Clap For The Covid

Sung to the tune of Clap For the Wolfman because it has the same rhythm.  Now that I've implanted that ear worm...

In the most bizarre news story of at least the last 15 minutes (hey, it's still 2020 after all) we find that Covid-19 is being blamed for a particularly nasty strain of "the clap:" gonorrhea.  The New York Post covers the story, H/T to Twitchy by way of PJ Media.

The unnecessary overuse of antibiotics during the coronavirus pandemic has created a rise in drug-resistant strains of super gonorrhea, according to a new report.

Azithromycin, a common antibiotic used to treat chest and sinus infections, has been used during the pandemic to prevent co-infection of hospitalized coronavirus patients and to treat inflammatory symptoms of severe infections.
...
“Overuse of antibiotics in the community can fuel the emergence of antimicrobial resistance in gonorrhea,” a WHO spokesman told the outlet, noting that azithromycin was used for COVID-19 treatment earlier in the pandemic.

Covid-19: is there nothing it can't do? 

I have lots of issues with this story.  The big summary is that it's just more fear mongering.  There is not one study cited to justify the claim, not even the associational "he who" studies that are the bulk of all the junk science in the press.  They didn't say anything like Covid patients treated with azithromycin were more likely to have antibiotic-resistant gonorrhea, and at least that makes some sense.  They presented no data whatsoever, except that there's more of this "super gonorrhea."  So frickin' what?  There could be reasons not even remotely related to using antibiotics to treat Covid-19.  Don't forget, there's this thing called coincidence, too.  

Besides, think of a Venn diagram of the sets of people who are fooling around with anyone they can find regardless of how sick they are and the set of people who are being treated for Covid.  How big do you think the intersection of those sets is? Who do you think comprises that intersection?  As a rough guess I'd say there aren't many 80 year old nymphomaniacs in nursing homes.  I can't say for sure, but I bet if an ICU nurse walked in on a patient hooked up to a ventilator having sex with anyone, that would be the stuff of legends in that hospital. 

(iStockphoto of a petri dish culture of something or other, used by the NY Post.  You know they meant to use a scary looking picture for their scary junk article.  Judging by the accuracy of the rest of the article, this is probably a cell culture of cucumbers)

There.  I saved you the time of reading this so I could make fun of the study.  Just doing my part to be a full service blog.

Most People Don't Think Like This

I suppose I'm used to it, but I noticed long ago that people don't think like I do.  Most of the time it's simply because I will do more math in my head and bound a problem during the discussion and I can see I've lost people.  Sometimes it's just because I approach problems differently.  This morning, I saw the headline on Rantingly that Nebraska State Senator Mike Groene of North Platte had said, "I finally got my wish and contracted the Covid-19 virus."  For months, now, I'll hear the news report some number of new cases, and I'll say, "cool!"  Are you going "WTF?" 

First off, the vast majority of those cases are either false positives or totally asymptomatic.  Never treated, let alone hospitalized or in ICU.  Second off, every real case with real antibodies is one person closer to herd immunity - which means the virus simply has a hard time hopping around the population because there aren't enough susceptible hosts.  It has plainly happened in many other countries and infection severity has gone down as the doctors have learned to handle the cases better. 

Allow me to illustrate a simple example of "most people don't think like this."  I've been reading William M. Briggs - Statistician to the Stars! as he talks about the pandemic.  He presents this plot of "excess deaths" by year, data from the US CDC.  I've marked up the plot to point out some features. 

The plot has a periodicity to it, so that it's not a relatively straight line.  The periodicity marks the winter and flu season.  It's easy to see there are bad flu years, like 2018, and easy years like '16 or last year.  They tend to alternate, but not strictly.  So superimposed on a background of about 52,000 deaths per week (7500/day) you can see a slight upward trend and modulation based on severity of the season.  The observation is that bad years tend to alternate with better years.  One of the mechanisms is that the flu and its complications tends to take out sicker people, especially elderly.  If the flu season is milder, like 2019, people that would have died to a stronger flu are now a year older and (on the average) more fragile.  People that might have died in '19 are then more likely to be killed by the flu (or other things) this year.  I think that partially explains why the death toll from Covid was so high last spring; the pool of people in nursing homes and other facilities was more frail from being a year older than during last year's flu season, then the idiot governors of those northern states shoved Covid patients into the nursing homes.  I don't think it works the other way; that people who survive a bad flu year are less likely to be taken out the next year.

Briggs also made the effort to extract an estimate for flu and pneumonia deaths, toward the bottom on the scale, and then ends that plot with the "with" and "from" Covid deaths. You can see the worst of it was back around late March, early April, and the easily predicted transition from Northern Temperate profile to more like Northern Tropical peak around June (see Hope-Simpson plot here).  We're transitioning to the Northern Temperate winter profile again, which will be a third peak, but since the '20 season was particularly bad, the pool of people likely to die coupled with the advances in treatment should keep the death toll lower than last spring's peak.

Another interesting plot he puts up is the deaths by ages from all causes along with the "with" and "from" Covid from CDC data as well.

As Briggs puts it, no matter what age you are, you're about 10 times more likely to die of something else, rather than Covid and complications. 

Briggs makes a big point of pointing out how so many people are worried about this with no justification.

Young (under 65) healthy people are not being killed by the doom—or much of anything else. Yet it is this demographic most panicked and most influential. We all have more to worry about with flu. That is, we usually do. But there is a problem with the flu: it seems to have disappeared, an impossibility.

I should add that the people he talks about worrying the most, saying "mask me, lock me inside" don't seem numerate enough to understand data.  Everything's an anecdote, "my sister's friend's yard guy is only 40 and he got Covid and died!" (never mentioning or even realizing he was the only person within 200 miles like that). 

He goes on to show another plot of CDC data showing a mysterious absence of the flu. The flu disappeared after week 14 of '20 and in October, when it starts showing up again, the CDC shows nothing. They've stopped testing for it. I feel bad about taking more of his data, so go read.

In this day when the most innocuous thing requires a disclaimer, I should give one.  Every death is a tragedy to some family, and many people will think it's heartless to talk about deaths as if they're just numbers.  Further, the one thing we all know is that some day we will all die.  I don't mean to sound heartless, I just think the best way to understand what's going on is to look at the numbers and understand as much as humanly possible.  Or more. 

Just a Reminder - Nature Wants You Dead

We had a reminder of that today. 

Actually, Mrs. Graybeard was the target of the reminder today; she went for a walk while I was working on a little project in the radio room. 

She came back in covered in blood and still actively dabbing it away with a blood-soaked tissue.

She had been attacked by a hawk.  It's nesting season around here and the local papers talk about people being dive bombed pretty regularly.  Both of us have heard about this for as long as we can remember, but neither of us had ever been hit by hawk until today.  She says it felt like having a brick dropped on her head and she had no idea what hit her.  She looked around in an instinctive reaction and caught a glimpse of the departing bird.  There are very few coconut trees around here and it's not acorn season so having anything fall out of nowhere and hit your head leads to lots of confusion as you try to figure out what it was.

I helped clean up her head and verified that the claw marks weren't deep enough to require stitches.  Scalp wounds can bleed a lot and she pretty much had blood on every piece of clothing.

I think there will be a visit someplace tomorrow for a tetanus booster. 

And by the most remote of remote coincidences, yesterday while taking the garbage out something made me glance down the side of the house.  Either one of our visitors from 2018 or a relative was on the same side of the house within 3 feet of where that last visitor was standing.  It's in the corner of the lot where trees from the four houses make a fairly dense cover.  As a rough guess, this guy is about 8" tall.

With those talons if he decided to to dive bomb you there would be blood as well.

Remember The Flu Boat?

Remember the story of the Diamond Princess that we talked about here in mid-February?  I had said having all those people quarantined on a boat might be a good opportunity to study the virus.

It turns out that it really was quite a good place to study COVID-19.  Thanks to a post on Watts Up With That and hat tip to Borepatch for seeing it first, we get to learn some pretty remarkable facts about COVID-19.

To begin with, it really was a scenario almost designed to provide massive numbers of infected people and mass casualties; a way to observe the virus spread across the thousands on board, perhaps killing hundreds.  If the fatality rate was the kind of number people were talking about months ago (10% or more), that could have meant 400 killed.

As you might imagine, before they knew it was a problem, the epidemic raged on the ship, with infected crew members cooking and cleaning for the guests, people all eating together, close living quarters, lots of social interaction, and a generally older population. Seems like a perfect situation for an overwhelming majority of the passengers to become infected.

Patient zero was on board on January 20th to the 25th.  They man wasn't diagnosed until February 1st.  In those five days, he spread the virus.  In the next week, the situation was like that previous paragraph.  People unaware they were spewing virus working in close contact with each other. 

• It was a "worst case" scenario, as people were confined for weeks with other infected people in very close quarters.  While this protected the general public from the infection, it likely maximized the spread of the virus on board the ship.
• It was a "worst case" scenario as the population on board skewed dramatically to older - and thus, more vulnerable - people.

The reality turned out far less scary.  Obviously, if you're one of the people who dies, it's very serious to you and your family, so I'm talking in the “detached, passive, scientist voice.”  Despite the dire situation...

• 83% (confidence interval of 82.7% – 83.9%) of the passengers never got the disease at all.  Said the other way, only 17% of the passengers were infected.
• The oldest portion of the passengers, over 80 years old, had a higher infection rate: 25%, but that's not even twice the rate of the general population.
• Wait - it gets better.  Slightly less than half the passengers (48.6% ± 2.0%) who would test positive for the disease did NOT get sick and showed NO symptoms.  They never knew they had it.
• The young (under 20) and old (over 50) disproportionally showed no symptoms after being infected
• The overall, age-adjusted death rate was 1.2% (7 cases total)

These two graphs go together.

This shows the percentage of each age group on board the Diamond Princess who did NOT contract the virus.  The youngest, birth to 9 years, looks to say 93% did not test positive for the virus.  Note that the lowest percentage who didn't test positive is the 80-89 year old cohort, which says the chance of contracting the virus seem so go up with age.  Note how the colored bars are shorter for ages 50-59 than the three groups above it, and then shorter every additional decade.

The next plot is percentage of each age group who showed no symptoms.

The birth to 9 years old group was 100% symptom free.  From the first plot, roughly 7% of that age group tested positive and that test was the only way it could be known they had the virus.  We can keep going on those; the second group in first plot shows 78% did not contract the virus, so 22% did.  Of the 22%, 60% showed no symptoms.  Even in the oldest group, with 25% testing positive for the virus, almost half of them (45%) had no symptoms.

The study itself is Estimating the infection and case fatality ratio for COVID-19 using age-adjusted data from the outbreak on the Diamond Princess cruise ship (PDF warning).  The study authors define an age-adjusted Infection Fatality Rate of 1.2% with a possible interval of 0.38%–2.7%. The wide uncertainty range is due to the small number of deaths.  Although this might not be relevant to an epidemiologist studying the disease, I see this as 7 deaths out of 3,711 passengers and crew on the Diamond Princess.  I don't see any reason to exclude the 83% who didn't get infected because they were exposed and could have been infected.  7 deaths out of 3711 people on board is a 0.19% fatality rate.  I hear the number 0.1% for the annual flu, but I don't know if that compares more directly to my raw numbers or their age-adjusted 1.2%.

These 3711 people were in a virtual incubator for the virus and there's every reason to think they were all at risk.  According to this article, a Japanese Infectious Diseases expert went onboard the Diamond Princess and was afraid of how poorly they implemented their quarantine.  The fact that 83% never got the disease hints that it may not be as communicable as everyone fears. 

It seems that the more I learn about COVID-19, the less concerned I am about it. 

Drug Prices: It Takes Government to Really Screw Things Up

There's a meme going around the interwebz, apparently started by this Twitter user, Laura Marston who describes herself this way: "video game attorney, politics nerd, type 1 diabetes since 1996; I advocate for lower insulin prices in the United States" 

Long term readers know that I have no problem with "raging against the machine", but I regularly try to encourage readers the rage against the right machine. 

This is another good example.  Ms. Marston thinks this is the fault of the drug companies, but they are using the system the Fed.gov set up for them to use.  Did the companies lobby the government to set up those laws?  Undoubtedly.  Absolutely.  That doesn't mean, however, that the congress critters couldn't have said, "hell no - you go pound sand".  The fact is, if they're obeying the law and the law is stupid, you have to start thinking stupid lawmakers are your problem.  The drug companies enlisted the FDA, the DEA, the FBI, customs and border security, and a dozen other taxpayer-funded regulatory and enforcement agencies to protect them from real competition with their willing, complicit help. 

The details are from author Laura Williams writing for FEE (the Foundation for Economic Education) in "A Government Guide to Keeping Insulin Unaffordable: 3 Easy Steps to Hogtie a Market" and she does an excellent job of showing just how these laws have destroyed the market.

First step: Limit the Number of Competitors 

Even though insulin treatment itself can’t be patented, improvements in delivery mechanisms can be. These incremental improvements, no matter how small, can be used to extend the 20-year patent on a drug, a process called “patent evergreening.” Sanofi has filed 74 patent applications on its long-acting insulin Lantus—nearly all of them after the drug was on the market—and boxed out generics for decades. Drug makers seek extensions to their exclusivity when they add pill coatings and alter inactive ingredients, extending their monopoly but offering no marginal advantage to patients.

Regulators and pharma CEOs aren’t opposing forces; they’re the same people—sometimes literally. Nearly half of staff reviewers at the US Food and Drug Administration (FDA) will go on to take jobs in the industries they’re tasked with regulating, often as advisors in navigating regulatory policy.

Shades of how financial regulators are in a revolving door relationship with the companies they regulate.  The patent and regulations don't just keep out US competitors, they prevent non-US companies from exporting their insulin into the US.  Even if a factory makes the same insulin for both Canadian and US markets, the foreign maker is forbidden to sell to American patients.

Next:  Exclude Competing Products 

The FDA almost famously drags its feet for years in the approval process.  That makes it practically impossible for small business innovators and researchers to "get into the game".  Faced with insurmountable costs they're likely to drop a new project or sell it to an existing giant with the legal staff to carry the load.

Any new drug must endure an FDA clinical trial and approval gauntlet that, according to independent reports, takes an average of 12 years and $2.7 billion to complete. Those costs must be paid by the manufacturer hoping to bring the drug to market, and only a handful of companies can raise enough.

It's worse than that.  Pay-for-delay settlements are an ugly consequence of a previous attempt to legislate lower drug prices. When smaller, generic manufacturers want to offer cheaper versions of a brand-name drug, its original maker will threaten costly litigation, which lower-margin producers can’t afford. Then they offer a way out, a “reverse settlement” by which name brands can (legally!) pay smaller companies not to bring a generic drug to market.

The hush money buys brands another few years of protection for their soaring profit margins. Insulin makers simply split the profits of their monopoly with anyone who tries to topple it.

First off, we see this sort of reaction from big companies in high tech.  It's why the largest Internet providers were behind "Net Neutrality" - they already have the staff of lawyers that smaller startup companies don't have.  It assures they'll never face real competition.  In this case it's raising the costs of getting drugs to market.  Keeping them high keeps the big companies on top.  The free market has been regulated out of existence.

The one that astounded me was that they could legally pay a smaller company not to bring a generic to market.  That helps the big company and the smaller one.  The FTC  (Federal Trade Commission - Protecting America's Consumers) claims they've "filed a number of lawsuits to stop these deals, and it supports legislation to end such “pay-for-delay” settlements."  It seems that by the essence of their mission statement, they should be able to stop these deals by themselves. 

The final way applies to the entire healthcare sector:  Hide and Distort Prices so No One Can Shop Around 

Patients, and indeed prescribers, have only the foggiest idea of what products are available and their real per-unit cost. Manufacturers like to boast that no one pays “list price”: Patients rely on a patchwork of health insurance, pharmacy discounts, and manufacturer rebates to bring the cost within reach. Such a complicated framework provides a wide scope for manipulation.

Prices paid by patients have risen steadily for a decade, but the price paid by health care actors has fallen. Pharma companies steeply discount the negotiated prices paid by pharmacies, benefits directors, and health insurers. Insulin is re-priced as many as four times other than the “list” price before it can be purchased by a consumer. At each stage, the reimbursement is based on a percentage of the list price. So the higher the list price, the better the returns for each participant in the process—even if no patient ever pays the list price.

Even shadier is the practice of offering steep discounts to insurance companies, benefits managers, prescribers, and other employees whose job is to decide (and limit) which insulin products covered patients can buy. Insurers and health plans pay a negotiated price well below the list cost but often well above what patients will pay. The difference, a percentage of that inflated list price, serves as a kickback from drug companies to anyone who will drive patients toward their priciest products. Class action lawsuits in Minnesota, New Jersey, Washington, and New Mexico are exposing the systematic manipulation of insulin prices by manufacturers, insurers, and pharmacies. 

Through this nebulous network of bully tactics and insider dealings, government agencies and corporate campaign donors conspire to deny patients the benefits of market competition. Desperate patients pay up because they have nowhere else to go—and their distress is deliberate and designed.

If you read Denninger's Market Ticker, he talks about this regularly.  It's among the biggest problems screwing up medical costs: nobody knows what anything costs, and different buyers pay different prices.  There is no posted (or readable) price list.  That's starting to develop some cracks in its facade with some sites that allow you to research costs for some drugs, imaging or other tests, but we have a long way to go. 

Step back and look at all three.  Does this picture look familiar to you?  It's nothing but pure cronyism, like we used to complain about when Obamanoids did it.  Did you think that would go away when we went from a D to an R?  Hah!  All that changes are the names getting the money.  The antidote for cronyism and higher insulin prices is not to increase the power of the government to regulate them, but to get rid of big government.

New Hope for People With Skin Ulcers

It's probably safe to assume that you know we're in the midst of a diabetes epidemic.  While there are some very promising treatments that will reduce or eliminate the overt presentation of the most common forms of the disease, there are millions suffering right now.  Among the common diabetic complications are skin ulcers; miserable, painful open sores that require many treatments.  It has been reported that a single diabetic foot ulcer can cost approximately $50,000 to treat.

This week brings news via Machine Design that the Wake Forest Institute of Regenerative Medicine (WFIRM) has developed a new 3D bioprinting technique to help enhance treatment response time and create overall better skin graft results.  WFIRM published their results in Nature, which is currently allowing us to read and download the paper (pdf).  Due to the need for a sterile environment, the treatment is done in an operating theater.  The patient then lies in the printer while it sprays layers of cells onto their wound. The end result is that it builds up, layer by layer, what will function as a skin graft.

The new bioprinter from WFIRM combines the delivery systems of inkjet printers with mobility and the scanning capability of different topographies. The research team outlined its design and printing approach in the paper “Bioprinting of Autologous skin Cells Accelerates Wound Healing of extensive excisional Full-thickness Wounds.” The main components of the system are a handheld 3D scanner and a print head that can move in any XYZ direction. The print head contains eight 260 μm diameter nozzles, each driven by an independent dispensing motor. The printer components are mounted on a small frame which can be used in an operating room. The system is 79 cm wide (patient head-to-toe direction) by 77 cm deep (cross-patient direction). The system includes a robotic arm and, when fully extended, adds an additional 50 cm—combining for a full reach of 127 cm.

The scanner attached to the printer system is the ZScanner Z700 scanner from 3DSystems. As noted, the scanner is handheld and easy to use. It can capture the entire wound in one continuous scan which results in a computer model of the wound. The model is processed via Geomagic Studio and imported into Artcam 3D software to obtain the full volume and the nozzle path needed to print the fill volume. The wound is split into Z axis layers for its depth, corresponding to dermis and epidermis layers, and each Z-axis layers is overlaid with XY lines that cover the entire wound.

The printer uses the same sorts of techniques as inkjet printers: the delivery system is based on cartridges, and each cartridge contains a different type of sterile compound rather than a different colored ink.  Each nozzle is connected to a separate cartridge, and each cartridge contains a matrix of fibrinogen and collagen. Separate atomizing nozzles deposit thrombin on the fibrinogen matrix to produce fibrin simultaneously (clotting, to hold everything in place).  The system is just barely pressurized - a mere 1 pound per square inch difference drives the material.

Skin bioprinter prototype. (A) Schematic demonstrating scale, design, and components of the skin bioprinter. (B) The main components of the system consist of 260 µm diameter nozzles, driven by up to eight independently dispensing systems connected to a print-head with an XYZ movement system, in addition to the 3D wound scanner. All components are mounted on a frame small enough to be mobile in the operating room. (C) Skin bioprinting concept. Wounds are first scanned to obtain precise information on wound topography, which then guides the print heads to deposit specified materials and cell types in appropriate locations (Images courtesy of LabTV - National Defense Education Program, Washington, D.C.). (D) Example of skin bioprinting process, where markers that are placed around the wound area used as reference points: (a) prior to scanning with a hand-held ZScanner Z700 scanner (b). Geometric information obtained via scanning is then inputted in the form of an STL file to orient the scanned images to a standard coordinate system (c). The scanned data with its coordinate system is used to generate the fill volume and the path points for nozzle head to travel to print the fill volume (d). Output code is then provided to the custom bioprinter control interface for the generation of nozzle path needed to print fill volume (e, f). (E) This system facilitates the depositing of multiple cell types with high precision and control. The layering of fibroblasts (green) and keratinocytes (red) is shown.

Based off this delivery system, the keratinocytes [skin cells] and fibroblasts [cells which form the collagen matrix that supports the skin cells] are mixed into a hydrogel and delivered directly on top of the wound layer by layer, replicating the skin structure and accelerating the healing of normal skin and function. The research team has had successful results on mice in clinical trials. The new skin begins to form outward from the center of the wound and, by using the subject’s own unaffected cells for new cell delivery, it allowed the subject’s body to accept the new skin and prevent tissue rejection.

“The technology has the potential to eliminate the need for painful skin grafts that cause further disfigurement for patients suffering from large wounds or burns,” said WFIRM Director Anthony Atala, M.D., a co-author of the paper.

“If you deliver the patient’s own cells, they do actively contribute to wound healing by organizing up front to start the healing process much faster,” added James Yoo, M.D., Ph.D., who led the research team and co-authored the paper with Atala. “While there are other types of wound healing products available to treat wounds and help them close, those products do not actually contribute directly to the creation of skin.”  Note: anything in square brackets added by me - SiG

All work done so far has been done on experimental animals, as medical regulators demand.  The next step is to conduct a clinical trial on humans, and hopefully replace the traditional donor or artificial skin graft treatment with the patient’s own 3D-printed skin.

Confidential to Bernie and AOC - We Already Know Medicare For All Won't Work

There's a wonderful quote attributed to Thomas Sowell that says, "It is usually futile to try to talk facts and analysis to people who are enjoying a sense of moral superiority in their ignorance".

Despite the warning from the obvious genius of Dr. Sowell, I'm going to try to present facts and analysis for AOC, Bernie, and all of the idiots running around now saying we need to have a nationalized healthcare system like those other countries.  Perhaps you have friends or family members who are parroting the same lines and this will be useful to you. 

We already know it will fail because it is currently failing in every single country that has it.

This is drawn from an article by author Jim Kelly at FEE (Foundation for Economic Education) called "How We Know Single-Payer Won't Lower Health Care Costs" and it's in the format of four questions for anyone advocating for this.

Let's start at the top.  Bernie and the Bunch say we'll save money because the government doesn't have to make those awful profits that insurance companies make.  Bernie says we'll lower costs 20%, others have gone as high as saving 60%.  This is really easy to dispel because all of those insurance company financial annual reports are available.  As Kelly puts it:

Unfortunately, outrage buys fewer tongue depressors than one might hope. The top health insurers averaged 4.1 percent profit in 2017 (per Yahoo Finance). That’s taken on half (at most) of spending for-profit insurers handle. Eliminating those profits would save about 2 percent. Since health care gets 4.5 percent more expensive every year, that would in effect roll prices back to last August.

The advocates say that we'll be able to negotiate better deals with pharmaceutical companies.  Maybe, like President Trump says, they're all awfully crappy negotiators now because Medicare is already the largest single-payer system in the world, and if they can't get a better deal now why should we think they'll negotiate better in the future?  That's an argument against Medicare for all, not for it.

What exactly has the Federal Government ever taken over and reduced costs over time?  Not education. Not defense. Not police and fire protection.

In what country is single-payer making health care cheaper from one year to the next?  Not one.of the 36.

Not to insult any of my dear readers, but if healthcare costs were going down, the growth rate would be negative and there's not one negative growth rate on this chart, which includes the UK's National Health Service, Canada and other places always put up as a paragon we should try to reach.  In fact, the US has a cost growth rate in the lowest third of all 36 countries.

Which says if we were to go to single-payer and even held costs down at the average rate, our costs would go up not down. 

Where has adopting single-payer lowered costs?  Kelly can't find any country that has lowered costs.

Granted that the first few years of the NHS in the aftermath of WWII were abnormal in the UK (and much of the world), but ...

In the first year, it spent 32 times what it had planned for eyeglasses. It had to raise salaries to attract more nurses. Prime Minister Clement Attlee pleaded over the radio with citizens not to overburden the system.

In the early days, prescription drug volume tripled and was threatening to collapse the system.  They had to start adding charges for prescriptions, which helped reduce the explosive growth, but over the last 68 years, their costs have gone up an average of 4% per year.

Let's assume there is still some waste in the medical industry.  The thin profits the insurance companies are making seem to be a reasonable indicator that there's not much waste.

Less than a dime of every health care dollar gets distributed to someone as profit. The great majority goes into someone’s paycheck—maybe a nurse, maybe an advertising copywriter, maybe an IT guy at the FDA. Health care is 18 percent of the US economy, which means 30 million of the country’s 165 million jobs.

Any health care reform that has us put fewer dollars in means fewer dollars out to all those people. For costs to halve, 14 million people need to lose their jobs. Or 27 million need to take a 50 percent pay cut. Or there needs to be some combination of the two, all without comparable drops in quality and while handling higher demand.

When the advocates talk about cutting costs, they don't talk about putting people out of work, do they?  Can you imagine a politician campaigning on wanting to put 14 million Americans out of work?

The public in general, but especially leftists, seem to have terribly inaccurate ideas about company profits.  The American Enterprise Institute published a study back in 2015 in which people were asked as rough guess what percentage profit companies make.  The average response was 36%, which is only 5 times higher than reality.

According to this Yahoo!Finance database for 212 different industries, the average profit margin for the most recent quarter was 7.5% and the median profit margin was 6.5% (see chart above). Interestingly, there wasn’t a single industry out of 212 that had a profit margin as high as 36% in the most recent quarter.

With ideas this distorted from reality, it's not surprising that Bernie, Occasional Cortex, and the rest try to sell the idea that they can save money by eliminating that big profit.

The truth, of course, is far more sinister.  By taking control over health care the Fed.gov gets total control over every aspect of your life and death.  It has always been, and still is, the dream of tyrants everywhere to have that control over the masses.

Imagine if We Paid for Food like We Do Healthcare

That's the provocative title of an article on Libertarianism.Org and reprinted by FEE (the Foundation for Economic Education).  The article is by Dr. Ryan Neuhofel, DO, MPH, a board-certified family physician in Lawrence, KS. As he puts it:

Imagine if you purchased food like most Americans obtained healthcare.

No, I really want you to try to envision it…

Struggling?

I am a family physician whose father worked in a grocery store and I enjoy eating at Mexican restaurants immensely, so maybe I can help:

I think most of us have some inkling of how screwed up the health care system is in this country, but Dr. Neuhofel puts together a world in which Food is paid for with a system just that screwed up.  Perhaps it's the "after" state for whose who argue that food is a basic human right.  I can't say I was really surprised by anything, but he did a good job of creating a parallel universe populated with a "Green Cross Green Shield (GCGS) Bronze-Select food plan" and an Affordable Sustenance Act (a.k.a. ASA, or “Obamafood”).  Instead of Costco, BJ's Wholesale Club, Amazon, Walmart and dozens of other companies competing to see who can provide a better price per pound or better quality food to get your business, this parallel universe features giant Food Plan providers and (of course) the Fed.gov totally destroying the market incentive to provide better food at lower prices.

I really recommend you read the whole thing, but as I usually do, I'm going to grab a few excerpts to whet your appetite.

Thankfully, your new Green Cross Green Shield (GCGS) Bronze-Select food plan is a benefit provided by your new employer. There is some payroll deduction stuff that you don’t quite understand yet. Most of the plan’s $680 monthly premium is hidden from you and drastically reduces your wages. Still, you are happy that your food plan costs only (as far as you know) $123 per paycheck.
....
Worried that you won’t be able to afford everything on your list, you cross off any special items and opt only for the basics. As you scurry up and down the aisles, you see there are no prices listed on anything, nor labels telling you what is a Bronze-Select item. You suspect the delicatessen with your favorite cheeses is off limits because of the large “included with United Food Platinum-Plus” sign above it but with no mention of Green Cross Green Shield. Remembering that eggs are included as a “free” GCGS wellness benefit you get 3 dozen of those—even though you don’t really need any right now.
...
During check-out, the cashier rings up the items and asks you for a $30 copay. You are given a 6-page receipt with indecipherable codes and then asked to sign a few other forms because some of your items will be billed to you later.

As you drive home, you remember that your monthly food deductible is $250 and you hope that the balance of the bill isn’t overly expensive. (Several months in the future you get a bill for $276 from FoodMart. Although vaguely suspicious that you’ve been taken advantage of somehow, you are happy that you got a big discount on your $18 box of Tasty Flakes cereal and have now reached your deductible.)
...
Upon checkout, you present the waiter your GCGS card, and you are asked to pay a $10 copay. (The billing statement weeks later reveals that the “plan discount” did reduce the initial charge from $64 to $37 and that GCGS paid Burrito King another $27 a few months later which got applied to your deductible.) You question how a simple burrito can cost $37, but nobody, including the majority of food policy experts, knows exactly why.
...
Politicians, regardless of their ideology and grandstanding, are lobbied heavily by a swamp of power players to preserve the status quo. Understandably, most Americans are fed up with all of this, and an increasing number now believe the only solution is a national, federally-administered “single food plan.”

As always, the thing that boggles my mind is those people arguing for a "single payer food plan" are begging the ones who screwed up the existing system to "do it again, only harder".  Whenever there's some sort of corruption found where some industry lobbies the Feds for giveaways, they pounce on the private sector guys and totally ignore the Fed.gov.  If someone bribes a legislator, they've both committed a crime.  

Walmart Expanding Their Healthcare Involvement

An interesting article came in my email this week.  Retail giant Walmart has long been know for having some additional kiosks (at least as they appear around here) in the fronts of their stores.  These include hair salons, restaurants, banks, Starbucks franchises, and optometry offices.  Our local Walmarts have had pharmacies for as far back as I can recall, inside the main body of the store, but optometrists and those others tended to be along the front of the store, near where the checkout lanes are.

Now, one Walmart in Carrollton, Texas, is getting a mental health clinic as well.

The clinic opened Wednesday and is the first from Beacon Care Services, which will provide outpatient mental health care in various locations like retail stores. It hopes to provide convenience and accessibility to more people who need care, according to its site.
...
There is a growing demand for mental health care, but the number of mental health professionals is not growing enough to meet that demand. This leads to issues such as long wait times to see a professional and the inaccessibility of mental health professionals for those who live in rural areas.

Over the years, I've heard people who are close to having an actual addiction to shopping refer to it as "retail therapy".  This puts a whole new light on that saying. 

According to the Foundation for Economic Education, the arrangement is based on something closer to a market-based system, rather than the typical model for all other health care where no one knows what anything costs.

Since the clinic opened less than three weeks ago, over 500 prospective patients have come in to talk with representatives and learn more. Interested consumers can expect to pay $140 for the first appointment with additional visits costing $110. This cost is drastically lower than other therapy services available in the marketplace, where an uninsured person can sometimes pay upwards of $200 per visit. For consumers who are experiencing extenuating circumstances, Beacon also offers a sliding fee scale to help make these services accessible to everyone.

It's likely to be a start of a spreading trend and more involvement in health care for Walmart.

When it comes to improving general health care, Walmart is just getting started. The company announced that it is going to make cutting health care costs a priority. Putting this plan into action, the company recently hired former Humana executive Sean Slovensk to head up its health and wellness division.
...
The company recently partnered with Anthem, one of the largest insurance providers in the country, to offer discounts on medical equipment and over-the-counter drugs to Medicare patients. And all this is being done without government compulsion.

It's often noted that the leftists are often opposed to Walmart, but Walmart has done more to improve the lives of the "little guys" the leftists supposedly care about than any government anywhere in the world.  They are ruthlessly free market.  I've known engineers that have been involved in proposals to Walmart corporate headquarters and I've heard stories that I can't verify.  Let's just say Walmart apparently cuts their own costs as ruthlessly as they ask vendors to cut their costs.

One of the reasons Walmart wants to help cut health care costs is that health care for their employees is the second largest expense on their profit/loss ledger, right behind wages.  From their perspective as sellers of Pretty Much Everything, they see that if their customers didn't have to spend as much on health care they might have more to spend at Walmart.  That sort of corporate greed, backed by the resources of one of the largest retailers in the country, might be able to make a difference.  

“So these are the things that drive us to be interested in health care: Our customers need help. Our associates need and want to be healthy. And it’s good for our business,” [Walmart executive Lori Flees] said.

Frankly, I see other potential private sector moves to cut health care costs and improve access and it's nothing but good.  More from CNBC, back in October. 

Walmart’s competitors are also investing in health care. CVS Health wants to add more options at its retail clinics, known as MinuteClinics, once it closes its acquisition of health insurer Aetna. Walgreens is testing a number of partnerships, including one with UnitedHealth Group to add urgent care centers to some drugstores.

Walmart earlier this year was looking to deepen its partnership with Humana, people familiar with the matter told CNBC. Flees said partnerships are “an essential part” of the strategy to lower the cost of health care and to improve the health of the country.

“If you take the expertise that lies in the industry and you combine it with Walmart’s footprint, it really is an opportunity to have a positive impact at scale,” she said.

The more government involvement there is, the worse things get.  We need more freedom, more market. These companies can't completely unscrew things themselves, state and local governments can always screw things up more, but it's a hopeful sign.

A typical in-store Walmart Pharmacy line.  Callaghan O’Hare | Bloomberg | Getty Images

Organ Harvesting for Transplant from Living Donors

Not a horror story from the Mideast perpetrated by ISIS, but a reminder of a column I wrote well over 6-1/2 years ago.

The Weekly Standard reports in it's September 17th edition about a push in modern medicine to allow organ harvesting from living people.

In its September 6, 2018, edition though, NEJM has outdone itself. With Belgium and the Netherlands already allowing the conjoining of organ donation and euthanasia, and with Canada debating whether to follow them off that moral cliff, the journal has published a radical proposal that would demolish the ethical foundation of transplant medicine—the “dead donor rule.”

The rule requires that donors be declared dead before vital organs are procured and that the surgical transplant procedure not be the cause of the donor’s death.

In the NEJM piece “Voluntary Euthanasia—Implications for Organ Donation,” Dr. Ian M. Ball and bioethicists Robert Sibbald and Robert D. Truog urge that those rules be loosened in countries where euthanasia is legal.

Although some patients may want to be sure that organ procurement won’t begin before they are declared dead, others may want not only a rapid, peaceful, and painless death, but also the option of donating as many organs as possible and in the best condition possible. Following the dead donor rule could interfere with the ability of these patients to achieve their goals. In such cases, it may be ethically preferable to procure the patient’s organs in the same way that organs are procured from brain-dead patients (with the use of general anesthesia to ensure the patient’s comfort).

Looking back at my piece from 2012, it's remarkable how similar its predictions are to today's situation.  In that piece,  bioethicist authors in the Journal of Medical Ethics were saying that “killing by itself is not morally wrong” and that killing a human was no different than killing a weed.

“[I]f killing were wrong just because it is causing death or the loss of life, then the same principle would apply with the same strength to pulling weeds out of a garden. If it is not immoral to weed a garden, then life as such cannot really be sacred, and killing as such cannot be morally wrong.”

Today we find that legal euthanasia in Belgium and the Netherlands is not limited to the terminally ill. In Canada, the euthanasia patient’s death need only be “foreseeable,” whatever that means, and even that vague limitation is under court attack.

Conjoining euthanasia with organ donation would thus send the insidious message to vulnerable people that their deaths have greater social value than their lives. For the particularly vulnerable, that could be the point that tips their decisions. Moreover, following the path the authors urge would transform a life-saving medical sector into one that also ends lives, imposing on transplant specialists the dual role of both healer and killer. 

Today, as in that 2012 story, the advocates in the New England Journal of Medicine are saying it's not killing to take the organs out of someone who is of no use to society.  In the 2012 article, they referred to people who have no abilities.  The NEJM piece depends on an invidious health-care rationing measure known as the QALY (“quality-adjusted life year”), which is an almost identical concept.  Adoption of the QALY has the effect of limiting care to the disabled and disadvantaged whose lives are bureaucratically rated as lower in quality than the lives of others.  If a 35 year old lawyer or other professional needs a liver or a kidney, it's not unethical to whack a 70 year old or a 10 year old to get one - even if that person isn't done with it quite yet.
 

Hippocrates.  DeAgostini for Getty Images

This is stepping too far for me.  To argue that it's not immoral to kill someone with impaired or nonexistent abilities leaves the gaping question of "who decides?"  Who defines what abilities allow someone to live?  In my view, bioethicists have no marketable abilities and are only employed because they're in a society so rich it pays for people to come up with ideas like this.  Does that mean it's ethical to kill bioethicists? 

Alfie Evans, Charlie Gard, the Liverpool Pathway and Ezekiel Emanuel

What do all those names have in common?

The story of Alfie Evans in the UK is another one of those "unless you've been living under a rock" stories.  It needs no introduction, but perhaps a summary.  The British National Health Service is insisting that Alfie be allowed to die with dignity - although reports from people who have seen the room say they're not even allowing him to live with dignity.  Stories and photos come back  showing the hospital staff leaves him to sleep in urine, and that mold grows in his breathing tubes.

Alder Hey, the hospital where Alfie lies, has a history of appalling treatment of patients.

In 1998, a heart specialist at Alder Hey accidentally revealed during an inquiry that the hospital was storing — in bulk — children’s organs. With no consent from the parents, Alder Hey Hospital was harvesting the organs from dead babies.

They were also caught selling human tissue to pharmaceutical companies in exchange for cash donations, but what they didn’t sell, they stockpiled. Alder Hey had 2,080 children’s hearts, over 800 other organs, and 400 full fetuses. A pathologist at Alder Hey was even accused of keeping the head of a baby stored in a jar. NONE of this was done with parental consent.

Now the hospital is not only denying Alfie medical care, they won’t let his parents take him home to die and say it's because the protests show the parents have a bad attitude.  Merseyside (city) Police threatened people who posted opinions that disagreed with the government.  Spokesmen for Alder Hey hospital are now saying that unless his parents have a “sea change in attitude,” they won’t allow Alfie to go home.  This week, Alfie was taken off life support and defied expectations by breathing on his own.  It took the hospital most of a day to decide to give the child water.  

Last July, in a similar case, the UK government insisted that Charlie Gard die - it's too euphemistic to say they allowed him to die, it wasn't that passive - and denied the parents visitation to be with Charlie when he died. After a lengthy struggle to try to save the child, he was transferred to a hospice, taken off his respirator, and quickly died.

It's important to recognize that neither case is about the cost of treatment.  In both cases, outside sources are guaranteeing funding and offering to coordinate the treatment.  In Charlie Gard's case there was a crowdfunding effort that gathered funds and an American researcher who thought Charlie might be treatable.  In Alfie's case, the Italian government has granted him Italian citizenship and has offered him treatment there.  Additionally, Pope Francis has offered to intervene, leaving an aircraft in the UK to take Alfie to Italy. 

The cases are about the governments ability to decide who lives and who dies.  Like the saying about gun control goes, it's about control. 

This shouldn't be a surprise; the UK enacted the Liverpool Pathway over 6 years ago.  The Pathway was a treatment protocol to kill off the elderly, primarily by depriving them of water and food, although there were allegations it was used on children.  Hospitals paid millions to reach their goal numbers of elderly patients "allowed" to die on the program (I hear the Mafia pays to get rid of people, too), and there have been many stories of complaints by relatives of how awfully their parents were treated. It's a system that a prominent oncologist called "immoral medicine" and "the most corrupt practice in British Medicine".  We shouldn't be surprised they'd yank treatment from the youngest.  Killing off the young as well as the old is a natural consequence of systems like the UK's. 

The same ideas are encoded into the laws of Obamacare.  This is what the media buzz about "death panels" was about back before Obamacare was passed.  The Complete Lives System, which came from a paper co-written by Chicago Mayor and former Obama Chief of Staff Rahm Emanuel's brother Dr. Ezekiel Emanuel.  The guy who said that he hoped to die by 75 and thought that was the right way to run a healthcare system.  The concept is most easily explained with a graph (pdf warning).

It's based on the ability of the patient to repay society for the cost of the treatment.  An infant like Alfie won't be in a position to pay back taxes for at least 20 years, so they get the lowest priority of treatment of any age group.  Let them die.  Someone over 60 might be able to pay back to society, but the chances they'll pay it back in taxes get lower the farther into retirement they go.

For a concrete example, consider someone needing a kidney transplant and we'll make up that one is 30, one is 5 and one is 70.  A 30 year old working a good job has the best chance of getting one.  Heck, yank one of out of a 10 or 12 year old in for something else and get that 30 year old back to work!  The 5 year old or the 70 year old probably isn't going to be getting a kidney unless one happens to be available.  

I've met people who defend socialized medicine; I'm sure you have, too.  In cases like this, the usual response is to talk to us like we're retards who can't grasp that there's always some sort of healthcare rationing going on and that the experts of the NHS know best.  There's tons wrong with the way health care is done in the US, but I've never read one thing about the NHS that made me say, "I have got to get me some of that!"


EDIT to add, 4/28 1042 EDT:  Alfie has passed away since this was posted last night (our time).  The State wins again and grinds on.

Seems Like This to Me

Lisa Benson's summary of the Obamacare story.

Like I said a couple of weeks ago (about "repeal and replace"): 

Why should we want to replace it?  Why wouldn't we just want to burn it to the ground and do everything we can to create a free market in medical care?   From what I can see, the problem with healthcare is over regulation and a thoroughly broken market because of it.  This brokenness has been building for over a hundred years.  Naturally, anything that took a hundred years to break is going to be hard to unscrew.

While I know the president is going through his campaign promises and ticking them off his "to do" list, Rand Paul is among the most reasonable voices in this whole mess.  Rand says repeal it now because everyone is in agreement on that part, then work on a possible replacement.   According to The Hill, Paul introduced a repeal bill on Thursday:

By introducing the new bill, Paul hopes to repeal the ACA without immediately rushing to replace it. He argued in a written statement that Republicans are much more united on repeal, saying:

“The Republican Party is unified on Obamacare repeal. We can honor our promise right away by passing the same language we acted on in the last Congress."

Paul continued by pointing out that they could replace it later on, saying, “we can have a separate vote on replacement legislation that will deliver lower costs, better care, and greater access to the American people.”

John Hawkins at Townhall.com has a good summary:

Although Barack Obama, Hillary Clinton and the rest of the Democratic Party are guilty of a multitude of sins against America, the worst one was Obamacare. The bill was never popular. In fact, it was so hated that it catapulted Scott Brown into Ted Kennedy’s seat in Massachusetts for a term. The bill was an albatross around the party’s neck and the results were devastating.

During the Obama years, the Democrat Party lost 12 governorships, 900 state legislature seats, 69 House seats and 13 Senate seats.

Why was Obamacare so costly to the Democrats? Because the bill wasn’t bipartisan. Because they sold it with lies. Because it was never popular to begin with. But most of all, they created a system that had a small number of winners and a large number of losers.

So popular, it drove the people in Massachusetts to give a seat that has been under Democratic control since the last ice age to a marginally competent rookie like Scott Brown. It has literally made the Democrats a marginal party.  All they can do is work at screwing up things. 

Look, I'm sure there's a subset of the population for whom Obamacare works.  Someone with an expensive existing condition, or was otherwise so broke and got such good subsidies that they got a winning hand would certainly be happy with it.  As many people have pointed out (including me); getting insurance for a condition you already have isn't the typical risk mitigation role of insurance, it's redistribution of the premiums.  On the other hand, most people were not in that small group and saw their deductibles and premium costs skyrocket.  Retirees are forced to pay for insurance for maternity care they'll never use; non-drinkers are forced to pay for alcoholism treatment insurance, and more.  They completely destroyed what little resemblance health care had to a market-driven system. 

Why should we want a replacement anything at all like Obamacare?  It was designed from the start as socialist income redistribution.  I could do (and have done) days worth of columns on this.  For example, way back in the first year of this blog, 2010, I wrote a piece on Donald Berwick, who had been given a recess appointment to be the Medicare/Medicaid czar in the early days of Obamacare.

Dr. Berwick is now in charge of a program with obligations of 95 trillion dollars (debt clock) - far, far higher than the GDP of every nation in the world.  As far as I can tell, he has zero experience with finances.

Dr. Berwick was not only an unabashed fan of "death panels", but of socialist redistribution of wealth.

"Any healthcare funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent healthcare is by definition redistributional," said Berwick. ...  Is health insurance redistribution?  I voluntarily pay into a system that will pay benefits to any member based on the money it collects from the members of the plan.  I fail to see that being socialist.  So if insurance isn't "just, equitable, civilized, and humane" what exactly is he advocating?  Taxing you to pay for other people.  Government, as Washington said, is force.  Try not paying your taxes, and if you're not a member of the administration (e.g., Timothy Geithner), how much do you want to bet that you eventually don't get a gun pointed at you?  No, this is not humane, it is theft.  

One of the architects of the law was Rahm Emmanuel's brother Ezekiel, who argued we should all die at 75 for a handful of egotistical reasons.  Another was Democratic street thug organizer and scumbag Robert Creamer, who came up with many concepts for Obamacare while in Federal Prison in the mid '00s. 

It is such a fetid cesspool of legislation it should be torn up from the ground up.  There's no reason to want anything like it at all.

I Don't Get the Whole "Repeal and Replace" Bit

My version goes like this.  Picture your doctor telling you that you have a tumor that's destroying your {insert organ name here}.  Then he tells you the treatment is to remove it and replace with a different tumor.  Who wouldn't say "WTF???" to that?

Why should we want to replace it?  Why wouldn't we just want to burn it to the ground and do everything we can to create a free market in medical care?   From what I can see, the problem with healthcare is over regulation and a thoroughly broken market because of it.  This brokenness has been building for over a hundred years.  Naturally, anything that took a hundred years to break is going to be hard to unscrew. 

(Michael P. Ramirez cartoons). It's going to feel this slow no matter what, but the Stupid Party pulled a major stupid by passing House bills to end Obamacare over 40 times, but not bothering to have a backup plan ready to drop in place.  It's not like they haven't known since November 8th that Trump was going to be president and this was high priority.  Obamacare wasn't written after he was inaugurated, it was written in advance; parts of it years in advance.  It was deliberately and strategically made hard to repeal. 

The stunning reminder to me of how fubar everything is was in a short story about California Senator Kamala Harris on the Blaze.  There have been reports that the coming reform cuts federal payments for Medicaid.  It boils down to this astounding statement.

But according to Harris, the Medicaid rollback would be detrimental to Californians because “1 in 2 Californian children depend on Medicaid,” the junior California senator tweeted Friday.

Half of the children in California are on Medicaid?  Half?!?  I don't think you could find a bigger indictment of California or of Democratic policies than that.  Unlike Harris, I don't define success as having half the population on welfare.  Success is getting them off welfare. Something needs to be done for those children, but is the solution to enlarge the welfare state or direct efforts to getting them out of poverty? 

Few people alive today have any memory of a working healthcare market; even fewer than the number of people who can envision a world without constant inflation.  There was a great interview last week, on Tucker Carlson's show in which the guest, Steven Weissman, former president of Palm Springs hospital in Hialeah, Florida, was making this point about the market being broken and nobody being able to know the prices for procedures or tests.  Go watch that video. 

The First 100 Days - God Save Us From Efficient Medicine

Now that we've had a few hours to digest the political history we've seen made, I think it's not off base to start talking about things that should be done.  Among the things we've heard the most often in the campaign was Trump saying he's going to "repeal and replace" Obamacare. 

I have a better idea.  Burn Obamacare to the ground.  Vitrify the ashes and bury them with nuclear waste.  Salt the earth so nothing can grow in it's place.  It's going to be difficult because Obamacare is economic cancer: it has tendrils everywhere.  Part of the plan was to weave the laws into obscure places.  And, yes, it was designed to collapse and force everyone into single payer.  If that wasn't transparently obvious to you at the start, about a thousand commentators and another million bloggers (including me) told you. After that, get the Federal government out of health care.  Yes, I'm fully aware of Medicare and the promises under it, but Find A Better Way.  Block grant it, privatize it, do something else.  Find A Better Way.  Medicare is on the verge of collapsing now; I know of few doctors locally who will accept new medicare patients because the requirements are odious and the reimbursement rates are low.  Medicare is rife with fraud, as you'd expect when the government has the biggest pile of money.  Stories are easy to find: "hundreds in Miami"; "73 People Charged"; "The $272 Billion Swindle"... for starters. 

You know that you're going to hear that the medical industry needs to get more efficient, but efficiency is close to the last thing you want in medicine.  When you're hurting, or when you get a scary diagnosis, you want responsiveness.  If  you're putting an organization together, efficiency and responsiveness are opposites of each other.  For example, think of your local post office, or perhaps your driver's license office; these are efficient organizations.  You walk in and get into a line of people waiting.  There's a small number of clerks that just works through the line.  They work all the time while you're being 100% unproductive.  Think of calling for technical support.  Those systems manage their call wait time, putting more operators in place when they expect more callers and sending them home if call volume is low.  For contrast, a responsive system is one where you walk in and the workers are sitting around waiting for you.  Ambulance services are often designed to be responsive rather than efficient.   Some of them drive around places in the city where car accidents are common, expecting to be closer to the next call.  If you find a lump where one shouldn't be and your doctor says to get a biopsy, you want responsiveness, not efficiency.  Get it out now, not six months from now when the surgeon has a spot in their schedule. 

Our system costs too much for several reasons, but a big one is that the free market is not allowed to work.  Karl Denninger routinely writes that our system is corrupt because our costs are way out of line with the rest of the world (one example).  I see that as a symptom, not the illness.  The illness is the free market not being allowed to work.  There is no price discovery, the balancing of supply and demand, because the people who pay aren't paying their own money in the same sense as when you buy a TV or a car or something.  In healthcare, there's essentially a handful of buyers: the insurance companies that sell the majority of policies to employers and the Fed.gov.  On the other side are tens of thousands of doctors, hospitals, clinics and so on.  That's not a free market of willing buyers and sellers. 

A sign of the market not working is that you're not allowed to choose what features you want in your insurance and this has only gotten worse under Obamacare.  As a couple we're both decidedly past 60, yet we're required to pay for maternity coverage.  Neither of us is much of a drinker, yet we're required to pay for addictions treatment.  The only reason I can't leave those coverages out is that the Obamacare authors want my money in the pool to pay for that.  When I buy car insurance, I can choose to leave out some coverages, although my state requires some amount of insurance.  Health insurance has gone from protecting you from risk to paying for everything.  Millions of people get their insurance provided entirely or partially by their employer and have come to think some mystical process pays for things, not that their paycheck is reduced by what insurance costs (both their and their employer's contributions). 

It has been said that there are only about three basic different ways of paying for health care: a fully free market, a single payer system like the British NHS or Canadian system where care is rationed by bureaucrats, and a third party system where someone other than the patient pays the provider, so market forces don't really work well and rationing is hardly imposed.  In my mind the fix is more free market and less regulation. Liberals are scared senseless by that possibility because, somehow, the same free market that benefits everything else won't work for health care.  Even though we know for those things that insurance doesn't tend to cover; things like purely cosmetic surgery and LASIK vision surgery, the market has been shown to be reducing costs and improving quality.

From a cost viewpoint, the third system is worst - it's the one we have.  It leads to higher costs which likely means fewer people covered.  A single payer, nationalized system seems to inevitably lead to shortages of care, budgetary problems for the government and (frankly immoral) intricate systems of bribes and kickbacks.  If you want the lowest costs and the most people covered, more freedom is needed.

One of those excellent Cuban hospitals Michael Moore thinks we should strive for. 

Techy Tuesday - Smart Dust

University of Michigan researchers have demonstrated the smallest complete computer to date: the Michigan Micro Mote.  They estimate 150 of them would fit in a sewing thimble.

“To be ‘complete,’ a computer system must have an input of data, the ability to process that data – meaning process and store it, make decisions about what to do next – and, ultimately, the ability to output the data,” says David Blaauw, a professor of electrical engineering and computer science at the University of Michigan. “The sensors are the input and the radios are the output. The other key to being a complete computer is the ability to supply its own power.”

Think of these as smart sensors.  With a power source, sensor and radio link, these could be used in places where it's too difficult to get something bigger.  Early talk is using these for medical purposes: monitoring processes inside the body, as well as conducting EKGs and detecting and monitoring tumor growth.  If you're of a certain age, you'll recall the 1966 film Fantastic Voyage.  It's not a miniature submarine with an equally miniature Raquel Welch in it, but the Micro Mote can actually be injected into the body to perform some of these functions.

Here's one perched on the rim of a nickel.   You'll note the glaring absence of a keyboard, mouse or monitor.  Instructions are sent to the Micro Mote by flashing a light at it (On Off Keying).  The output comes over the radio link, which they say is short range, on the order of 2 meters. 

The biggest problem in creating these dedicated computers is power.  The Micro Mote includes a "solar cell" which produces enough power to run the computer even indoors.  With a 1mm² solar cell producing 20nW (20 nanoWatts, or 20 billionths of a Watt), the device can harvest enough energy under ambient light to run perpetually. The device’s standby current consumption is 2nA - 2 billionths of an Amp - claimed to be about one millionth of the standby current in typical cellphone. 

The University of Michigan website has some ideas on interesting uses for "smart dust".  I think we can count on some of these being developed!