How not to do healthcare

By Edward Hadas
December 11, 2013

Almost every healthcare system in the world is a lesson in how not to do it. The pricing-based model fails miserably in the United States. The rationing model works almost as badly in the UK. Both fail in the core task of ensuring that the right healthcare goes to the right people.

Price systems should provide clear information to consumers and producers, helping both make sounder decisions. They can help make hard decision about what care is worth giving, but only if the prices accurately reflect the costs. But that doesn’t happen in American healthcare.

Every service and each drug has many prices, depending on who is providing and who is paying. Almost none of the prices bear any clear relation to costs. The New York Times reported earlier this month that the price of a dose of codeine ranges from $1 to $20 in San Francisco. Hospitals routinely send much higher bills to uninsured patients than to people with insurance. The uninsured have less ability to pay, but they have no clout pre-treatment and less clout than insurance companies in the inevitable post-bill negotiations.

The price chaos in American medicine is much less economically sound than the haggling in a Middle Eastern souk, where the negotiations are largely ritualistic and the final agreed prices are basically fair. The final prices paid for American healthcare are so arbitrary that patients, insurers or would-be reformers cannot tell which services offer poor value for money.

Inept pricing is not the only reason why the United States dedicates almost 20 percent of GDP to healthcare, according to the World Bank, far more than any other developed nation – while experiencing worse basic health outcomes, in aggregate. But it certainly makes everything worse.

The British approach avoids the problems that stem from relying on inaccurate pricing. The National Health Service has a near monopoly, and it does not charge users anything. Instead, it relies on rationing. Demand is restricted intentionally by explicit limits on care set by management and politicians. It may be further dampened if patients are also kept away by an unpleasant environment and extended waiting times.

Rationing sounds like a good way to allocate healthcare. Experts are better placed to make good decisions than ill-informed and emotional customers. Also, most voters do not want people to be deprived of needed care just because they cannot afford it. Need-based and income-blind allocation can be arranged more directly through rationing than through the American mix of prices, insurance and government subsidies.

And in some ways, the British system works. It is reasonably popular and relatively cheap at 9.3 percent of GDP. However, in many ways the NHS delivers a poor outcome. There are long waits for basic care, massively overcrowded emergency facilities and some of the worst hospital infection rates in any developed country. General practitioners are overwhelmed and preventive care is underfunded.

Poor rationing techniques contribute to the problem. The NHS and its political masters hate to admit that some people’s ration of healthcare will sometimes be far less than citizens would like. So they try to do too much and are fuzzy about what they are trying to do. The result, in the words of a recent academic study , are “unclear goals, overlapping priorities … and compliance-oriented bureaucratised management”. These leave “staff struggling to deliver care effectively”.

It is all quite ironic. Modern healthcare is one of the great accomplishments of industrial economies. And those economies would never have been constructed without accurate price arrangements for some goods and services and shrewd rationing for others. Yet these tools fail in the provision of healthcare.

The underlying problem is easy to identify. Healthcare is connected with life, death and loved ones. In the contest between these cosmic matters and prices and rationing, the latter end up losers. Still, the allocation techniques could be improved massively without resolving the grand debate. Both the U.S. and UK models could work better.

American healthcare needs a big dose of cost accounting, which would ensure that prices fairly reflect the total costs of production. With standardised and realistic pricing, it will be easier to make the political decisions about what care should be available to all, and the personal decisions about what additional care to pay for.

In the UK, the rationing is half-hidden. It should be explicit. That requires political courage: a public declaration that the state will not try to satisfy all medical desires. If British people want more, they should be asked to pay for it.

In short, the British should learn from the Americans that prices can help allocate healthcare, but they need to avoid the U.S. mess. And the United States should admit that the British are right that governments must ration healthcare, even if rationing can be done more effectively.

44 comments

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Once again Mr. Hadas hits the nail on the head. He is the only one to date to suggest that taxpayers can’t afford what they want and won’t be happy with what they can afford.

In matters of life and death of “loved ones” (or the loss of their earning power) there remain those who claim it impossible to put a price on human life. And yet, in the cases of the many who died on 9/11 or who died in Iraq or Afghanistan in the military or as a civilian at some point a “for hire” bean counter must reduce each life to dollars and cents before life can move on.

And yes, some are worth more than others. I think it is this that some people have the most difficulty accepting. They CAN’T HANDLE the truth! But in human affairs if there must be a remedy there also must be a price for everything and everyone, just not the same price.

Posted by OneOfTheSheep | Report as abusive

Healthcare is a tough nut to crack but here are some points I would try:

1. Another grade of medical practitioners between doctors and nurses. You can probably study for three years to know almost everything there is to know about treatment in a specialized area – no need for all doctors to ‘know everything’ and then specialize in a field – 2 years is much cheaper than 10 years.

2. Allow people to prove they live and eat healthy. If they do, pay them as they are no longer a burden on the healthcare system.

3. Tax cigarettes, fast food makers, televisions and alcohol producers far more heavily.

4. Build bicycle lanes and up the tax on cars.

5. Make use of generics compulsory.

6. Have a cap. If you are well off you pay. This can be done as a bond over your house or a death entitlement so it is not necessarily in cash.

7. Have a cut-off. Over 65 you no longer get x, y and z because your time has come and these million dollar treatments give on average six months more.

Posted by BidnisMan | Report as abusive

@OOTS – Except in the case of your wife if you recall your conversation with me a few weeks ago in an earlier article by Mr. Hadas.

What is it with you – you try on political/economic philosophy if it looks good as your mood suits you? When have you ever expressed the least concern for those who now make military life a career? These are not the days of conscription, remember, and these guys want the prestige, or at least the income, of a career in the military. And there were hordes of very hungry or greedy vultures much too eager for anything the “war of terror” could generate by way of personal fortunes. The country has not been engaged in a war on terror for anything more than an excuse to engage in terror, otherwise there is very little reason to maintain the military establishment’s bloated and disproportionate take from the federal budget. And because it has been fed so well for so long it only gets larger and wants more. The entire country has become addicted to that enormous part of the federal budget: almost 60% according to a little flyer I received from the American Friends Service Committee. If it were reduced it would take the steam and a lot of the aggression out of this rattletrap of a country. And counties are always rattletraps. Those people went into a risky life for very dubious reasons that will cost this country fortunes in care for a cause (at least Iraq) that really should be prosecuted by a real world order (that this country seems to do its best to scuttle because it knows it will have hell to pay) as a war crime. What do you usually say regarding personal responsibility: “they made their choices”?

And how do you decide, self-styled old chameleon sage that you are, whose life is worth more than another? Net worth? That’s it, isn’t it? That’s is the historical rule actually. Do you want the rest that goes with a social system based on historical models? That’s the conservative point of few for the most part. Wealth usually bought more years or better care and more leisure. Other people without funds took the risks and had to wear themselves out just to stay alive.

But back to Mr. Hadas – pricing on almost anything in this country does not seem to be established by cost but by what the market can bear. The biggest problem with seeking health care in this country has always been that the patient can’t find out what it is going to cost ahead of time so even the patient him or herself can make a personal decision whether or not to waste the resources on his own care. Most people in the Hospital I visit don’t know how it’s done and can’t explain anything about costing issues. The very competent surgeon who removed my tumor didn’t know how the pricing was established at all and doesn’t worry about it.

Rationing may be the only recourse in the future but self-styled winners like OOTS will resent being deprived of the arbitrary care they know money can always buy. After all – he insisted on no expenses barred treatment from any available funding sources regardless of age – mostly because he is attached to his wife and wants “the best”. I have an ancient overweight Aunt who styled herself a suffering survivor because she underwent chemotherapy to fight off a mere 5% chance of recurrence of breast cancer after an operation to remove a lump. I’d have counted myself fortunate to survive the operation let almost take the risks of chemo. And then she gets pious about it and thinks her “faith in God” saved her. Not a word about the enormous cost of the operation and treatments to keep her bloated carcass on the road a few more years. Her “faith” is little more than a terror of death. She and her husband live without children in a very large house and they are by no means struggling except maybe to pay the heating bills on their future white elephant.

The healtcare system will never be adequate as long as people think it is there to give them comfort and assurance that they somehow aren’t going to die eventually. It is up to them to grow up and accept the fact. Even the “war on terror” so called is being fought to guard the pampered and very demanding brats this country has become from the misdeeds and crooked dealing with other governments by past administrations and to salve their fears about just about everything. It’s still amazing how the government can still pull people’s chains and play on their arrogance, fear and greed. And I’m definitely talking about this society’s “winners”.

I have to apply for financial assistance with the Hospital I have seen in the past – for old age issues like back strain, etc. But the bills I ask relief from are usually horrendous for what never looks like much care at all. Even simple measures like a pain shot to kill excruciating back pain can cost thousands. The emergency room – there was no where else to go on a weekend – is not an exceptionally expensive physical setting and even an operation I had a few years ago for a tumor showed me that the room itself was actually very simple and built like any conventional office space. The only expensive looking equipment was portable and there was very little of it. I also receive a battery of examiners when all I needed really was a quick shot to kill the agonizing pain and a prescription for some pain meds because that’s really all anyone can do about back pain. Most all my issues that required emergency room visits, because there is no place to go off hours, could have been handled by the old fashioned family doctor who made house calls, or at least kept extended hours, and could have been solved at a tiny fraction of the cost. There were two big exceptions to personal history, but they too seemed to be grossly over-billed. It guarantees I can’t pay them.

Lets face it – everyone can talk about cost cutting and making services economical or fiscally sensible but that isn’t how a society as centralized and sophisticated as ours works. It isn’t about saving money or doing the sensible “yankee frugality” thing at all. It is about making sure money keeps moving into as many hands and mouths as possible or the natives get very restless and angry. Government is essentially about bribing everyone in that society to play along with those who control the budget at the top or the natives start to look for ways to kill those at the top. Usually they are “bastards” and “crooks” if they fail to feed enough of the big feeders closer to the top. The big feeders than get the rest of the society worked up to “kill the bastards” so they can replace them and occupy t positions closer to the fountain of funding that is a state’s treasury. And those with the deepest pockets can be the most demanding and greedy of the lot and can exert the greatest influence to make problems for those in control because most of their income is spare and surplus for their needs. Poor men want to be rich and the rich men want to be kings, as the saying goes. .

Lets face it OOTS – Old peoples lives aren’t worth as much because their productive days are usually over and they become dead weights with gagging medical costs.

BTW – I definitely believe in euthanasia and I’m very inclined to consider too old to bother anymore a valid reason to off it. My biggest question regarding personal medical care is how much pain and how expensive should continued years be to endure? The first 60 years of my life was not noticeably painful but that is changing rapidly and the costs have never been higher for some very dubious continued years. I don’t ever consider it an act of heroism to tuff it out and gobble up medical care like I hear so many old people I know seem to flatter themselves they are doing.

OOTS – you always complain about the fly covered over crowded masses of the planet whose sole social “fault” is they were born and are under funded. You think they litter the world and should limit their numbers to leave more for the pampered likes of you. But so many of them take far less from the planetary resources than our domestic and very gilded crowd, and they thrive on relatively small feed. Our gargantuan appetites need mega meals or they suffer and feel deprived. And we are teaching the rest of the developing world to live with the same frivolous and fashion addicted tastes we have become accustomed to demand or our idiotic economy and the even more ridiculous way we built the infra structure for the past 60 years will suffer.

You can never satisfy gluttons.

Posted by paintcan | Report as abusive

@BidnisMan,

1. Basically agree, except the country should look at how our military going into WW II met it’s varying needs. Adopt more uniform compensation for a “service life” in medicine (outside of the geniuses that should, by definition, be in competently managed R&D programs).

You could have nurse’s aids (basically minimum wage people), nurses (with basic education and experience, nurse practitioners (nurses with higher levels of education/experience) that could handle the “routine matters” of family practice and specialty practice, doctors, specialists (with compensation above “Doctor” based on additional education, experience with a NUMBER OF SUCCESSFUL PROCEDURES factored in.

There would be an appropriate salary range within each level that would also have “adjustment” based on how desirable or undesirable a particular “term of service” in a specific locale is in terms of applicants for same. A doctor in “private practice” could receive NO public dollars towards care rendered to his/her patients. It is doubtful many such “private practices” could be financially viable.

2. OK, but there are other factors, such as genetics, that contribute to a “playing field” that is not level. It should be expected that people “live and eat healthy” within limits. You can’t mandate that everyone buy organic, or eat yogurt. There would have to be a series of categories of specific foods in which good choices would yield useful incentives and bad ones would be discouraged.

So long as you stayed in “the zone” of required compliance you would be eligible for the generally provided level of timely government health care. Those who don’t “live and eat healthy” to the required extent would not be eligible to receive timely government health care.

3. Revise financial incentive and disincentives to promote healthy living, with due “credit” for the value wine and good liquor contribute to a “good life” as well as red meat once in a while. Television keeps the mind of the average person from meaningful thinking and meddling where they should not and so should not be limited but subsidized. It is the delivery of music, drama and sports to the masses…our equivalent of the games of the Romans or Shakespeare in the middle ages without the smell.

4. No. Make bicycle generators publicly accessible with money or credits for playing hamster. Put them in booths that project great locales from the world’s best “rides” with free music of choice. Make electric cars inexpensive to rent/own/lease/operate and those with internal combustion the opposite.

5. Yes. Lower the period a drug could be sold without a generic equivalent, and allow Medicare and Medicaid to negotiate pricing for their bulk purchases.

6. Absolutely, a sliding scale for financial eligibility and a lifetime total. A bond over your possessions or each would pay premiums on a insurance policy in such amount as necessary to fund “average lifetime care”

7. Your time has come? Get real. Ours is a society in which we are supposed to run like a hamster in a cage to get an education, then get a job and run like a hamster to afford wife and family?

Then when family can’t get jobs, you run like a hamster to keep them fed and healthy? That’s no “life”. When is YOUR TIME?

From 65 to, say 100 or more should be the “golden years” of golf, sailing, community volunteerism, Peace Corps, helping others with their taxes, community gardens, whatever you WANT to do. A “Star Trek economy that is PREPAID through your “professional working life”. A life well lived should offer a reward in THIS LIFE.

Posted by OneOfTheSheep | Report as abusive

The very sick do not work and therefore lack funds. Any health care system that works has to address that problem. Also few people have any medical training to make informed decisions. For the system to work there has to be decision makers with such training. Not only that they have to paid to do what is best for majority and moral.

If they work for profit seeking insurance companies not paying out, what was promised maximizes profit. The only possible system that work are either heavy handed regulation or direct government control. both require honest politicians working for the good of everyone. We have best politicians money can buy and every one wants then to screw the other guy.

Posted by Samrch | Report as abusive

@@@@, paintcan

With your education and many accrued years it is truly amazing to observe so much confusion and lack of basic understanding in a mature mind. When cancer threatened my wife’s life, I gave that fight all that I had, and then some. Today she is today some seventeen years out from a six months survival prognosis by a leading oncologist. In February we will celebrate our fiftieth wedding anniversary, an achievement by no means certain for a very long time. Since you obviously you resent that, I can only pity you.

Of the many curves life has thrown me over the years, I have embraced each as a learning experience (and fight better because of it). From court and legal experience of a personal nature I have learned the value of creative ambiguity. In your hands, even the truth is unrecognizable, so forgive me if I don’t explain further.

I served four years in the military. To my knowledge no one was “concerned” about me. I was delighted to have my nothing down GI Loan when I bought my first house. Was too busy doing productive things to make use of my G.I. Now I get some care at the VA. The military wasn’t for me in the long term, yet it is YOU that hates it.

If you would unilaterally disarm as America did after WW I and WW II at a time when other powers would LOVE to “take over” you are a fool. If you would fight our battles here on American soil rather than elsewhere, you are twice a fool.

If you would expect America’s sons and daughters to fight with anything less than a winning advantage it is only because you have no children. If you have come to hate America and all it stands for because it has given you in full measure that which you have earned, why would any rational American seek or accept advise from YOU?

It is not for me to define the value of an American life, but for ALL Americans with a “stake” in America’s future. Like any other society America needs garbage collectors, cooks, waiters, singers, actors, police, firemen, teachers, accountants, financiers, electricians, plumbers, designers, drivers, computer operators, pilots, mechanics, and, yes, even politicians and bureaucrats. We don’t need ANY unions.

An individual’s value is in some proportion to their productivity, supply and demand. It is for government to adjust incentives according to how desirable or undesirable a specific endeavor is, what level of study/experience is appropriate for necessary competency, and how many we have versus how many we need.

Perhaps others can establish some “value”, positive or negative, for carjackers, pimps, hookers, drug dealers, etc. Just as each individual has needs, so does society.

It would be foolish for society to spend as much on “saving” a drunk that stumbles off the curb into a busy street at rush hour and gets severely injured as it should spend on behalf of a gifted research scientist who gets T-boned in traffic by a drunk illegal fence jumper without insurance. Society’s “needs” MUST be prioritized, and defined such that they NEVER exceed projected financial resources.

Other denizens of our failed underclass neighborhoods undoubtedly include hard working taxi drivers, clerks, hamburger flippers and pizza delivery people, some of whom who put forth extra effort will manage to escape their humble beginnings. In real life everyone doesn’t get a trophy in life just for showing up, but such “up and comers” stand out like a candle in the dark.

Those who spend everything they get (and more) typically have little in reality or expectation. Those who defer gratification for education, experience, who put forth “more” to get “more” tend to do better in America. You and I probably agree that those “”businessmen” who “invest” in the payday loan field should be taken out back and summarily shot without trial and left in the street next to their storefront as a lesson to one and all.

Yes, each of us should be able to go online and discover to the last penny, in advance, what a given medical procedure will cost at a given facility. Just like a pizza, should we be able to evaluate price and qualifications of our doctor, anesthesiologist, necessary nursing and specialty care (with an insurance premium consistent for the variables and intangibles) in advance? Definitely. We don’t order pizzas we can’t afford!

The day could come when the fat diabetic with gangrene is facing loss of the leg. Removal today with an electric saw is quick and cheap, but anesthesia might have to be paid “up front” and then they put you on the bus with an extra bandage to go home and convalesce. Hey, that’s a lot better deal than soldiers got on either side in the Civil war! The human being of today does NOT “deserve” more if their society cannot produce “necessary” resources.

Doctors need to know a LOT more about the dollars and cents of what they recommend to their patients so that they can be both honest and realistic. Should society pay for a liver transplant for an alcoholic? There are those who view alcoholism as a disease and it’s victims not directly responsible. In terms of “personal responsibility” the victim of a child who kills is no less dead, and “society” should not be stuck with the bill, either morally or financially.

It’s always be “People” who know nothing about what things cost who rush to order caviar when their budget calls for pork and beans. Issac Assimov was right when he said: “Never let your morals get in the way of doing what’s right.

You obviously hate and envy your “ancient overweight aunt” her ability to get competent medical care, her good luck in survival, and how “…she and her husband live without children in a very large house…”. You get YOUR health care with NO forethought at the Emergency Room like countless other moochers and THEN complain about cost? Please.

I disagree that “…old peoples lives aren’t worth as much because their productive days are usually over and they become [financial] dead weights.” “We, the people” supposedly put into Social Security and Medicare sufficient of our earnings in our “productive days” that we can live out the rest in reasonable comfort and dignity. OUR enforced frugality was mismanaged, plundered and spent without our permission or benefit, and now OUR government wants to roll out the welcome wagon for 20+ million illegals to get on the same “gravy train”? I THINK NOT!

Our politicians are all we have to plan for us, and they don’t do anything very well except get reelected (which happens to be their highest priority). Just as the old prospector hits the mule in the head with a 2 x 4 to “get his attention”, perhaps a strategically placed pair of vise grips on sensitive reproductive parts would do the trick? Seniors control a majority of America’s wealth, and it’s long past time we start “punching at our weight”.

Today’s fly covered masses in the third world that produce only urine, feces and more of themselves are just being born to die. The only questions are how soon, how, where and how painfully. It will not be by their “gifts” that man develops a Star Trek economy, or ultimately leaps forth into the very stars.

These people are but an ever-growing anchor holding man back from his potential. The ax in the farmer’s hand has the same purpose whether or not the turkey “figures it out” in time, or not. Gluttony has NOTHING to do with it.

Only capable and motivated humans can give humanity PURPOSE! The future ALWAYS belongs to the capable among the young who leap forward to meet challenge. If humanity makes the jump to the stars I would cheer. If humanity chooses to remain confined to this planet and suffocate in our own own filth, we deserve no better.

Posted by OneOfTheSheep | Report as abusive

In other words OOTs – The young would pay the total burden for their own healthcare and the costs of the seniors who amazingly never get ill, can play the rest of their very long lives, that could potentially be as long or longer than their working lives, and somehow all that value that is somehow amazingly accrued during their working lives is never lost to attrition or inflation and they never get ill themselves nor do any of those ever so durable and apparently indestructible seniors, who must have all been bred in a lab with special blends of superior DNA, can live in the perpetual and scrupulously honest care of the nearly perfect nanny state you usually hate. Those are going to be amazingly expensive employees whomever they work for and they will be paying taxes the likes of which even the former communist regimes never levied. They will be doing tah and paying their enormous and escalating costs for higher education too? Oh and they have to come up with the money for rent and or a home. They may not have children at all under all those burdens and your recipe for future world will not last a generation. They would also have a common ethic that is iron clad and never a word of disagreement about common goals would ever trouble their amazingly programmable minds. Those play land seniors may never be able to pay for their young sponsors services. The young will smell a rat very quickly. In fact your world would replace the rat race or hamster run with the perfect clone state or pheromone driven human anthill because that is the only way it would work.

You must be being sarcastic because the social world of Star Trek was always a total fantasy series. It is an orgy of wishful thinking that never quite deals with real life. It only resembles it with its share of paid for shots of current product placements to give it the feel of today. Their paid for ads in the form of product display are the modern equivalent of the old practice of putting donors names on windows to pay for church stained glass windows. Many movies do this now. The audience has becomes such a captive of its consumer goods and its fashion trends.

Your comment must be written with sarcasm or else you are exhibiting something like what Carl Jung would have called enanteodromia.

Life should offer rewards in this life but it doesn’t and that’s why people make religion. And that won’t change because of a silly series like Star Trek. But it’s amazing how people who claim they have none or they make their own are still forced to work with the same old emotional needs and wishful thinking.

It is stunning that someone who consistently derides the incompetence of big government should nurse fantasies of the perfect future government with the amazingly omnipotent wisdom and self-control of saints or, at least, not the old classical gods because they fought like small children.

All your prescriptions for the perfect healthcare system of the future amounts to is a retread of the old Puritan Calvinist ethic that workers with responsible habits deserve to prosper and those who can’t or won’t don’t. They were tight fisted, narrow minded and terribly superstitious farmers, those Puritans, and were jealous of each other far more often than they really liked each other. As soon as they were up and running and became prosperous traders they stopped being Puritans and their ethic has taken a beating ever since.

Life is nothing better than a bundle of contradictions.

And I’m not logical?

Posted by paintcan | Report as abusive

@paintcan,

I can not deny reality with your ease and I am not the source of the contradictions you see. A substantial majority in BOTH of the major parties already committed to achieving greater influence in ever bigger government. If you see from a hill two train racing toward each other on the same track, all one can do is be the first to call the hospital for ambulances. What will be, will be.

Yes, the costs of government will continue to be paid mostly by those under 65 years of age. Why? Because, to paraphrase that legendary bank robber, Willie Sutton, “that’s where the money [taxable income] is”.

The Star Trek series merely suggested a feasible evolution of today’s welfare state over many years if everything went just right. Our government today bumbles along without a meaningful budget because long ago the idea of finite resources was swept aside by more and more people who look to government to just print whatever money it needs to give them what they “deserve”.

Star Trek is no longer in series production. Current American economic practices are but another collective fantasy that will prove unsustainable over time. Where are the future leaders willing and able to prioritize government expenditure and limit same to incoming revenue?

Life in America HAS offered ample rewards to hard working, capable American citizens in far greater measure than any alternate system of comparable complexity and size since WW II. The average working American achieves “food security” with relatively few working hours each week or month. America’s “poor” DRIVE!

There are multiple food banks, many churches and countless programs such that only if momma and/or poppa place drugs at a higher priority than family food do children of citizens in number go hungry here. My “healthcare prescriptions” are not fantasies of abstract perfection, but an incomplete glimpse into how ANY financially sustainable health care system MUST work.

When there are ten politicians with new spending programs for every new source of reliable government income, contradictions are inevitable. Let’s compare Congress with five monkeys (and ignore the monkeys’ objections).

Put five monkeys in a room with a bunch of bananas hanging from the ceiling and a step ladder. When one of the monkeys tries to get to the bananas you spray all of them with ice cold water. After all five monkeys have tried to get the bananas and been sprayed with ice cold water, none will try to get the bananas anymore because none of them wants to get sprayed with ice cold water.

Now replace one of the monkeys with a new monkey. Now when the new monkey tries to get to the bananas the other four stop him till he stops trying. Now replace the remaining four monkeys one at a time.

Now no one goes after the bananas but no one knows or remembers why.

Soon the individuals that comprise our Congress will journey home for the holidays. Envision a cartoon with just two people…any Congressperson and any constituent. Now, consider how Congress works (or not). Which, in actual practice, controls the cold water; and which is just another monkey?

Posted by OneOfTheSheep | Report as abusive

There is no reason on earth why I or anyone else should value your sense of entitlement as one of the chosen in life.

I used the emergency room only because there is no other available medical care after hours or too early n the morning and I didn’t choose the time of my injury. You really are a smug old man and never seem to get any less selfish and self centered so don’t lecture me on understanding the realities of life. I think I may understand them a bit better then you do actually. It is also a 30 mile trip to that emergency room from the small town where I live. But $2500 for a shot of pain medication so I could get home again and see the doctor at regular hours when it could be scheduled is a bit much, don’t you think? How much can a shot of pain medication really cost? Nothing else they did was required. They charge for all the other tests they do when it was obvious I had wrenched my back at 62 doing some heavier manual labor around my house that I am really getting too old to do safely anymore. A bottle of pain pills was all that was required for the rest of the few weeks my back remained in spasm.

That is hardly the act of someone milking the system for all it is worth. They milk the system for all it’s worth and the patient is the excuse and the insurance companies are the accomplices. They set their prices God only know how and probably can’t figure it out either and no one working in that system actually seems to understand how it is done. I even had a bizaar conversation with a man in the billing office from whom I attempted to learn how I was billed and what they all meant. I was receiving them from a host of doctors and specialties I never recall seeing and he said that it is good to get educated on how the system works but he then hung up and never answered a single question ?????

It is also hazardous going for any kind of treatment if other disciplines are called for like X rays. In this local hospital that is subcontracted and they don’t want charity cases at all. They charge for how many X rays they want to take as their policy not what the doctor might use or what I, the patient, might ever actually see. One technician actually hid the second of two X rays of my back so I couldn’t see it while I stood there watching her download them from the completely digital plate. And I was only shown one of them and the doctor only seemed to refer to one. It may be a charity case but I show more restraint in my requests for treatment than the self important like you or you wife ever do. I am sure of that. Beggars can’t be choosers as they say and I hate feeling the beggar. You people tend to think life owes you life and nothing is too good for you. You really don’t care what effect that will have a many millions more that you consider beneath contempt. The world is stuffed with over priced jerks like you too and you aren’t nearly as important as you think you are. I am willing to pay bills but all of them are well beyond my reach now.

BTW – MRI scans were only about $300 dollars a few years ago and are now twice that price. That is what may well happen with the entire system under the new plans and people will find they have been roped into mandatory insurance that will absolutely not keep prices stable or controlled. You can very nearly count on that. The system is stuffed with the self important who all want to make fortunes on health care.

And the aggravating thing about their continuous tinkering with the system is they have an outpatient clinic to relieve stress on the emergency room (after all I was suffering an emergency and they never said I wasn’t) and it was the first place I tried to get into but I had come too early in the morning and the receptionist sent me back to the emergency room. But for earlier issues of back strain I had years before I was able to pay at the time of the visits the far more reasonable prices. Less than $200 for a checkup and a prescription of pain meds. What else can they do with sciatica like issues? It took weeks for those to subside and the leg is still not right. It is still slightly dead after at least 6 years. A week later I had to return and went to the emergency room first but was ignored and went to the other clinic instead and they saw to the chronic pain.

Here’s an example of idiocy. For an attack of sciatica a few years I was prescribed ten Oxycodone at a time with a recommended dosage of no more than 8 per day that were expected to last me for a week, at least until I could have a follow up visit. I would break them up into halves and quarters just to be able to stand up and yet the Doctor I spoke with after a week accused me of “abusing them”. I actually made the ten pills last a week and actually continued to produce an architectural model for one of my clients that I still had at the time in spite of the fact that my left thigh felt like it was being boiled in oil for almost two weeks. Where was the abuse? Couldn’t he do the arithmetic?

Your cite the drunk but the real victims will be the garbage collectors, the fast food workers, the Walmart employers and all the others who don’t get well paid and are not worth much monetarily in this economy so that people like you and your selfish “me first – nothings too good for me” wife can get the premium care because you think you are superior characters of far greater value to this society when actually all you really were was a glorified salesman selling expensive hospital equipment. My injuries and problems have usually never required the full tilt treatment but some simple, and one would think, very lost cost attention. But someone, everyone has to pay the notes on those marvelous and rather showy devices and the system will tap everyone and any funding sources to do that. I don’t care for the glitz and glamor of high tech devises that also have a way of becoming status symbols for a hospital when they seem to make it impossible to work without them. They don’t actually bring down costs at all but tend to raise them all even higher but the hospital without the latest gadgets just isn’t considered a good hospital. They have to satisfy demanding and rather shallow characters like you and your wife. We ahte age or aged looking things in this country and are so used to the look of freshness and innovative like devices that we do that unthinkingly more often than not whether they really help that much or not.

I am not jealous of my Aunt but really find her selective piety and sense that no risk is too expensive for her insurance to swallow a bit to smug like your are. I don’t milk the system for all it’s worth. People with insurance like you tend to do that with bells on. You make it impossible for low paid people like me to ever expect to pay our own freight because the bills seem to match what the market will bear. And Hospitals like to have the best equipment because it looks good. I’d go to the local vet if he was allowed to treat humans. I am quite sure there are many things he could treat just as well and far more simply than the human branch of the medical system. What’s the point of getting well if all one faces is bankruptcy in the process?

BTW. My Aunt is also very overweight and has so much money she doesn’t really need to worry about it. She might not die of breast cancer but heart disease, stroke, high blood pressure probably all have her in their sights. She got a hefty settlement for early retirement from the school system she worked for because she had union protection. She was also the kind of person who would give waiters and waitresses hell if they didn’t show her the respect she thought she deserved as an elementary school system teacher years ago. And she was absolutely neurotic about respect she though she deserved. And then she’d punish them with a lousy tip. It took the patience of saints to deal with her. If I’d had to wait on self anointed princesses like her I would have thrown her soup at her. She was proud of her ability to show her “inferiors” how inferior they were.

The world has been stuffed with idiots like her since they invented idiots like her. They even show up in the Bible. I remember her in the 50s and it’s no wonder the 60′s came along very soon after. She demanded discipline of everyone else but her own appetites.

Posted by paintcan | Report as abusive

Let’s face it guys, the problem is humanity. The vast majority of humans are greedy, self-centered, spiteful, un-ethical, and basically just nasty animals. The only thing keeping us from total anarchy is fear. We create societies with laws and rules to keep each other in check because we fear what they would do to us otherwise.
So what’s the answer? How will things ever get better? I mean really better for all humanity? Simple. Change humans. Human gene and DNA manipulation would solve all our problems. When all people have true morals and ethics and rid themselves of the nasty thoughts they have nirvana will have been achieved. But I really doubt it will ever happen as that same answer will undoubtedly be used to create worse humans instead of better ones. I guess I’m just not feeling the love today.

Posted by tmc | Report as abusive

@ paintcan For back pain, get in touch with egoscue.com. They are far simpler and less expensive than conventional care, and they have kept me on my feet and out of pain for years. It costs nothing to talk to them, they will tell you whether they can help you.

Posted by Oma | Report as abusive

@Oneofthesheep: re: your first post, before you decided on submitting a thesis (as usual), How do you define ‘worth more than others’? Are you referring to distinctions of class or between your 98 yr old grandma vs. my two year old. Really. I’d like to know how you delineate.

@Bidnisman: re: your #1 it’s nurse practitioner. #3 tax tv’s. Good luck. Euro bashers would string you up. #7 Again, fat chance anyone would agree w/you, at least at 65. Maybe 75+. But who decides?

@Oneofthesheep: Unfortunate you perceive paintcan’s original remark as being resentful of your having a wife.
Secondly I take issue with your overbearing and reactionary response to paintcan. He’s not against the troops, he is not for disarmament and he does not hate America. He is against imbeciles who kneeejerk label anyone against our out of control military expenditures as a communist, etc.

You also label all unions as unnecessary. So obviously they’re all evil. I guess professional ball players should just suck it up and negotiate individually because anything else is un-American. Why there’s no reason why any union is needed (what, with all those honest businessmen?). They must all be scum.

For your information a person’s worth is NOT based on his/her ‘productivity.’ That would be their net worth and it is vastly different than their true worth. So by your definition a mother is almost worthless because her productivity is, probably in your warped view, not commoditized. Your ‘up and comers’ with their candle is completely at odds with your prior statements re: someone’s “worth.”

Agree with ‘OUR enforced frugality was mismanaged, plundered and spent without our permission or benefit’, illegals and election priorities but you do seem to be preoccupied with the poor, the third world and science fiction.

I think it’s safe to say you’re another pod person feeling safe in your cocoon, who has neither the understanding nor the humanity to deal with “reality.” You social Darwinists bore me. I’d love to shoot holes in some of your positions but you and paintcan can’t seem to focus on what the other said so it’s not worth my time.

Posted by Mac20nine | Report as abusive

@Mac20nine,

To fully define my statement “…worth more than others…” would take many words, and well above my pay grade here. But I would hope that your two year old would not be judged until there is some record of accomplishment (or lack there) as compared with his/her peers. At present it’s mind is as a CD with less than a full song fully burned. It’s “worth” at present is ALL potential and NO accomplishment.

The 98-year old who serves as a volunteer guide at a veterans’ memorial is the precise opposite. He/she has pretty much done what he/she will do but is still contributing to his society. His senile compatriot in a bed somewhere untended in filth may have won combat decorations, or cooked necessary meals. Is it compassion to expend the funds necessary to preserve a life no longer sentient, without dignity or pleasure?

Paintcan’s resentment of my having a wife is incidental. He resents anyone who would dot the i’s and cross the t’s in frank and honest discussion of costs and options PRE-TREATMENT. Given, many are not persuasive or persistent which gives those who are great advantage. So it has always been and so it will always be. Life ain’t fair.

You deem my response to paintcan “overbearing and reactionary”? Response and reaction are one and the same in such context. And you’ve obviously mistaken me for someone who cares what YOU think.

Paintcan has a distorted view of our military. He is aware of how it benefits “the entire country”, but thinks it absorbs 60% of the federal budget. That’s simply delusional.

He thinks all countries are “rattletraps” and that America should yield leadership to some undefined and unproven “real world order” yet still pay most of the costs? He believes America guilty of war crimes? Ridiculous. Individuals, yes. The country? Get serious.

He misrepresents my position regarding this country’s responsibility to those ”in service”. It is NOT “they made their choices”, but “whatever it takes” to get them back on their feet again as productive citizens.

A majority of the citizens of this world owe their improved circumstance and relative freedom America’s post-WW II leadership and pocketbook. A majority are also ingrates who would bite the hand that feeds them at any opportunity out of envy.

Since even those who would allow the U.S. bases for troops can and do change their mind, it has become necessary to construct and maintain fleets of carriers and submarines to project quick response power. The “military-industrial” complex essential to our ongoing superiority is a capability gone forever if disbanded.

Our world has shrunk greatly in terms of the time distance from an aggressor would buy us to rearm and prepare to fight again. Individuals, from engineers to fabricators of weapons and the troops that wield them, hold “good jobs” that contribute greatly to the very economy they exist to protect.

Those who would unilaterally disarm are defeatist. Their eyes are blind to those who would leap at any chance to topple the U.S. from it’s well earned position in the world order.

I think professional ball payers utterly unnecessary and grossly overpaid for their contribution to our society. Yes, I think all unions are scum and equally unnecessary. They value seniority and restricting access to work in order to get a better price. I believe society better served by encouraging individual competence, excellence and effort in all who would offer their hands and minds to an employer for a “going rate”.

You confuse “net worth” and “societal value”. The latter actually gives the stay-at-home mother greater value than I would. I sought a mate that would work as would I and together we prosper. I value the working mom far, far above those who would bond a male and his income to purposes he may not share at the expense of his dreams. We each “pursue happiness” from a unique perspective in our own way.

If I seem preoccupied with the poor, the third world and science fiction, it is because each has lessons to teach those who would learn. But I would accept the label of Social Darwinist as a compliment.

Posted by OneOfTheSheep | Report as abusive

“But I would accept the label of Social Darwinist as a compliment.”

Unless you have had children, you are an imaginary so called Social Darwinist and are only indulging in some personal pretensions and that’s all.

Unless you have children to leave those so called better genes or greater powers of intellect to or even your money to, what difference does it make if your old hide managed to hang onto life in better quarters and with a bigger bank account than the fly covered masses you despise? And you never cite social history and are not at all a scholar or historian. You spend a lot of time looking at movies and reading things online, I suspect. Social Darwinism has to lower the bar to allow guys like you to think they are the deserving “winners”. Social Darwinism is a very inaccurate theory and one of the vanities the former gilded age thought was so flattering to their pretensions. hey invented an excuse to indulge in mass quantity consumption while all the time realizing that there were teeming slums in the country with quarters for human beings they wouldn’t let their favorite pets sleep in.

You’re really only ever sound like a selfish old man with an enormous sense of entitlement.

Maybe that’s why I love to argue with you. I may be one too and I understand old farts like you. Argue with the American Friends Service Committee regarding the military’s take of the budget. I am only citing a brochure they send frequently. I think they are also including all sorts of military related expenditures that are not considered the Defense budget. The VA may be one of them.

A country that needs the military related spending is the opposite of a country like China that tries to make it’s military self supporting and not dependent on the government till. Look what they have able to do in 60 years with a country with half the arable land this country has and almost 4 times the population? I doubt the Chinese are deeply impressed by our country and know better than to do it our way. Most countries in the world probably know not to imitate this country because in many ways it is a legend in its own mind and doesn’t generally admit to its real failings or it’s inadequacies. It can never quite decide what they are. The Chinese after WWII knew by very clear example and horrible experience.

But even an attempt to massively change its direction would probably bring about the same chaos and massive loss of life that has typified every upheaval or regime change anywhere else in the world at any time in history and the patient might not survive the operation. In fact it is guaranteed to happen with a population armed to the teeth – some of whom are spoiling for a fight, any fight if they don’t even know completely what or why they would fight.

Revolutions may start with some goal in mind but they don’t necessarily achieve any of them or only a few and if they are like the Russian or French revolutions they never quite end for decades and even up to a century – depending on your take of the history of France during the 19th century. You go in but you really never know how or who will come out. Feeling lucky there Social Darwinist winner? You might also count on loosing a great many of you benefits and perceived strengths during the upheaval or change of policy and never see the end because you weren’t really one of the winners after all. Winners in one regime can easily become losers the next. And do anything at the level of government that brings about the further upheaval and disruption of too many lives and you open the door to gross civil unrest and let the devil out to have a field day. He will eat until he is gorged.

And some former “losers”, fly covered or not, or those far less up in the ranks like Danton, Robespierre or even Napoleon (who was actually petty nobility from the provinces) and Stalin could have some real surprises in store for the former gilded upper crust and the self styled winners.

And all countries ARE rattle traps. So many of their citizens are, so what could make them so much better than the materials they are built from? And everyone’s lives are far more frail and prone to disruption and even destruction than most people care to think about.

This country can’t keep calling the operation expenses of its own domain the measure of its own economic vitality. I don’t think the Chinese actually do that or weren’t. It is very like the owner of a great house trying to claim that all the money expended to maintain the estate, pay the staff and feed and cloth the occupants are the definition of his income. They are really expenses and healthcare and military expenditures are not the measure of economic vitality but are really maintenance costs. We are not the Roman empire and the military is a defense tool becoming far too aggressive. The old Romans and all the old European empires were armed bandits. They were using that money very differently.

But if this country tried to do that today it would rightly be destroyed or crippled as the maniac and criminal country it would have become. The Nazis tried to imitate the old Roman way of doing business.

BTW – I recall discussions about rationing over 35 years ago at a course I took at night at Boston University. How the debate moves so slowly but the costs are climbing so much mere rapidly but I have to admit the utility of care seems to be better and I am thankful I an getting financial help to pay for it. Otherwise I would be so deep in debt it would be pointless to even show up at a Doctor’s office. It is very easy to accept the idea that my life has reached the terminal point of diminished returns. The door can close completely on it now but I hope it happens quickly.

Posted by paintcan | Report as abusive

excuse me – not “utility” of care but “quality” of care.

That was spell check.

Posted by paintcan | Report as abusive

@paintcan,

You verbally thrash around like a chicken with it’s head cut off with similar coherence. “…what difference does it make if your old hide managed to hang onto life in better quarters and with a bigger bank account than the fly covered masses you despise?” Why, all the difference in the world, of course. A life well lived is ample satisfaction over injustices endured or overcome.

My goals in life have been and remain modest. For the most part I have achieved them. While I still have a few dreams to pursue, I am quite comfortable, content and (relatively) secure on a day-to-day basis. My obligations are minor and credit cards paid off in full every month.

“You’re really only ever sound like a selfish old man with an enormous sense of entitlement.” And what would you expect of an only child of modest success? I never worry about anything I can’t control, but I have contingency plans for everything deemed adversely possible.

I try to share with any of open mind that which I have observed or learned (that worked), and care not whether they benefit or ignore me. The sun still comes up every morning.

We do not pick our social revolutions, but if we keep an ear to the tracks anything truly convulsive on a social scale can long be seen coming and measures taken as are feasible. The personal computer will have greater effect on mankind than the Industrial Revolution, but it’s changes to how we live are slow enough to easily avoid the negative and fully benefit from the positive.

The two most likely things that could keep man from a magnificent destiny is the emergence of a democratic majority embracing a Soylent Green future for one an all, and some impotent egomaniac blowing everything up before we have people living off planet permanently and independently.

The odds appear about 50-50 neither will happen before I expire, hopefully of old age. For now, I’m going to enjoy a generous splash of B&B to warm the cockles of the heart.

Dew knot trussed a spell checker too fined awl you’re miss steaks.

Posted by OneOfTheSheep | Report as abusive

“Dew knot trussed a spell checker too fined awl you’re miss steaks.”

That is very funny and you’re right. But my eyes are getting so much worse with old age and I have always needed a heavy prescription since I was very young. I don’t know why because neither of my parents really needed glasses. But sometimes the parents genes don’t blend all that well.

Here’s an interesting factoid or hunch, at least. I may smell like my mother or have some trait that the McCaw my father still keeps recognizes. Since she died he never speaks. But on my last visit a year or so ago the bird started to talk as though he thought I was she. Perhaps they can smell something in skin tissues? That they can smell DNA or something not related to deodorants or cologne or even the cigarettes I smell like? It could not have been my tone of voice or even my mannerisms. I might smell like my mother at a cellular level? Many animal species can smell each others tissues or glandular secretions or some other inmate and distinctive odor.

You may be able to get out of the way of social convulsions if they let you and you can afford to get out of the way. Many people in Syria can’t seem to get out of the way or are shot trying by one side or the other. A lot of people in Iraq were being shot by our side trying to get home in time for curfew. The book Fiasco mentions whole families being shot. And the notorious Wikileaks video showed a mini buss with a few kids being shot from a helicopter eager to blow away a Reuters photographer and a man carrying an RPG launcher but not aimed at anyone and slung over his shoulder.

BTW -and this is more off topic info. Did you know that during the early years of the French Revolution the very high aristocracy was very willing to accept the abolition of their feudal prerogatives right at the start of the convention while the lower and not so affluent aristocratic class, that were sometimes very poor and had only their family names to keep them warm, were those who put up the most resistance to the change of government.

I think it was either de Tocqueville or Schama who made that point but Schama drew heavily from de Tocqueville. I read both but years ago.

I’d like a little pipe full right now. Whiskey always tastes like paint thinner – or what I think paint thinner would taste like.

I really don’t think we are going to see many people at all living off planet in a very long time. They will have to induce their own gravity because long term weightlessness apparently does cause some bone loss.

Even to live in earth synchronous orbit is as large a distance as the diameter of the globe. That’s quite a haul. The oceans are so much nearer and if one is going to build tours de force in the ultimate in deadly hostile environments, why not do so on the one that makes floating materials to it so much easer as a first start and has at least an atmosphere? Space stations, however large, would always be hermetically sealed and their atmospheres would have to be scrubbed constantly and thoroughly. They might start to smell rather peculiar after a few months. How would you like to live in a n enironment that might smell like a stuffy pair of old socks? Modern office buildings with sealed windows always provide some fresh air and manage to keep the funky smells down. They won’t have that opportunity in space unless they take some from earth and then they will have to pay for air too. It could well be the ultimate company town and slavery expressed as a euphemism.

We are still animals and we have needs related to our environment and the difficulties of living in space might be subtle and not show for a very long time?

But there are no recognizable habitable planets discovered yet outside our solar system that are within conceivable reach of even unmanned exploration and not many options within it. There is only Mars and the oceans would be paradise compared to it. There are few or no flies at sea so all those “dirty masses” can get clean and make a living at fish farming at the very least at first. At least something to start an economy from the bottom up and not the unbelievably expensive ordeal of trying to live in cans in space.

You may grossly underestimate the charm and even psychological necessity of being able to go outdoors for a breath of fresh air and a dose of old fashioned home world sunshine and a breeze with varying moisture contents and at vastly varying temperatures with even rain and snow. That may never happen in a space station and the environment could become so monotonous and claustrophobic after a few years the inmates are ready to head home to earth as soon as they can. And if they can;t return to earth because it has become too deadly or uninhabitable, they will be trapped in a mechanical exile and that hardly sounds like an enviable future.

Or they have to breed creatures capable of standing it because they lost some of the needs of the normal human animal. That might be very hard to accept as they could very well have become less sensitive. We don’t actually know how to define what it means to be human – that is a very subjective idea – let alone how to make it better or even what making it worse might be.

BTW – in another too personal comment I submitted before the last one Mr Hadas or Reuters saw fit to squelch – and I can’t argue with their discretion – I mentioned that your attitude about grades of human workers and ranking workers access to health care according to their “value to society” is really only a rehash of the novel “Brave New World”. There is always something obscene about that novel and Huxley was more humane than that, it seems to me.

The future that uses so many machines in place of human labor may have no need for a ranking of human beings at all. And all men and women would truly be equal. BUT THEY COULD BORE EACH OTHER TO TEARS and the “perfect” equality might actually make them somewhat stupid? But it is also somehow immoral to make differences in human beings as a matter of economic or social necessity. I imagine the future will maintain the attitude the Universal Declaration of Human Rights implies that it would be illegal.

Social Darwinism may have sounded very comforting to those folks siting at their gorgeous tables during their seasons in Newport but not even they were always the brightest bulbs in the box, remember, nor were most they particularly good at doing much more than keeping up with their very expensive Joneses (Edith Warton’s relatives were the real Joneses) spending money in massive amounts, managing large staffs or vast numbers of employees, wearing change after change of cloths and doing other leisurely things that could actually stultify the intellect and talents and not make them flower at all. All the writers of the time that are actually still read by most people tended to find the environment of the very wealthy very tedious.

Human beings might not generally thrive in very rich environments any more than they do in very poor ones. Quite possibly too rich or too poor are both potentially hazardous. It wouldn’t be all that hard to make a case for that with examples but deciding what too rich or too poor means might be a bigger problem?

Posted by paintcan | Report as abusive

excuse me again – not the diameter but the circumference of the globe. About 27,000 miles.

Posted by paintcan | Report as abusive

@paintcan,

Man may well move into the oceans before he relocates to space…it would make sense both from the standpoint of making the “most” of that which our Earth has to offer. But to be human is to be unpredictable and even hostile to our own kind. The human ego is too large for not only our bodies but this Earth. I am by no means certain that the universe will welcome the presence of man once free of his biological quarantine of Earth

It will not be comfort or desirability of life in space, or even profit (the only reason people live on the north slop in the oil fields). Until at least some have sanctuary from the powerful but mentally unbalanced man literally has “all his eggs in one basket” and is but one self-inflicted cataclysm from extinction.

Fortunately we are almost infinitely adaptable. Athletes and Astronauts adapt to the smell of living in confined quarters. I found after switching from whole milk to fat free that my taste buds quickly became used to the “new normal”. The Fat Free became delicious and whole milk is the new cream.

My uncle had a wonderful sign on his desk: “All I ask is an honest advantage”. If one merely keeps one’s eyes open for every possible advantage in location, profession, etc. one’s options are, over time, significantly greater than those who do not.

It is one’s options available in time of challenge that can make the difference between life or death, comfort or desperation, and whether others value or respect your existence. Yet when one must choose between multiple options, some of which conflict, there is the final challenge of choosing wisely. Personal insight is always the key.

Posted by OneOfTheSheep | Report as abusive

Man may be infinitely adaptable but that doesn’t mean a man or group of early colonists can do that in their own body. They may all have to expect the fact that the whole experience might be a bit like Moses not quite entering the Promised Land. And space doesn’t sound all that promising – especially not as a refuge for the Human race. It could become the mousetrap of the more well healed and aggressive mice. The dubious trap for Social Darwinists who think they can live above it all and seek refuge from the wreckage either they or everyone else, or both created. Isn’t there a movie along these lines out there now? Something about a space station?

Man may be able to live in all the environments of this planet but that ignores the fact that most of the adaptation was obtained the hard way through death of the unfit for the rigors of that new environment and the tenuous existence of offspring who could actually survive the rigors of the new environment. Think of the first settlers in the colonies here. So many of them died on the “trip across and the first winter killed off a great many more. And some of that may have been due to nothing more than the stress of making a very hard to establish new life that required very hard work and it killed them. Stress kills or it wears you down. Some are more durable, others less so.

The Euroepans that colonized this new territory also did so at the cost of infecting the natives with deseases they had no immunity to. They also tended to inhabit climates very like those they had left. The Spanish went south, The French and English went North. The English couldn’t seem to handle the rigors of the south and died in larger numbers down there. That may have been why they had to use black slaves who could handle the heat better.

England is a very cool environment “the green and pleasant land” as William Blake called it in that beautiful hymn I wish I knew the name of. I can only remember the melody and hardly any of the words. It is usually not humid or full of insects and other environmental threats they were not at all accustomed to. I can never understand how they didn’t bring the black death here? They had scarlet fever, sometimes Cholera and probably other diseases but I don’t know much about this. London had a severe plague in the time of Charles II. But there was never a plague in the colonies as far as I know yet there were ships from China in our ports too. Why didn’t that happen? Perhaps because the houses were so separated by large open spaces?

I wish you wouldn’t preach about “wisdom”. It is seldom transferable and never seems to work in new situations. I probably had my share in life but now that I am old and weak and very poor no wisdom or good choice I ever made seems sufficient and all I tend to look at now are my faults. I was raised a Roman Catholic. The prayer “through my fault – through my fault, through my most grievous fault”. You should love that one but you only see it in everyone else. There have to be limits to that phrase but they never seemed very good at setting them But what does God expect? All I ever saw were faults. God didn’t quite seem to have his act together either and I couldn’t live in a monastery. I may sound like “Debby Downer” but unless one is aware of the fact that life isn’t all optimism it always comes as a rude surprise. I’ve read novels and watched movies that make me feel like Pollyanna even when I’m ready to snuff it myself. Well not quite. You make too many excuses for what man wants to do anyway and you make it too easy for yourself. How about living with no advantages, honest or not, and see how well your wisdom holds up to that?

Poverty is a killer. Time may call Pope Francis the person of the year but most of his followers don’t want to walk his walk and he is only doing St. Francis in the media friendly version for the at home TV crowd. He is not truly walking the Franciscan way except by adhering to the rules of his order. The stories of St Francis I read said the St. Francis had a much harder time of it and was very afraid during his life that the church would turn on him and call him a heretic, kill him and destroy his order. He had to spend some time trying to get Papal approval as a way to protect them all. They are as dependent on the political will and public acceptance of their actions as any other human organization is.

It is also ironic that a Saint who preached poverty founded an order that actually got very wealthy. Go figure? All the orders got very wealthy for the most part because their adherents were voluntary slaves and spent little or nothing on themselves but could generate fortunes in incomes. It is an ugly business shot through with fraud and outright theft if you follow the money trail of Vatican finances, if even they could follow the money trail and I’m not at sure they ever effectively could. Maybe the Borgias “knew the ropes”, but a lot of those Popes may not have. It would not have been unusual for the time when so many crowned heads, princes and aristocrats didn’t always now how to tie their own shoelaces either. They all lived with bureaucracies too and organizations can and do have minds-or not-of their own. They are managed as much as they manage and systems can make an idiot of one and render one’s best instincts useless and can waste all of one’s best efforts. The Catholic Church learned the secrets of how to become large and powerful but that also meant they made “friends with the devil” you might say, and had to live with the corruption and all the temptations and “sins” they preached against. I actually understand that better than it sounds and I think I understand how and why that happened and they could still claim they followed in the path of their founder. Judge not lest ye be judged

BTW – It chills me to the bone every time I think of the Gospel saying – “sell all you have and give to the poor and follow me”. Christ did not say – “sell all you have and give it to me” he said throw it away and give it to those who need it more than you. You are a guy who tends to congratulate yourself about your success and that is not such an admirable quality. In fact it is not at all admirable. If you were a flower you would be the ridiculous one who always praised itself for it own beauty and you aren’t that beautiful. Self congratulation is disgusting and so tacky. You may as well just beat off on yourself. I’ve done that in a mirror because I haven’t so much as touched another person in almost 14 years. I’ve heard glib wisdom and even disposable advice and so called advice for better living my whole life and it is as prone to changes of fashion and of mood or even total amnesia on the part of the whole society that it is very nearly worthless now.

Doing the Franciscan thing terrifies me and now I am living on a very small income. But it is boring and very depressing. I am not a happy camper and feel like sin on toast with hardly any butter. And the next question I ask – If I do that – follow what in the flesh where? At 62 I’m a dead liability to any organization that could use what I can still do. I don’t really want to and life is already more than enough of an hallucination as it is. I do so love to tease myself. But I do think those people know something that most never see and can’t imagine. They learn somehow to forget themselves and they do not make monuments of heir own egos. And that is where those people are so much better than you OOTS, or me with your smug masturbatory “wisdom”.

Religious people don’t do like you do OOTS and congratulate themselves on their good fortune and baste themselves in their own juices. And they do not usually pretend to an easy user friendly wisdom (insight into what?)that somehow never hears anything that doesn’t perturb him. You lie to yourself and everyone else every time you do that. Or you would not make so many preparations for the awful to the exclusion of all other concerns.

BTW – Ocean living shouldn’t be all that insurmountable. The larger the structure the safer it is. There are a lot of shallow ocean water areas nearer to shore that go miles out. The foundations of very large ocean structures could actually require about the same subsurface preparations as the very deep and sometimes complex foundations of large office towers. They can use their own surface area against the water to relieve some of the weight on those foundations in as much as they could be buoyant and the foundations are really a way to keep the structure stable and at a constant elevation above sea level but would not be as heavily loaded.

I have no other way of sharing these ideas so I do it here.

I love to light up and sketch myself silly. One could produce floating bays with high enough protective walls – that could also contain useful space and at the same time provide for cheap and easy to construct homes – I have drawn up dozens as sketches – for thousands or even tens of thousands of inhabitants – all of which could float like houseboats. And I mean everything from floating homes – like the typical houseboats to much larger buildings like apartment houses or even Venetian Palazzi (an idea I tried in a few sketches – but not made of stone. Modern architecture can apply style like it was wall paper. It can be done much better than that but I’ve never considered myself a very good designer. .

Substantial structures able to meet the force of the seas and storms would shelter much less ocean worthy craft. The streets are the ocean surface and unlike land based cities nothing within the protective walls is fixed in place permanently and can be moved around as needed.

One of the reasons slums develop on land is buildings get trapped in declining areas or people are trapped in decay. People who fear the situation for good reason, leave and entire neighborhoods start a downward decline of neglect and exploitation by building owners who are themselves trapped by the situation. The neighborhoods become terrible places to live and it is only because the buildings are trapped along with their inhabitants. If no building is fixed in place but is docked -then the trap can never close. If a settlement on the water declined the structures could be moved to one that isn’t. The buildings need never be torn down for renewal but could always be used somewhere and even taken back to shore for recycling of for some other uses and even for use on land.

Why does Mr. Hadas let us go on like this. We are so off topic? But I hope he puts this one in.

Posted by paintcan | Report as abusive

Quote: Modern healthcare is one of the great accomplishments of industrial economies

Really! I thought it was a triumph of the Rockefeller empire in convincing people that toxic drugs, surgery and radiation (from which they profited) were more effective than natural therapies. This culminated in a war upon traditional healing, spearheading by Morris Fishbein.

Posted by TocoToucan | Report as abusive

Get off it Taco Toucan – If all wealth is inherently useless or evil, and the stuff of some kind of dire conspiracy, or the wealthy feathering their own nest and roping all the rest of us into their way of doing things. What have you got without them?

The world of faith healers, and witch doctors is also full of crackpots and frauds and charlatans just as eager for your health care dollars and even less accountable.

How do faith healers, or whatever alternative to Rockefeller grant recipients you seem to think exist, set broken bones or tumors or cysts?

I had a crank healers think she could cure me of depression one day when a friend I knew brought her to my house. She had me sit on a chair and put her hands on my head and then started to make blowing sounds out her mouth? I was nice to her and said I feel better but only to get her out of here. For one thing the depression is real for some very real and good reasons. It isn’t going to be sucked through her hands so she can blow it out her mouth. She just added to it.

Sounds like Morris Fishbein may be a physician, knows the human body is a very understandable mechanism (within the limits of present knowledge) and it can be opened and explored and indeed healed.

I’d really like to know how traditional medicine would manage to piece together a person torn up by a road side bomb or a highway accident. The amazing thing is some actually walk around and live at all. Or do we really have to believe that Rhinocerous bone is a valid cure for something I forget in Chinese medicine. There are a lot of different traditions of “traditional” medicine. Do they all agree on even the structure of the human anatomy?

Traditional medicine very likely buries its mistakes and never keeps records of its failures – or perhaps even fudges the record on its successes too?

If anything is real then it can be proven with experimentation and objective comparisons and the results are reproducible.Traditional medicines seem to hate rational thought. The Chinese don’t even see the same central nervous system. Has anyone actually attempted to make experiments that prove that acupuncture works and this it isn’t just a matter of power of suggestion?

While we’re at it – What about things like Feng Shui? That superstition can be the reason fortunes have to spend to sight buildings so they don’t offend evil or encourage good energy to affect the inhabitants. And yet not one person who will work or live in those buildings can ever prove that anything they did actually works.

It may be cute to know that a large Hong Kong bank had to be repositioned on its site at significant costs to the developers but it also added to the cost of the space.

Aren’t you curious to know if it was worth it?

Posted by paintcan | Report as abusive

site not sight buildings.

I would lie to suggest an experiment to the Chinese if they haven’t already tied to do something like this. For demonstration purposes.

The should set up a room. Either an office or apartment room and invite as many Feng Shui Practitioners as they like or are interested in this experiment ans see what each one does to it without any of them being able to know what the other did. Reset the contents or remove additions after they have been recorded for each practitioner – keep them all in situation either in the same room or separately to make sure none tells the other what each had done. And then compare all the results to see if any recognizable pattern emerges that indicates that there is either a consistent tradition or no pattern exists at all. None can know what the room will look like before and won’t know results until after and the records should be clear that there is no suggestion that anyone fiddled with the results.

The old communist system outlawed these people as quacks and scam artists and they were right. In Hong Kong and Taiwan they apparently thrive.

I think the tradition is charming but within limits and as an aesthetic system. But if I were a modern architect or developer or even building owner in a modern city and found that one of the objections to the placement of a building or the color of it or its size or shape had to do with offending imaginary forces I think I would be seeing red and it wouldn’t be an auspicious color.

In Feng Shui – the tradition is devils like straight lines and can’t go around corners. They must love Versailles and the entire repertoire of Baroque architecture in the west. In the west “devils” don’t seem to have any special inhibitions or difficulties with spatial maneuvering at all. Are western devils smarter?

Posted by paintcan | Report as abusive

@paintcan,

The countdown clock that is wound but once ticks off the time until some individual or group of losers tries to “roll the dice” for control of ALL mankind. Like a suicide bomber, the choice will be: “Yield to me and those who are with me or I will kill us all”.

Not much of a choice…another “dark age”; or they blow everything up or otherwise make the Earth uninhabitable. Or, perhaps worse, some incompetent sets everything off accidentally.

Man would have his fifteen minutes of cosmic fame in his own self-destruction. If the Earth’s land is poisoned, the seas will be too; no refuge there. If man’s dna be reconstituted in the future by ones far wiser, a few of us might be preserved in zoos here and there as a bad example to one and all.

Wisdom exists and is of huge benefit to those with access. Knowledge can be distilled from wisdom and knowledge can be transferred. Perhaps the supreme failure is to find yourself old and not wise, as you claim to be.

Your accusations of self congratulation miss both mark and target. There is no reason to envy the contentment and happiness of others if their path be known and easy to follow. Set the bar low. If you raise it, have a good reason.

My goal has never been to get everything I want, but merely to want that I which get. Even the gift unwanted evidences the giver’s desire to please. Is appreciation so dear that it should be rationed? Gratitude and appreciation are the necessary lubricants every decent society requires, the more, the better.

The car I drive is not new or expensive. It is responsive, economical, and a pleasure to drive and drive well. Our living accommodations are similarly modest, as is the expense maintaining a full fridge, freezer and cooking at home. We need not a new this or new that to be happy. There is both challenge and satisfaction in structuring one’s affairs so as to live WELL and comfortably within one’s means.

We all have strengths and weaknesses. To fixate solely on the latter would likely make most anyone “…living on a very small income…bored and depressed.” Of COURSE you’re “…not a happy camper…”, sounding like “Debby Downer”, and being “ready to snuff it yourself”. You exhibit above-average intelligence and education, yet, to you, nothing you have accomplished in your life has EVER been enough.

SNAP OUT OF IT! Your never-ending frustration is that of the clumsy, immature child that drops the ice cream from their cone and knows no one is going to “make it right”. Please. You won the lottery of life just being born in these United States, as did I.

Neither of us had anything to do with receiving such a huge advantage, and yet I remain genuinely appreciative and try to productively employ most advantages thus conveyed. You judge yourself so unworthy that to feel better you look down on not only YOUR country, but deny the political stability it has provided and associated economic advances that make today’s median standard of living world wide the highest in recorded history. Why are you so hard on yourself?

To be 62 and not have touched another person since your late forties reveals how long ago you quit living. To “light up and sketch yourself silly” I interpret as tearing off sheets of flimsy, stoking your pipe with some good buds, and letting dreams of a future without limits spill forth from a soft lead pencil.

It doesn’t take a rocket scientist to find persons of common interests on the internet. Your ideas as to the practicality of ocean living, with your training, could become real (if you can convince others they are feasible). That presumes that your weed-induced fantasies do not become ugly, meaningless scribbling in the cold harsh light of dawn when real life reasserts itself into your realm.

It is for you to give focus, form, and function to your musings. It is clear you can conceive concepts of merit. Work with others as necessary to refine, explore and develop them. Such effort might result in another professional “chance at the golden ring”. Even if someone else steals the “glory”, one or more of your original concepts might somehow help mankind in the long run.

In any event, any change whatsoever to what you’re doing (and not doing) would at least let some light better illuminate such years as you have left. May you rediscover that the person in your mirror isn’t so bad after all.

Posted by OneOfTheSheep | Report as abusive

You two need to get a room!

Posted by euro-yank | Report as abusive

Just read an article in the Wall Street Journal (12-14-13) where the US government is back-tracking and now the insurance companies will be on the hook for the government screw-ups. Guess the next meeting between government and insurance executives will be far more interesting than the “make nice” meetings they have had. Sure would be fun to be a fly on the wall.

Posted by AZreb | Report as abusive

No OOTS – I don’t always feel like I described. I do purposely misrepresent you at times and perhaps you me otherwise we would be in each others embrace and there would be no polemic. But I know many people with far fewer comforts and even less monetary security than I do and it leaves me more than a bit shame faced that they can carry on at all. And it’s ironic – they generally don’t have higher educations but have learned things in life I didn’t know existed. Living with the middle class comforts and income insularity of modern American life has its disadvantages too. In fact I actually leaned more about life going down than I actually ever did going up the ladder in society. I have always been a little afraid of heights on a ladder. I’ve never been afraid of them in even a private airplane. I suppose I took to a life a bit like a private plane. I fly solo.

I don’t think the rewards of life are even given without some hefty and often hidden bills attached. It might take a struggle to get there but it is also a struggle to stay there. But you can never know that unless you could actually get through the whole struggle and so many times in my life it wasn’t my fault that I couldn’t achieve my “pursuit of happiness” and fulfillment – it was the fact that the economy had once again entered yet another recession or mini depression. That is not such an unusual situation. The glib semi popular expression “it’s all good” never quite cuts it. And I was also educated at a time when teachers in high School – and I went to a good high school in what is called a good neighborhood – actually did tell us – don’t pursue your life’s work with the aim of making a fortune.

But back to the health care cost issue.

A friend of mine just suffered a stroke that has left him with the loss of his left foot yet he still feels a chronic pain in it. That is the sort of condition my old age could very well inflict on me. The expense is gagging but he has insurance. He was once on the faculty at Princeton and his wife is a retired registered nurse and both of them have chronic ailments now and they live in a smaller house than even mine. My mother’s illness could have wiped my fathers income out and I would be destitute too because since 2008 I have had to take about $10,000 a year from him too and there isn’t much of a chance I will ever be able to pay him back. They did have some insurance coverage and my n mother was able to stay home for most of the last few years except for one week of crisis where she was basically left to starve to death so he took her home and kept her alive for anther two years. That might have been a mistake. It doesn’t get better and she was not happy. She developed serious never healing bedsores and could not even be touched at the end with pain. .

My lack of great self-regard may actually serve to my advantage. Christ only had to suffer a few hours on his cross but there are people today who must do that for years and even decades. Modern science has so greatly extended the ability of human beings to survive inconceivable disability it is almost frightening and could easily be seen as the stuff or torture nightmares.

Money in such situations and the ability to hang onto dear life almost becomes bizaar. What does wisdom, especially one that recalls that money makes the world go round, have to say about the extension of life when the quality of life has deteriorated so much one can’t help but wonder what the remainder is really good for. My friend isn’t quite there yet but what if it happens again and again and strokes slowly reduce him limb by limb? The costs for each occurrence must be gigantic and mine will be at the sufferance of “the people” or the Concord Hospital. If I’m not a happy camper now what will the money others could perhaps better use be buying me or taking from them? I may have been self-centered prig my whole life but now I have to ask myself if the little idiot is worth preserving at all especially when he could be having days that make depression feel like a comparative picnic. One can get used to depressions but pain always has a way of staying sharp as nails. What about years of crucifixion, if someone like me can borrow the analogy? There is such a thing as cruel and unusual punishment, like that wasn’t? There are pain pills of course and they help but they also make their own problems and they never quite mask it all without loss of other faculties too, or that’s been my experience but I can’t say they weren’t a big help and I am used to some kind of drug use as a recreation of sorts..

I don’t think I am in any position to get too demanding but should I ask for anything? What are my rights or responsibilities? So far I hand myself to them and take what they give me. It does greatly simplify matters. I go in when I have a problem I can’t ignore. It has been fine and even better than I would have expected. But I am aware that these costs are absorbed by the entire system. My complaints about cost are that they could be lower, it seems to me, and I would be able to better pay part of them. But I also want to know how much extension of my life is worth, especially if my life becomes so filled with suffering, suicide looks like a comfort? I was out on an operating table for an hour, was feeling no pain and didn’t miss a thing.

It puts a different spin on toughing it out and braving all pain when the bills are one of the contributing factors to anxiety and suffering or even the guilt that someone else is actually having to pay them. Most of us want to be our own person and be responsible for our own affairs. I did and it is a great blow to my sense of autonomy and self worth. Or it was and now I feel like a bit of a slob. How much is my carcass worth, OOTS, when you think it is reasonable that medical care should be rationed according to one’s worth to society?

The issue of one’s worth to society has never been clearly a matter of society’s opinion alone, has it? Few of us live that way or they may as well throw away the Constitution. But the crisis of cost and responsibility could jeopardize the viability of some core concepts and privileges afforded by that Constitution. And it has already done that in the form of the present attempt at Romney/Obama care. They are about the same thing, as I understand the situation. And it still may not work.

And if you can’t assign a value to someone like me, how can you possibly assign values to anyone else? I never generated a very large income my whole life. I never made more than about $20,000 in any of my working years. Most of what I did to provide a roof over my head was done over time and as much with my own labor as a possible?
The most expensive interaction I seem to have with anything is the medical establishment.

@ Euro Yank – Stop peeking in the door if that’s all you’ve got to say. Go twitter somewhere else.

Posted by paintcan | Report as abusive

@paintcan – no, seriously while both of you have good points to make, you sully it with your apparently love/hate relationship. I’m not sure that this forum is the best for you two to have your affair.

Posted by euro-yank | Report as abusive

Mr Hadas or Reuters – don’t seem to mind. Love hate relationships aren’t something that sully anything. They are some of the most interesting and educational experiences life can offer. They are agonies or contests. You cannot live in cotton and insurance, and reliable routines your whole life or you will never live and you only see in life what others show you and can even control.

We are both old and OOTS is about half way between my father’s generation and mine. He wants to take the part of the wise angel and so do I and we are arguing about who really might be either.

I’m an amateur writer and I have never had so much fun or therapy shooting my mouth off between the safety of several thousand miles of distance and a digital screen. We are both big boys of sorts and old now – so what have we got to loose? Death is going to take it all and put a sock in my mouth sooner rather than later now so what the hell have I got to loose?

BTW – I thought of something getting up this morning. Life is frequently a case of bait and switch, I find, and if anyone is too young to remember, it was an unscrupulous practice that furniture and appliance salesmen would use to peddle higher than advertised goods to inexperienced and uneducated people in neighborhoods like Roxbury and other low income neighborhoods. Although it is supposed to be illegal it may still exist. I don’t buy much of anything anymore and know how to recognize at least some of the scams of life designed to trap the unwary and the vulnerable, there are things you don’t know at 19 that you might know at 60.

And the first school I attended thinking it was the one most eager to accept me – I got accepted to most all of the 6 or so I applied to but I can’t remember if I got accepted to MIT. It was the last letter I got but by that time I had already sent my matriculation fee to the first. I didn’t think I would hear from them and that letter came a month after the last of the others.

If I got accepted there – and I think now if I did I was an ass and probably deserve my on again off again misery. My father worked for one of their subsidiary labs and I could have gone there for free. Instead I accepted another school that one of the other schools counselors recommended. That was the bait and switch or something like it. Though it might have been more my social or emotional speed. MIT was full of very socially adept and far more sophisticated and self assured people, it seemed to me, but their architecture studios looked like such a mess. But I could very likely have been involved in the riots in Harvard Square during the Vietnam war. My second year there could well have been totally disrupted by the situation. But it would either have been that or I could have been drafted. I had a low lottery number the first year and a higher one the next.

I knew a cute guy in the first school I accepted who was an only child, was not very emotionally mature of sophisticated either, and who had a nervous breakdown his first year and it is very painful to see. I hope he came out of it but I never saw him again. Things beyond one’s control can screw your trajectory. Why do you suppose that for so long people who are religious say, “Thy will be done?”. If they didn’t say that life might very well drive them crazy. But you can get over crazy too.

That is why I am so cynical about war lite. I seem to recall thinking with that last letter – it’s too late now, I already sent the fee. And all those forms and records were thrown out years ago.

Isn’t it nice to see love hate? It means neither is a terminal stage. And what does anyone have for as long as they live but their own thoughts, feelings and ideas, and everyone else’s too if you have the room and some kind of internal record keeping system to store it all away in your ever expanding head and heart?

I hate to think about this – I could weep.

Posted by paintcan | Report as abusive

Dear Paintcan,

Wow- wearing your pain on your sleeve in such a publlc forum can’t be good for you. If I weren’t older than you claim to be, I would not be serious enough to suggest that this forum really won’t resolve the issues.

Yes, I can see that you are frustrated and you are quite good at expressing yourself in writing. And yes, you need someone to talk to. But no, I don’t think online love/hate relationship with OOTS or others in public online forums will help.

What I suggest is that you stop staying home tapping your emotions out on this forum. I don’t know where you live, but based on the timezones your replies are made, I know it’s a world away from where I live. So, I’m going to suggest that you seriously look for real people in your community to talk to. I know that they exist. I’m just guessing that you are too isolated or afraid to reach out to them. But you are wrong – they would love to meet you and learn from you. Just reach out.

And if you really can’t imagine yourself talking to real people, comment back with an email address & you’ll have someone willing to listen (if you understand I probably won’t always agree with you.) And we’ll tell OOTS we’ve gotten the proverbial room.

So stop worrying so much. The fate of the world and America does not rest on your shoulders.

Posted by euro-yank | Report as abusive

That might be nice but you know what happens on a small income – it gets very hard to move around.

You don’t answer the practical question I asked about how do I decide when enough is enough considering that this country and the hospital and society are really paying for my senior years. You may not like the pain of that question but i that doesn’t make it disappear.

The affairs of my own life rest on my shoulders and how is it people like you find such clear distincntions between your own concerns and those of your community?

Out of curiosity – how old are you?

BTW – I just spend an entire summer working with my community sitting at a local museum with an almost non existent budget, with all chiefs and apparently only one Indian. me, and almost the first thing I heard were the local controversies about who walked off with the income generated by a local festival that used to provide some cash for the place, who to talk to or not talk to, and other low key squabbles. Do you get out and work with your community or or you giving me more advice lite from non practitioners? And go to hell with your “wearing my pain on my sleeve.” And least it o is on my sleeve. It tends to eat your heart of if you keep in for too long and I am hardly a Spartan youth willing to let the wolf devour me in silence. Mr. Hadas should appreciate that quote.
Here’s an example of working with a real community and I have many times in my life and I even had a brief stint as an elected official.

I was aksed to get up early to proctor – I suppose you’d call it – was given nothing but inaccurate information about what to expect and who in the school was coming and had to get up far to early and be on time on time to make sure the place was open and ready only to find that some self important busy body that usually never sets foot in the place had decided that I was her personal servant and should make sure that the papers for an event irrelevant to the museum were set out for them. She considered herself too busy that when I wanted to step out for a few minutes to grab a cup of coffee she said – I can only stay ten minutes and seemed to resent that I dared to ask her – an important local person and significant contributor to town affairs in everything nut money as far as I know, could go on with her busy social schedule. I did the hard work of getting there to introduce the group and was expected to stay the day to see to that the place was secure and she – at the last minute, decided she would introduce the group, didn’t do that and ignored me. I just walked out and went back to bed. It’s too cold in the late fall to sit in that little place anyway that place hadn’t seen more than a few dozen visitors for the last few months.

Some of you people must live in a dream world. Please tell me where they are – I’d love to work in a dream world where social life is such an easy road and no local problems bring the events to a crashing halt or you are made to feel an idiot for disturbing your own routine only to have to hear the problems of the community or at least take some kind of side or you have wasted your own time – I could better spend sleeping and not get aggravated by other people’s issues.

Do you live under glass that nothing out there ever gets into you? OOTS doesn’t have to mean a word he says you know? And his wise advice is given from the safety of a retirement community or his own patch of ground somewhere in Arizona. He may talk his talk like you – but he really doesn’t have to walk the walk. Hell, he’s retired and sipping B&B. Why should I believe one word either you or he says? WHAT DID IT EVER COST YOU IN TERNS OF PAIN OR OF TAKING PAINS? OOTS life was was evidently more painless than even mine was and his gerat claim to “crisis” was making sure that some other people had to work harder for his wife’s care than he did and all he had to do was through his enormous ego and someone else’s wealth at them to bully them to give her the treatments he demanded because both he and she think they deserve the best out of life.

That’s is why I tend to despise his cheap and easy so called “wisdom’. My God, the smug are disgusting.

Posted by paintcan | Report as abusive

@paintcan – I’m sorry sweetie, but the only thing I can reply is that I wish Obamacare offers you the mental health help you so obviously need. Thank you for making me feel like an old fool for trying. Best of luck.

Posted by euro-yank | Report as abusive

excuse me throw – not through.

Posted by paintcan | Report as abusive

Just what help were you offering? Sweetie? Perhaps I only showed you that you really are only an old fool after all and perhaps your life depends far more on good luck than on any innate merit? You better hope you’re luck holds out because it sounds like that’s all you have going for you. It sure as hell isn’t the quality of your insight or so called wisdom anymore than OOT’s has.

This in only infotainment after all – so enjoy the show.

BTW – do you know what mental heath “help” really amounts to in this country. All the medications that can bring on other side effects that they can dispense quickly because they really don’t have the patience, time or training – most of them, to do a really adequate job. And if you do not have the money – you do not get the care. And they cannot deal with issues that have more to do with the environment or factors beyond anyone’s control.

In other words, fortunes can be thrown at health care and the patients still continue to get more and more ill costing more and more for health care. It is an aging society after all f stuffed to the rafters with some of the most pampered darlings the earth has ever known. But stop that attempt and the conditions and emotional atmosphere will go into the toilet so fast it would make your head spin.

I don’t take any and followed the advice of the only sensible psychologist I actually talked to among several for a few months years ago. He said a little grass didn’t hurt and I was fine. I suppose you could call him “holistic” and a whole lot less pretentious than a lot of them. He was so refreshing and ever so much more affordable but that was also a matter of receiving help at reduced rates. BTW – the musical chairs of pschologists – bot psychiatrists – was not a matter of me giving them a hard time – they just didn’t seem to stick around very long.

You don’t actually walk the walk of your cheap advice, do you? Not one step.

You could have replied to the more important question I keep asking. End of life issues. After all, mine will very likely be at your, or at least, OOTS expense.

How much is enough? The question won’t go away even it it beyond the wisdom of you armchair sages.

Posted by paintcan | Report as abusive

…if it is beyond … My eyes are decaying too. No two ways about it. It stinks to get old and there is no turning back. But I am now into the territory that many old people I knew never seemed to have been able to handle too well either. They died, but the costs were never as large, or the procedures as complex as they are now and that end can go on longer than ever before. And not one cent of it ever buys a complete life again.

Hope you enjoy paying my bills because I really am trying to get an idea of how I might help you. Maybe I shouldn’t bother thinking about it at all and that is so very easy to do. However, I will avoid community involvement and group events like they were the plague because somehow the fine line beaten my life and that of the larger world is never cut and dried.

Perhaps old fools only ever think it really is. You may not like thinking about the issue and think you are as hard as nails, but they never seem to get any less pointed. Your day will come.

Posted by paintcan | Report as abusive

excuse me – between. I can’t seem to see these mistakes until they are posted. It may be because they are a larger font in the posting. They are twice as large.

Posted by paintcan | Report as abusive

@paintcan,

“Some of you people must live in a dream world.” Entirely a matter of perspective. You choose to exist in a nightmare, not “living” at all.

“OOTS doesn’t have to mean a word he says you know?” Yes, and on the internet no one knows you’re a cat.

My very consistency and precision reveal my utmost commitment to each of my public thoughts, actions and statements. You are quite personally aware how quickly I clarify when someone gets the wrong impression.

Your admission that you “…do purposely misrepresent [me] at times…” confirms but one way in which you are mentally disingenuous. The child who manipulates those around it more for the reaction than the result may not comprehend or even be aware of the fundamental dishonesty and evil implicit in such action(s).

As the layers of the onion that is your public persona are removed it is increasingly apparent we are to the point from which only rot and decay remain. Words and concepts composed and put forth solely for effect are too confusing to have merit.

Consistence is a concept too sophisticated for a mind so chaotic that there is no “side” to any such exchange. Your empty words spill forth as from a mental Möbius strip.

The time and concerns of others are wasted on a “piece of work” like you. Look up #1, 2, 3, #8. #9:

http://www.urbandictionary.com/define.ph p?term=piece%20of%20work

Posted by OneOfTheSheep | Report as abusive

OOTs give it a rest. Its a hobby while the snow is on the ground and at any other times I don’t have much else to do. Don’t get yourself so strung out either. Your own comments have never been a model of maturity if you can recall. I haven’t said one thing that anyone truly “wise” could characterize as dangerous.

You laid out a ridiculous plan to solve the entire health care dilemma and you can’t stand some back talk. The world is stuffed with the smugly self congratulatory like you.

It didn’t make much sense and it still doesn’t. And that plan wasn’t dangerous?

I am not going to bother with your citation right now. It is obvious the article above is lost. Remember – it is talking about rationing. Rationing is something that only occurs in a healthy society during times of sever crisis and especially times of war. That is, if one can call that a healthy society? And what does anyone really get from a tweet length comment?

It still leaves the question – what about end of life health care? Should I admire my neighbor as he undergoes stoke after stroke and encourage him to keep on plugging, or despise him for not somehow giving up by now? I am not going to despise him but I know I do not want to follow his example. He has to do it on past insurance payments but I make even less then he does and they ask to borrow money from me once in a while. I don’t have insurance and could never really afford it. I help them anytime they ask. I lend it to them. I do not demand repayment – not in their case anyway. It is much easier for me to give them rides when they need it or to do household repairs etc. It doesn’t require the cash. And it probably represents more value.

ObamaCare does not offer a guarantee that all these new plans won’t continue the rapid escalation of premiums that I saw the last time I tried to get and hold it. Bait and switch does tend to be the rule these days, specially in things like war. I never liked the fact that insurance companies are involved and this country didn’t go to a nationalized system because what happens if someone looses a job and never gets another? The unemployment problem hasn’t even begun to be fixed except perhaps on a seasonal basis. And this government seems to know how to lie like the professionals they are. Many simply fall out of sight. Are they any better able to get insurance than they were before and don’t they loose whatever money they paid in, as in any private insurance plan? It doesn’t accrue like a Social Security type health care contribution would. You can be out of work for a long time and not loose past contributions. Houses in my neighborhood are still not selling as far as I can tell so the economy is not an barreling ahead.

My neighbors have a funny way of making exaggerated attempts to thank me profusely and even to start giving me things I never ask for and don’t even want. Eveen refusal doesn’t work. For some reason he gave me a very expensive pair of high powered binoculars that I returned because I don’t even know how to use them and never watch the night skies. His wife gets it into her head once in a while to buy things for me and I am not without cloths or shoes etc. But than weeks or months later they are broke again. This country does not seem to be running on maturity anywhere I can usually see. It is stuffed with little popes and little Caesars, (I had to work for one of them once and he ran a company town), little Napoleons (or the experts on military strategy and the blow em up with a nuke crowd) or just your garden variety racists or self hypnotizing religious fanatics. It is amazing that you mistake my self criticism as mental illness or immaturity. I tend to call it – not taking myself too seriously. I suppose I could go for complete zombification and get medicated till my eyes curl up in my head and I can’t think a “negative” thought if I tried but what’s the point? I have never been quite sure how anyone was ever able to set the polarity on thought so easily, anyway?

If the question makes you uncomfortable and makes you want to attack me personally, (you go for my mental health – I only question your character and or integrity) I am only giving you what you opened the door to on my very first comment to you so many years ago when you contemptuously dismissed most of the human race – those that are far more prolific then you or I are – as dirty fly covered garbage – in so many words.

Don’t presume to give me lessons in maturity or even mental health until you learn it may be more than a matter of a rather pompous writing style over a few sips of B&B while you despise all the Mexicans you evidently can’t stand in the Southland.

You see life from your more affluent point of view and I see it from a much lower funded point of view. And be honest- you would be jealous, you just don’t recognize the characteristic in yourself because you thrived on it. It was one of your motivators in life. The two worlds we live in may occupy the same planet but they don’t look like quite the same worlds, actually because they aren’t.
My father tends to dismiss the people I know as garbage too without differentiation, because he’s actually never met any of them and never visit either, yet one of those pieces of trash is a damned good musician while my father could never quite master his mandolin and gave up on it. I never had the skill or talent to play a musical instrument at all. I’m deeply impressed by that piece of underfunded “undesirability”. Both sides of his mind are very alive and working and that is what that two handed skill required to play any musical instrument requires.

Never judge a book by its cover or for that matter by the condition of their skin or cloths and the number of their siblings and relatives. In 40 years I never received a visit from my sister and if I had more brothers and sisters I might actually have had one. I have visited her alone and unescorted bot not once has she returned the favor. My father and mother both lived with larger families but they are becoming something of a luxury in their own right.

BTW – I met a guy up here who’s tiny little mother actually had 17 kids. They are almost all alive still and almost all successful. I think she beat Maria Theresa, Empress of the Austro-Hungarian empire and mother of Marie Antoinette. And they all managed on peanuts. Somehow that is admirable. They had some kind of self discipline most of us don’t have.

Life does not fit into neat cartons or readily adapt to marketing schemes and user friendly packaging. And it isn’t wise to expect it to.

BTW – I volunteered for a stipend program at that hospital to work as a volunteer. The stipend was about minimum wage to pay for gas and perhaps a meal there for a few hours a few times a week. The woman I met for an interview took one look at my resume and small business brochure and seemed to become obsessed with her mother’s art work and seemed to forget I was there. That would have been a way to pay back something I suppose? I never saw the job that would have been to either escort people through the building or to bring pictures for patients to hang in their rooms. I do not look like a derelict but I wans’t as doled up as she was. But I have a hunch it was because my teeth were showing their age? But who knows. Maybe she didn’t like her mother and took it out on me? A lot more people have parent issues than I and I know it.
Now I don’t have my problem teeth and the program doesn’t seem to exist either. I have bee here since and there are no volunteer (or minimum wage) escorts.

Posted by paintcan | Report as abusive

As a British Citizen I find it highly interested reading articles such as this as I have never experienced the US Healthcare system, but instead only ever read about it through its portrayal within the UK media.
However this article does make some valid points that both the US and also the UK can learn from one another in order to improve their healthcare systems. Yes the UK system seems laboured with extensive waiting times for seeing your general practitioner, getting an appointment with a consultant at a hospital and also ridiculous waiting times within Accident and Emergency departments. But ultimately the idea of rationing has proven the cheapest and best option for the NHS by providing each citizen with an equal level of healthcare. We do however contribute towards the running of the NHS through tax contributions and aspects such as prescription medicines are not free to all in Britain, the majority of members of the country will have to pay for their prescriptions, yes the pricing does nowhere near go as far as the healthcare costs in America but not all of the healthcare services in the UK are free especially if a patient decides to have private healthcare.
Us in the UK could learn from the pricing system that is present within the healthcare system as this could help decrease the waiting times for seeing consultants and general practitioners and this could then improve the conditions of the hospitals and treatment provided by the NHS.
But the US could indeed learn from our system of rationing so that all people have the opportunity to have equal healthcare and this could infact standardise the costs of services and drugs available to patients.
Even though both healthcare services could improve and learn from each other’s mistakes and take on board new ideas such as pricing in the UK and rationing within the US healthcare system; you ultimately cannot put a price upon life.

Posted by laurenashton94 | Report as abusive

As a British Citizen I find it highly interested reading articles such as this as I have never experienced the US Healthcare system, but instead only ever read about it through its portrayal within the UK media.
However this article does make some valid points that both the US and also the UK can learn from one another in order to improve their healthcare systems. Yes the UK system seems laboured with extensive waiting times for seeing your general practitioner, getting an appointment with a consultant at a hospital and also ridiculous waiting times within Accident and Emergency departments. But ultimately the idea of rationing has proven the cheapest and best option for the NHS by providing each citizen with an equal level of healthcare. We do however contribute towards the running of the NHS through tax contributions and aspects such as prescription medicines are not free to all in Britain, the majority of members of the country will have to pay for their prescriptions, yes the pricing does nowhere near go as far as the healthcare costs in America but not all of the healthcare services in the UK are free especially if a patient decides to have private healthcare.
Us in the UK could learn from the pricing system that is present within the healthcare system as this could help decrease the waiting times for seeing consultants and general practitioners and this could then improve the conditions of the hospitals and treatment provided by the NHS. But the US could indeed learn from our system of rationing so that all people have the opportunity to have equal healthcare and this could infact standardise the costs of services and drugs available to patients.
Even though both healthcare services could improve and learn from each other’s mistakes and take on board new ideas such as pricing in the UK and rationing within the US healthcare system, you ultimately cannot put a price upon life.

Posted by laurenashton94 | Report as abusive

@paintcan,

You just don’t “get it”. Reuters provides and maintains these forums as a public service, where ordinary citizens can participate in meaningful exchange on subjects pertinent to current events. They do better than most in terms of allowing free speech and wide scope, and seem to censor with good reason and common sense.

People with nothing else to do and whose interest is to entertain themselves in public with their own verbal diarrhea have nothing meaningful to contribute. Until “found out”, such people dilute or even frustrate serious discussions.

While it is impossible to “advance the discussion” without prolonging it, you misuse your access to obscure rather than clarify. Since you are hopelessly confused, you delight in diverting others into mental backwaters.

By preaching that there is no truth, no wisdom, and no meaningful answers to the many questions life raises, you want others to accept as you have that to even hope otherwise is futile. Doesn’t work.

The only people open to your argument are life’s other losers, who got where they are because of their consistently poor judgment. Poor company, at best.

It has been said (and I agree) that to complain without offering suggestions for improvement is a waste of everyone’s time. Suggestions I offer freely may not be the best possible or even fully formed, but each is offered in good faith as basis for further discussion.

You admit you could not comprehend (…make sense of…”) my thinking to resolve ONE SMALL PART of the “entire health care delimma”, yet infer it “ridiculous” and “dangerous”. Please. You cannot fairly judge that which is beyond your understanding.

Because you dare not stay on the same subject long, you then leap to “rationing”. Mr. Hadas discusses how health care resources are apportioned primarily by price in the United States and primarily by rationing in the UK.

You substitute your personal opinion for fact when you define rationing as “…something that only occurs in a healthy society during times of sever (sic) crisis and especially times of war”. As usual, you are wrong.

To ration is to allot, conserve, give out, or restrict. It is also to allocate, apportion, assign, budget, control, deal, distribute, divvy, dole, issue, limit, mete, parcel, proportion, prorate, quota, save or share. Healthy societies repeatedly do all of these these things every single day, without exception.

From that red herring you leap to “end of life health care”. Why? “Healthcare” in the context of Mr. Hadas’ article includes pretty much everything the world over.

“Obamacare” purports to serve those NOT on Medicare, Medicare Disability, Medicaid or VA programs. Each meets the definition of ”socialized medicine”. Each covers a variety of conditions but not all.

At present, and by common consensus, it is understood by most Americans that hearing aids, eyeglasses or “end of life health care” are NOT “covered”. But YOU want to discuss “end of life health care”, or is it your neighbors, or Obamacare, or a “nationalized system”, or private insurance?

Your mind strikes out like the tongue of a frog with no stomach, seeking every bug in every direction within range without hope of satisfaction. You do appear irrational.

I must point out that it was euro-yank, and not me, that brought your mental health into question. You “only” questioned my character and integrity (without basis)? Please.

Without further exploring the “two worlds we live in”, our motivations, our individual perspectives (or your father’s), your musician friend, the fellow whose mother had 17 kids, volunteering, your teeth or parent issues, I’m done here.

Posted by OneOfTheSheep | Report as abusive

I am happy to say the wildcard is telemedicine. This is a big part of the future of medicine, the current reality of some of medicine and something that many people are unaware of its existence. Telemedicine is rapidly expanding. There are anticipated shortages of doctors and the opportunity to have a doctor camera in, listen with a stethoscope, look at your ears and eyes, see your medical record all from thousands of miles away is amazing. Every day people are treated in a hospital by a doctor remotely. If I were to guess it would be in the thousands.

Last I knew there were 80 some odd US hospital systems that had a telestroke program, I believe there are more telepsych programs, teleICUs is in at least 60 hospital systems. Teletrauma, tele-rapid reponse, telewound, telederm, teleophthalmology, teletranslators, the opportunities for telemedine are wonderful. Prisons and the millitary see the value in telemedicine. There is now the new start up company in Ohio (forget the name at the moment) providing what looks akin to photo booths that will provide teleprimary care to strategic areas of the US. I hope they are successful and populate the US.

I feel like this is truly a Renaissance in medicine. Heck we even have the DaVinci Robotic surgery- less invasive, usually a quicker recovery time (by several days).

The broad disseminations of EMRs, the use of meaningful use to make sure doctors actually “doctor” their patients as opposed to churn patients. ie. not providing the proper routine testing or follow- up’s.

I am incredibly optimistic that barriers to healthcare, issues with throughput in hospitals and access to primary care doctors will be addressed with EMRs usage and telemedicine.

Posted by Heidimother | Report as abusive

Than good – be done here! If Mr. Hadas objected to my mental diarhea he would have blocked the comments. He did it on one other in this thread and I would have taken the hint. He could simply continue to block any further attempts to add to them. And stick to your “I’m done here”. I love having the last word, especially with you. And both of us are being examined for our mental health as well as a number of other issues by so many people I would be in danger of soiling my underwear if I actually ever set eyes on it.

For a business paper – an awful lot of people conveniently forget, at times, that the deficit and national debt are higher than at anytime since WWII and they show no real signs of being solved or of being really reduced. The conditions of this country’s demographics – it is aging and there are more people in my neighborhood my age, or getting there, and hardly any new kids. And this is not a retirement community. This area represents an aging and expensive case of people – like old buildings that need a lot of up keep, have very few tenants, and yet are never as functional as when they were first built. And renovations have never been so expensive or so sophisticated as they are now. How can anyone dither with the details and ignore the big picture?

How long can one go on believing, that because the GDP measures the movement of money only, but not what it is buying or how it is used, that is a sign of a healthy economic situation? One can believe only so long that national deficits and debt somehow live according to different rules than a person’s domestic budget but this country carries far higher debt to income and lives in a more precarious condition than even the personal budgets of those losers you seem to still despise. You can’t include the analogy of mortgage debt to personal income, because this country can’t sell the assets of the federal government and the states to get out for under the load to pay off the back debts. And you can’t afford to make money too funny or no one will believe it is anything more than a flimsy con game. Isn’t that what credit ratings are about? But you also cannot solve the issues of deficits and credit worthiness while at the same time destroying or making too much harsher, the lives the money is supposed to serve or by trying to wipe out the inconvenient losers. Don’t even think about it or the lives of the winers loose some of the security they cling to now. I may not be the impatient type but my life isn’t under some of the stresses many others – far less patient are.

Do the words incipient failed state mean anything to you?

An awful lot of drowning men are clutching at straws it seems. They even clutch at straw pols for some easy relief and boosts to the ever bipolar mood swings of Wall Street.

No one is blocked from answering or even ignoring my “rants” if they care to and can add to them any time they like. Have I taken up all their concentration span or are they fixated on our conversation to the loss of concentration on whatever they would like to add or change? There’s is no reason why other threads and other conversations can’t also go on at the same time? Why should this thread differ from any other in this forum or in any other thread?

So many can propose comfortable abstractions, almost as vanity exercises in self importance, but look so good in theory but can work so badly in practice.

BTW – There is nothing wrong with taking the weight of the world on one’s own shoulders but even as a mental effort it can be exhausting. I have nothing better to do with my time now and it is only possible to do this because I do not have to bear the real weight with my limited personal strength. How do you avoid that if you read the papers at all? How do you avoid becoming fat with information if you have lived as long as we and have read a great deal and even thought about so much of it? And you do not even have to add to the heap greatly, each year, but accumulate slowly and you will have a mountain of information to digest.

I have read great debates and they do not always refer to each other’s comments. There are no clear rules for these sites.

Posted by paintcan | Report as abusive

Excuse me – There are rules but it has been years since I read them. No profanity (a matter of taste perhaps?)and stay within the subject – more or less. And not using upper case letters for long screeds like you were screaming. Those are what stay uppermost in my mind. Repeated posting of the same comments seem ridiculous too. I’ve always had some vague ideas that I departed from the rules many times but figured if the paper accepted them I was OK. I never report comments abusive except maybe once early on. Everything anyone writes here is a matter of opinion and is nothing to be truly afraid of, it seems to me. It’s better to rebut that to censer. I’ve had about 50 comments removed over the years or not posted at all and never really worry much about it.

The departure from the rules is what makes them more entertaining actually. And the person takes the chance of playing the fool by doing so. I’m too old to ever understand PC. I mean “politically correct” – not the gadget.

But even kings need their fools to stay sane. Don’t we all? The fool always knows what the king knows about being human. He may even know it better because he doesn’t have to decide anything. And no one commenting here ever really has to decide anything. We can all play the fool if we like, it seems to me?

It’s only really embarrassing when it isn’t such an act after all.

The best thing about this site seems to be that it allows anyone interested to write “a letter to the editor”. It is so much better than the old days where space limitations allowed only a handful of well reasoned arguments, or those from well respected people, to ever be printed.

Posted by paintcan | Report as abusive