Friday, January 1, 2016

Global Health Crisis

Charles Hugh Smith, a writer who I admire, recently wrote an essay titled The Global Health Crisis will Crush the Global Economy.  In his essay Mr Smith discusses the health impacts and related economic costs of environmental degradation (air pollution, polluted water), overeating and sedentary life styles, aging, smoking and so on.

He ended the piece with a bit of optimism.  "We have agency in this story".

I want to write about an aspect that he did not address:  The darker side of not taking agency.

Incremental value of Human Capital vs. the Cost of keeping people alive

We tend to think of Human Capital as having ever increasing, positive value.

That was a very accurate when the oceans seemed limitless (more fisherman meant more fish caught), the prairies boundless (more sod plowed meant more grain harvested), and science still had much low-hanging fruit (more compounds tested meant more medicines discovered).

Under those conditions the imbalance between the cost of keeping people alive and there marginal value always drove set point for the equilibrium higher.

It is more difficult to make that case, from an economic standpoint, today.  Even in the sciences, there are limits to the size of molecules that can penetrate cell walls and combinations of economically recoverable metals that alloyed.

One more person in the lifeboat is not always a gain.

Passive euthanasia

People who have the very highest per-capita medical costs are those with chronic conditions.  Those chronic conditions make them highly dependent on certain technologies and classes of medications.

Those people are in a position where they are vulnerable to passive euthanasia.  Ultimately, the high cost of chronic illness is self-correcting.  The human with the lowest healthcare cost is a corpse.

Example one:  COPD, Chronic Obstructive Pulmonary (lung) Disease is often related to air pollution and cigarette smoking.  Technologies include CPAP machines and aerosol drug dispensers (inhalers).  Drugs include prednisone, albuterol, bronchial dialators and so on.

You think that nobody would dare reduce availability to these life saving devices and drugs?  You are wrong...they already have.  The Federal government caused the elimination of an inhaler that dispenses pseudoephedrine because it used CFC propellant.  This was the "Eppy pen" back-up of choice.  No comparable product replaced it.

Another example comes from the Affordable Care Act.  CPAP machines are used for sleep apnea.  Insurance coverage became contingent on meeting aggressive usage targets.  Patients who could not tolerate the required pressures were not reimbursed.  Patients who used the devices as-needed (perhaps during allergy season or after visiting a bowling alley) were not reimbursed.  For many patients, this made use of a CPAP machine impossible.

Example two: Patients experiencing kidney failure become dependent on dialysis machines.  Kidney failure is often a co-morbidity seen with high blood pressure or diabetes.  Disruptions in access to dialysis machines will cause people to die.  Those disruptions could be rioting near city hospitals, interruptions in the supply of osmosis membranes, long term power outages.

Example three:  Type One Diabetes. This is the favorite of writers discussing EMP and other events that can cause damage to the Grid infrastructure.  Type One diabetics are insulin dependent.  Insulin is perishable.  Insulin is produced by a narrow base of firms and is subject to logistical hiccups.

I apologize if you fall into one of these groups.  I do not mean to denigrate you.

I want to alert those who have not developed those conditions that it is much better to NOT get them.  Those conditions tend to be chronic and progressive.  As individuals we give up our ability to respond after we become dependent.

Mr Smith calls us to take responsibility for our own health.  Only by taking responsibility for our health will we be able to remain autonomous.

Now you will have to excuse me.  I have to brush my teeth and walk my three miles.

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