presidents and their staffs can get work done, might be a worthy investment. Somewhere in Oregon maybe? Call it Camp David West or something. The casinos could kick in some funding as friendly sovereign nations, willing to sit down with the Federalists and talk turkey, negotiate about the ecosystems more.
The Pacific Rim states are less Eurocentric and might help North Americans outgrow their silly fascination with European thinking about money and stuff (not that the Swiss are stupid or anything -- they're invested in Asia too). People grow up thinking there's "capitalist" and "socialist" and every configuration of every ecosystem is supposed to be a mix of those two somehow. Why think in such a mediocre fashion? Is this the best philosophy can come up with?