The Camel, the Straw, and the Broken Back

I have been thinking and thinking about how to say this, and here is what I want to say: 

If the last straw had been the first, it alone would not have broken the camel’s back, but each and every straw the camel was asked to carry would have contributed its weight to the final result. 

Poem: "Watched Kettle"

Watched Kettle

Watched kettle resisting boiling point,

Toaster refusing to relinquish

       Or crisp the still-soft bread it holds,

Silent, stared-at telephone,

Cloudless, rain-withholding sky,

Bobber motionless on sun-struck water

Over baited hook awaiting fish—

All these stubborn deserts of waiting

       Stretch on day by day,

       While meanwhile

The children grow up overnight.

- P. J. Grath

November 3, 2012

Why Is American Medicine So Costly?

I read with interest the other day praise by a fellow bookman for libertarian politics. I became a big Ayn Rand fan at the age of 17 and clung to Objectivist certainties until my late 20s, when life experience, broader reading, deeper critical thinking, and subsequent gradual disillusionment intervened. The main charge made in the short piece that got me thinking about this stuff again was the writer’s contention that it is government interference in health care that has sent medical costs soaring. I want to examine that claim.

Certainly a statistical correlation can be found between programs such as Medicare and rising costs since World War II, but other, equally available correlations are left out of such a narrow focus. Three come instantly to my mind.

(1) First there has been the rise of the for-profit hospital. Hospitals used to be owned and run by communities and churches. They were not expected to “make” money but to provide care when needed. These hospitals were not free, but neither were their charges governed by the “free” market. Schools, libraries, hospitals—these were seen as necessary provisions of civilized communities for their members. For-profit hospitals have changed the landscape utterly. Younger people can be forgiven for not remembering a history they did not live through. My generation has no such excuse.

Along with for-profit came (2) more and more health and practice liability insurance "products." Insurance is not in itself a necessarily bad idea. In fact, the pooling of economic risk and sharing of economic benefits are (does this astonish you?) basically a socialist principle. But does anyone not realize that private insurance companies exist to make money? As much money as possible for shareholders and investors. The more you buy—and the less they have to pay out—the more money they make. As for liability insurance for physicians, can a doctor even without malpractice insurance in a for-profit hospital? (Any hospital?) Lawsuits would certainly put profits at risk, and reducing risk to the company is what actuarial calculations are all about.

Also in the postwar period came (3) advances in medical science. These have brought Americans more and more expensive testing and treatment options, and they have also made equipment more expensive to hospitals. Not only are more people kept alive longer (some of them only "alive"), but because more and more new tests and procedures and treatments and equipment all the time come to be regarded as “ordinary care,” the cost of ordinary health insurance continues to go up correspondingly. 

Put it all together and look at the expanded picture again. For every case of a Medicare patient costing big bucks, there is a corresponding case of a healthy person with private insurance whose physician has ordered a dozen expensive, often unnecessary tests, "just to be on the safe side”; a man or woman “suffering” from the usual effects of aging and taking prescription medication to hold those “symptoms” at bay; or a comatose patient in a hospital bed being kept “alive” as long as private insurance is footing the bills.

Americans want to live forever, they want to stay young forever, and those who can afford to pay top dollar in their futile search for the Fountain of Youth make it almost impossible for those of us who would be content with basic care to find no-frills providers and institutions. It’s like looking for simple, basic dental care, when the way dentists make money these days is with expensive cosmetic procedures. Who wants to serve the lower end of the market? That won’t pay off medical school debt or help meet malpractice insurance bills!

My point is that private insurance companies, for-profit hospitals, scientific advances, and the race to the top of the medical market all fit perfectly well into the free-market, libertarian model. Why is American medicine so expensive? Blaming government interference is simplistic, narrow thinking. But it’s got “sound bytes” working for it.

It's Far From Over

Anyone who thinks fall color is over is walking around with eyes closed--or, more likely, driving around with eyes closed, which is even scarier. 

Question varies, answer remains the same

Answer: It varies from year to year.

Question could be any of the following:

What’s winter like here?

How much snow do you get?

When do the cherry trees blossom?

How hot is it in summer?

What’s the best week to catch fall color?

Predicting Election Results

Please, someone tell me what is wrong with my nonexpert analysis of predictions of election results based on probability:

Probability cannot foretell the outcome of a specific event—say, any particular flip of a coin—but can only be assigned in percentages to a range of possibilities. Weather is more predictable than coin flips, human actions more complicated than horse races, but for any prediction on a specific event’s outcome based on probability, no outcome will or can show the prediction to have been "wrong." The person having made the prediction need not even acknowledge having left out relevant factors. Picture the careless shrug and casual statement to the effect that a “less likely outcome” prevailed. What I’m saying is that anyone can criticize a prediction for not taking everything relevant into account but that no one can ever say, regardless of outcome, that the prediction was “wrong.” 

Am I right that such a prediction cannot be wrong? If so, tell me again why we should give a rip what anyone predicts? If not, please explain.

Rumblings Around Leelanau

Thunder rumbling is what we need. Well, rain is what we really need. The rumblings, however, are coming mostly from agricultural machinery. Old orchards are coming out, and land is being cleared for new trees. That’s the noise from the south end of the township.

Up at the north end, a young bear has been sighted several times, in different places. The hairy youth has caused no problems so far, but dog walkers are being careful where they wander.

It’s summer’s end and fall’s begining, and that spells fruit flies Up North. One thing that can be said for fruit flies is that they’re quiet. They arrive, they annoy, they die—and all without a sound!