American Healthcare Should Adopt the Cocaine Standard

We Americans have a certain schizophrenia about health care. It is “mom-and-apple-pie” to bemoan the wait times, the hours of operation, the check-in, the lack of house-visits and primarily the cost of care. Nevertheless, people view it as a utility. No, that is certainly not correct. Utilities are paid for. The more electricity, water, sewer service and television channels one gets, the more one expects to pay. Medical care in the USA is viewed as a right, like clean air, without even an EPA-like agency to safeguard its continued availability.

Like expecting free water, free food, free housing and free services of a local business woman of negotiable virtue, free healthcare is a myth. It is a personnel-intensive, material-intensive industry which suffers under harsh regulations.

Healthcare is valuable.

Currently, 18% of American GDP[1] goes to providing healthcare.[2] For an average gross income of $52,000, therefore, this amounts to $9300/year. All receive healthcare yet almost half of Americans pay NO income tax.[3] So the current healthcare debate could be rightfully changed in regards to a national free healthcare scheme to:

“Why should about half of Americans pay for ALL of the healthcare?”

There are some obvious answers:

  • Epidemics of preventable disease are costly to all people, not just the victims.
  • Aesthetically, unnecessary disease and death are unpleasant for all.
  • Prolonging a useful career is beneficial not just to the individual but the society.

I understand that this is not the usual argument, which is couched in terms of a moral imperative.

The question is why anyone with enlightened self-interest should choose to lose one’s possessions and livelihood, earned by their own labor, to help another.

If one chooses to be charitable, the argument is no longer a political one and outside the realm of this article. There are numerous opportunities to donate and have been available for over a couple millennia.

The issue is one of political compulsion, and for extraordinary actions, that of using the bayonet of government to extract payment from a free citizenry to supply a service which is otherwise available, extraordinary arguments must be mustered. That is the standard which must be met before “free health care” becomes reasonable for a free and democratic society.

Contrary to fright tactics, healthcare is provided to all in the United States. I am not saying all care, all the time, in all places and for all the levels of care to which a patient might desire. I am saying that free care is provided. People do not die in the streets and have not since the Spanish Flu of a century ago.

What care is provided?

Specifically, every hospital is mandated to evaluate all those presenting with a potentially emergent condition. (Think chest pain, MVA, pregnancy). On-site care must be provided and transfer to a higher level center if that care is indicated. This is not “dumping” as that is prohibited. (See COBRA regs). The hospital and doctors eat the cost.

Newborn infants, even those requiring moths of intensive care, are covered with no cost to parents. (Over the years, over half of my patients fall into this category.)

Specific diseases, such as congenital heart disease, are treated gratis by teaching hospitals.

Childhood immunizations are provided free.

Is this enough? For an “immortal” twenty-something, generous in the extreme, as he needs none of the services except the removal of inconveniently-impaled skateboards on occasion. It is hardly surprising that as a group they view compulsory medical insurance as an unfair tax. It is.

For those of us with fewer years ahead than behind, not so much. We all will need healthcare unless we make arrangements to die in another bizarre skateboard-related mishap. Disease, while not being avoidable, is nevertheless unpredictable. Catastrophic costs visit the provident as well as the foolish. It seems reasonable to insure only against the unpredictably catastrophic and not against what should, for a provident person be viewed as the “cost of doing business.”

Where then can costs be cut?

Litigation is a runaway train. The USA is blessed with more lawyers per capita than any nation in the history of the world. We have more living lawyers than all of history back to Hammurabi with scant improvement to a more just society.  American juries seem to vie with each other to add zeros to judgments. Outrageous claims are made for “pain and suffering” which have no monetary measure nor recompense. Money is passed out wholesale for illusory injuries such as loss of psychic powers.[4] Even after juries have come to a decision to acquit a capricious lawsuit, jurors still inquire whether they “might give some money to the plaintiff.”[5] From whence comes this supposed charity? Presumably from the innocent doctors.

The whole medical system is canted to to the idea that fighting a malpractice suit is futile, being sued for no reason despite demonstrating no authentic malpractice. Applications for hospital credentials give copious space to recording each suit but do not even allow the likelihood that a suit would go to trial and the doctor be found innocent, asking again and again “So it was settled?” rather than conceiving of the chance that the defendants prevailed. Wasting weeks in trial and years of litigation does not serve to reduce the price of medical care nor the availability of doctors.

This dubious success of the legal trade has spawned another costly extravagance. Regulation upon regulation attempt to institute by fiat what can only be accomplished by professionalism. Every time a surgery starts, even for a cesarean section, a “time out” procedure must be done. This was instituted to ensure that appropriate legs were removed when needed. I fail to see how one is going to open the wrong uterus. The procedure generates one more piece of paper that is never subsequently looked at.

After multiple dozens and dozens of pettyfoggingly silly regulations, you create a patient chart that has all the forms required and is yet impossible to discern any medical judgment therein. Lawmakers, lawyers to a man, feeling neglected have instituted all their pet peeves into requirements such as the Congenital Heart Disease Screening, a simple-minded rather insensitive test which any pediatrician worth his salt would ignore in favor of a good stethoscope and a quiet room. The false-positives of the screen generate $9000 every time it fails. I know of no infants it has discovered and many it has failed to discover who had real heart disease.

In a larger sense, the patients’ attitude in regards to healthcare must change if any savings will ever be realized. ER visits are certainly abused.[6] Misapprehensions about the appropriate use of emergency rooms are rampant, with Medicaid and Medicare recipients leading the pack. Fully 64% of ER visits are too inconsequential to justify its use. At the cost of $1200+ for each cold ( disease an infant will get about six times a year normally), they are a waste of money. Considering the 4-hour wait (compared to 20 minutes for an urgent care center and even less for a doctor’s office), they are as burdensome for the patients as they are wasteful.

Healthcare is valuable.When no value is ascribed to it, it is treated as if it has no value.

What does have value are illegal drugs. We are beyond the tipping point when 90% of the circulating currency has been used in a drug buy at one time or another.[7] The narcissistic abuse of illegal drugs by an overly wealthy, indulgent and non-introspective population creates its own healthcare problem. Nevertheless, it is a cash market amounting to $110billion in 2013 and $125billion today.[8] While not anywhere near the cost of national healthcare, it is a fair bit of change.

Abuse of emergency rooms is seen most often by people who are unaware of the value of healthcare. If healthcare is free than a visit to and ER is as good street theater as any.

To dissuade these feckless suffering victims of America’s healthcare crisis, I propose that they EACH fork over a dime bag of cocaine before seeing the doc, a real object lesson in the value of healthcare.

I suppose that arrangements could be made for the user’s drug of choice, say 10 grams of weed, a couple oxycontins, or a few tabs of MDMA. Conversion table could be posted, giving the waiting public something to do in the interminable wait of overcrowded waiting rooms.

With luck, this would allow patients to accurately assess their needs for professional hospital care. It would provide a fund of material to cushion any perturbations in the payments cycles, selling off the cocaine as needed to make ends meet and doing in small part what needs to be done to make American Healthcare the envy of a troubled world.

[1] 17.95 trillion USD (2015)

[2] https://www.forbes.com/forbes/welcome/?toURL=https://www.forbes.com/sites/danmunro/2015/01/04/u-s-healthcare-spending-on-track-to-hit-10000-per-person-this-year/&refURL=https://www.google.com/&referrer=https://www.google.com/

[3] http://www.marketwatch.com/story/45-of-americans-pay-no-federal-income-tax-2016-02-24/

[4] http://lawhaha.com/plaintiff-sues-for-loss-of-psychic-powers/

[5] 2013, Floyd Co. Ga, Duke vs et al.

[6] http://blog.bcbsnc.com/2014/04/5-emergency-room-myths-busted/

[7] http://news.nationalgeographic.com/news/2009/08/090816-cocaine-money.html

[8] https://en.wikipedia.org/wiki/Illegal_drug_trade_in_the_United_States

 

Exiles’ Escape Prologue “First Hand Sapping”

Prologue

 

(Twenty-two months before the events of the first book)

Stanton, Pensy[1], Democratic Unity of America

Infinity Acres Retirement Community

Product Reclamation Floor

06.23.02.local_01_Jan_AU75[2] (2127 AD)

 

“Good morning, Ruuf. Tie one on last night, did you?”

“I musta had a good time, Gurry. Can’t remember half of it, ‘n’ Sheilah wouldn’t talk to me this morning.”

“You probably deserve it. Fecking stupid that the zoots even bother to have us come in.”

“How many we got cooking, anyway? Any chance of a light day?”

“We have only one induction, four maintenance, and three consolidations. Bravo twenty-seven smoked it overnight.”

“Only one start-off? Father me, I may yet survive the day!”

“You’re forgettin’, this is the day we start the new setup. The dose goes down to twenty-two on these guys. They say they get more geeks out of the process, but we have to keep fecking new records and do vids.”

“Thrilling. What do you want to start with?” said Ruuf as he donned his padded suit and fishbowl helmet. He grabbed up a two-meter pole with padded jaws on one end and moved to a line of gleaming stainless-steel doors that lined a wall.

“Bravo twenty.”

A stainless-steel door swung open. Ignoring the stench and dodging the flung feces, Ruuf waited for a chance and then slipped the jaws of his capture pole around the Sisi’s throat before dragging the creature into the light. Immediately, Gurry pounced on the naked old man with a section of metal grid, pinning him, face down, to the floor. Ruff released his grip and retrieved the Sapp-gun. Gurry’s tattoo gun snapped once as the man’s arm came up to protect his face.

“Number 201000A-01_01_AU75. New Sapp[3] dose, zero point two two mils of hundred gigaparticles per mil per meter squared times 1.73 square meter yields zero point three eight mils. Check the math, and here you go, Gur. Ready to boogie.”

“Check, Ruuf. Good to go.”

There was a nearly noiseless pop just before the screaming started. Within minutes, Gurry released the man as he subsided into whimpers, moans, and guttural nonsense sounds. From the ranks of stainless-steel cages, a wave of hoots, harangues, and a few shouts of “Wait till I write my congressman,” erupted. Ruuf shoveled the old man back into his cage as Gurry, looking at his tablet, started to laugh.

“Says here that guy was a professor of English. Wonder who needs to be taught their own language?”

“Beats me. Probably smart. Think he’ll rise within the ranks, then?”

“Depends on whether he can still talk in a week, don’t it?”

“Tea?”

“Yeah, sure. They’ll be quieter when we get back.”

As they left the room, each put on a uniform hat. Instead of the usual DUFS[4] uniform cover, each black hat bore a death’s head insignia.

 

 

[1] After the Glorious Revolution, many place names in the Democratic Unity were simplified.

[2] Unity date-time convention: hour.min.sec.time zone (GMT= zulu, local, EST, CST, etc.)_day_month_year (in Annum Unita = AD-2151). A timeline is available in the Appendix.

[3] Unfamiliar terms may be referenced in the Appendix. Sapp is the agent used by the Unity to turn their excess population into compliant foot soldiers.

[4] Democratic Unity Forces for Security. As posse commitatus has been repealed, all policing and military functions have been combined under the DUFS.

NB Decided to remove this from the MS for publication. This will probably never see the light of day other than this blog but it does pre-sage some of the events in later books.

Guest Blog-“How the Right Was Created” Ernest Enax

Guest Post by My Friend Earnest Enax
Frequent Flyer in FB exile (repeatedly for the same post now over a year ago)
 

How the Right Was Created

 
Some of you are apparently “triggered” because you are posting how “sick” you feel about the results. How did this happen you ask? Well here is how it happened!
 
You created “us” when you attacked our freedom of speech.
You created “us” when you attacked our right to bear arms.
You created “us” when you attacked our Christian beliefs.
You created “us” when you constantly referred to us as racists.
You created “us” when you constantly called us xenophobic.
You created “us” when you told us to get on board or get out of the way.
You created “us” when you attacked our flag.
You created “us” when you took God out of our schools.
You created “us” when you confused women’s rights with feminism.
You created “us” when you began to emasculate men.
You created “us” when you decided to make our children soft.
You created “us” when you decided to vote for progressive ideals.
You created “us” when you attacked our way of life.
You created “us” when you decided to let our government get out of control.
You created “us” the silent majority.
You created “us” when you began murdering innocent law enforcement officers.
You created “us” when you lied and said we could keep our insurance plans and our doctors.
You created “us” when you allowed our jobs to continue to leave our country.
You created “us” when you took a knee, or stayed seated or did not remove your hat during our National Anthem.
You created “us” when you forced us to buy health care and then financially penalized us for not participating.
 
In addition, we became fed up and we pushed back and spoke up.
And we did it with ballots, not bullets.
With ballots, not riots.
With ballots, not looting.
With ballots, not blocking traffic.
With ballots, not fires, except the one you started inside of “us”
“YOU” created “US”.
It really is just that simple.
 

What good the Retarded?

What good are the retarded?

America has done much to improve the lives of the “intellectually challenged,” the currently acceptable designation of those who were designated “mentally retarded” when I was a child, as “idiot” when my parents were children and “moron” when my grandparents were children. No doubt, we will have another euphemism in the next generation when we have used up the current one, when the disdain from the old term has been fully transferred to the new term.

Since the mid-seventies the “Intellectually challenged” have undergone mainstreaming in public education, being placed in classes based on their abilities rather than a global classification of intellect. Whether this has improved the education of the ninety-and-nine normal children in the class was not considered important by the social experimenters in that age of the triumph of Science (All Science, mind you). Each new wrinkle of advance which could generate a pilot project and its attendant grant money, was embraced as timeless educational doctrine.

Not surprisingly, the cost per capita of public education has skyrocketed, almost doubling (in inflation controlled dollars) in thirty years (1970-2000). This is during a time when the college board scores fell precipitously, even requiring a “resetting” of the score in the mid-1990s, and high school graduation rates fell. With little to show for the policy of mainstreaming, one wonders why it has continued, save for inanition and momentum.

Last Saturday, I went shopping at a grocery story. It was relatively crowded and there was a fair amount of backing and filling of cart to allow people to navigated up and down the narrow aisle of the Schnucks Store of Alubus, Missouri. I started down an aisle and noticed that another man and cart were coming my way. I pulled over and motioned for the man to come on. He did it clumsily. The reason for this was that on his arm was teenage girl.

The man was small, slim, and middle-aged (as opposed to my own age, bordering on the elderly) dressed in a neat button-down plaid shirt and slacks. On his arm was a girl, taller than he by perhaps three inches, overweight, lumpish and drab … except for her face, which smiled at me as she turned the corner.

“I going shopping with my daddy,” she said to me as our eyes met.

“Yes, you are!” said I. “How lucky for you,” I thought.

I looked back at the duo as they proceeded slowly up the narrow aisle past me, stopping every once in a while to  look at one thing or another.

I was mostly done and checked out almost immediately. Carrying my few purchases across the front of the store toward the exit, I looked back to see if I could find and capture the eyes of the girl who was shopping with her daddy. I did and waved to her. She did not see me, having eyes for her father. Her father did see me and waved back at me. When I got to my car I wept, for no great reason.

Our care for the disabled, our love for those who may never be able to pay us back in kind, seems to me to be assessed wrongly. We do not do it for them so much as for ourselves, to remind us all that our selfless care is a boon to all mankind and a joy to the hearts of us all.

Genres of Science Fiction

There are only two varieties of Science Fiction.

Yes, I know.

Wikipedia lists forty-seven varieties of Science Fiction genres, from “Afro-futurism” to “Weird Western.”

It is confusing, to state the obvious. From a Feghoot, something of a shaggy dog story ending in a pun, to Mathematical, like Flatland, to Decopunk, there seems to have been a profligate multiplication of designations, all appearing more descriptive than defining. A naïve editor would be hard pressed to categorize a work as Mundane Science Fiction versus Noir Science Fiction accurately.

As a confession, of sorts, I was trying to get Amazon to create a genre Political Science Fiction” for those works with a paucity of golly-gee whiz-bang elements but rather more of the political and social aspects of society. Into this new genre, I was urging placement of Brave New World and 1984, along with, not surprisingly perhaps, my own Outland Exile: Book One of Old Men and Infidels. Each has a degree of speculative technology, respectively: surveillance tech and perpetual world war; and flying-cars, reproductive-tech and recreational drug use. My own concession to future tech was a “pulse” weapon, necessary for the climactic battle and incidentally useful as an ice-melter. The rest of the OE-tech (surrogate pregnancies, depot contraception, brain ablation zombies, and chimera production) while not common, is possible. If Amazon had agreed, I would have been in wonderful company!

Amazon, in its greater wisdom, did not.

Fortunately, several critics in their reviews have agreed with me, describing OE as a cross between BNW and 1984.

Outland Exile languishes in the “hard,” dystopian,” and “military” Sci-Fi categories. I find the lumping with other genres prompts some people to disregard it because of dislike of the genre, especially the “dystopian.”

“Dystopian,” unfortunately has become a Young Adult and New Adult genre. The trope is: birthed into a horrible world with ineffectual, absent, or intolerant parents, the plucky, young, (and very frequently female) protagonist strives against a society not of her making to win through, in the end, gaining new insight into herself while saving those she has come to love.

Sound familiar?

I tried very hard to turn that on its ear with OE and the whole OMAI series. My teenage heroine is actually middle-aged. She is perfectly copacetic with her society and has never been burdened, she thinks, with parents.

But in another way, I think that science fiction really only comes in but two flavors: Fantasy and Alternative.

SF-fantasy: Speculates a society of plenty. There is usually faster-than-light travel. The two things sort of cancel each other out. They become FTL adventure-fantasy stories where the next challenge is just on the next planet. Slimy space aliens and ray guns abound. Man-Kzin Wars (Anderson, Niven, Ing), Gor series (Norman), and the whole Star Wars franchise fits nicely into this genre. One could imagine each of these being worked out with alternate villains, dangers, and locations in the byzantine world of 12th century Europe on a much lower budget. Enjoyable if not taxing!

SF-Alternate: Speculates a society of want. It answers the question of “what if.” What if we could travel back in time? (Timeline by Crichton) What if we found a new epidemic (Scarlet Plague by London)? What if the socialism triumphed (1984 by Orwell)?

What is absent, generally, is an inscrutable or unrecognizable distant-future, extreme technology, and inscrutable social forces. Speculation is what this genre is about. What if? This includes much of what is called dystopian, no doubt, because if one said “… And everyone lived happily ever after” it would not sell well. Dystopian presumes that something went wonky … and now somebody has to fix it. Star Trek is more this style, despite the culture of plenty and the FLT. Each episode is a mini-“what if.” “What if we went met improbable rock-people?” “What is the nature of sentient life?” And et cetera.

Conflict comes with want. Fantasy comes with plenty

I have no doubt that Sci-Fi editors will rise up en masse and to a man ignore this plea to simplify the genres just as Amazon ignored my attempt to add a new genre.