Denial drives the cost of Health Care

In case you missed this essay by Charles Hugh Smith Being Healthy is Unprofitable

There are two Americas.  Half of America brushes their teeth, takes their vitamins, exercises, eats healthily, gets almost enough sleep and is blessed with "average" health.  They consume, on average, $236 of medical care per year.

The other 155 million Americans consume, on average, 100 times more medical care per year.

I have four children.  Imagine going out to lunch.  I give two of them $1 for lunch and the other two I give $100.

The government has a solution.  They passed a law that requires everybody to buy a $12,000 per year health insurance plan.  Then, they pass a law that subsidizes the costs for low income families so it only costs them $400 per month....

Not much of a favor if you belong to the half of America that incurs only $236 per year in medical costs per year.

To be really plain-spoken about the government solution, they did not address the costs.  They played a shell game to make it look more affordable.  They moved much of the cost from Peter-to-Paul and they moved the out-of-pocket from the individual transaction to a monthly bite.

Denial

We are all going to die.

It is not a choice.

It cannot be avoided.  Even trillionairs will die.

The best we can hope for is to be at peace with our Maker, our family and to leave an enduring legacy.

Skin

Some people have far more "skin" in the game than others.


About 9% of Americans are diabetic and you can bet that nearly every one of them thinks the current system is way better than what it replaced. ($14,000/year)

0.3% of Americans are HIV positive ($25,000/year drugs)


About 0.1% of Americans are on dialysis. ($80,000)

And we wear out as we grow older.  Like a 100 year old house, the wiring and plumbing are marginal at best, rotten and decayed at worst.  Plumbers hate quoting work on old houses.  There is just no way to know the scope of the project because you cannot know how much pipe you will have to replace before you get to sound piping.

Dilution of responsibility

Clarity is difficult to achieve due to the diluting and clouding effects of sharing risk.  It is easy enough to remove this distortion.

Suppose one had enough money to set up each grand child in a profession, be it welder, hair cutter, accountant or thoracic surgeon as bet fit their abilities.  Now suppose you are on your death bed and the Grim Reaper offers you a deal:  he will allow you one more agonized breath if you hand over your grand children's future.  Would you do it?


I propose that most people would opt to protect their grand children's future at the cost of one less breath in this mortal plane.

Furthermore, I believe that most people would be willing to give up six months at the end of their life provided they have come to terms with their mortality and made peace with God and their family.

Martha

Martha (not her real name) was the mother of my closest friend in high school.  In her late eighties she was in slow decline due to a heart condition.  Her doctor projected that she had six more months.  It would not be painful.  She would sleep more.  It would be harder to wake up in the morning.  It would be harder to keep her extremities warm.  He anticipated that she would be lucid right up till the end.

But there was a procedure...it was risky for somebody in their late eighties but it would probably add two years to her life.

Her response was, "What the heck.  Why not?  Let's go for it!"


The operation was a success.  A success, that is, as defined by the surgeon.  She did not die on the operating table.  She died in recovery.


It was a success from the stantdpoint of the accounting department.  The surgery created billable events so they could amortize assets with excruciatingly high fixed costs.

Fixed costs

Herein lies much of the problem.  The world is filled with plucky eighty year olds who figure, "Why not?"


The medical industries ability to create "billable events" at will creates much greater return-on-investment than any other industry.  Go down to your local car dealership.  Ask them how much money they could make if they could conjure up customers at will.  Ask them how much money they could make if every department was fully scheduled around-the-clock.

That unwordly return-on-investment attracts more money which is sunk in......more fixed cost.  Which requires more Marthas and more "successful" surgeries.  The true cost of healthcare will not abate until enough Marthas opt for the graceful, 6 month coast-down at the end of their life.  Enough Marthas such that the return-on-investment sags below alternative investments and the sick-care industry stops attracting hot money.


Only then will fixed costs attrit out faster than new capacity is added.  Only then will sanity return.

Running

I subscribe to the belief that civilization would not have happened had it not been for the effect that women have on men.  If, by some biological quirk, men were able to reproduce without the assistance of women then civilization would have never progressed beyond the stage of banging rocks together to create sparks.  From a guy's point of view, how can it get any better than being able to remotely ignite flatulence?

Daughters

Of course, it is not just "mates" that motivate us.  It is all of the women in our lives.  My oldest daughter will be visiting us soon.

She runs.

She expects me to run.

History

I started running when she was a freshman in high school.  "Old" Mr Smith was the Cross Country coach and he is a sly and crafty old dog.  He looked out over the ninth grade class of Business Economics and he announced, "I am the Cross Country coach and I am looking for  9th grade women to join.  Are there any women here who enjoy running and hanging out with a nice group of high school boys and women?"

My daughter's hand shot up.

I am protective of my kids and I did not want her to run alone.  Following her in the truck when she ran had issues.  Problems occurred on the hills.  She did not speed up enough when running down hill plus it was difficult to modulate the speed as she went uphill.  And she hated it when I started honking the horn to encourage her to pick up the pace.

Finally, she laid down the law.  No more truck.  I had to run with her.

Stress relief

Once I got "tuned in" I was surprised to find that it was excellent for stress relief.

The company I worked for eventually applied for Chapter 11.  Our fixed costs were like a black hole insatiably sucking up assets.  Attempts to get control of those costs were always too little, too late.  During those last years of working my work assignment changed 12 times.  Each closure of a facility involved another case of musical chairs.

Two of those changes involved longer, daily commutes.  In one case it was a split shift (10 hours on first shifts Friday/Saturday, 10 hours on second shift Sunday/Monday) 74 miles one-way.  In another case it was at a factory 94 miles one-way and they worked seven days a week.  There was no shortage of stress.

And running helped.

Retirement

Well, much less stress....and I stopped running....and I gained weight.

My daughter saw a recent picture of me in social media.  I did not put it there.  She was aghast at my beer belly.  She did not believe me when I tried to pass it off as the effect that gravity has on men's chests.  She promised me a week of boot camp the week she is visiting.

So I started running again.  A little bit.  It is that men-women-expectation-stepping up thing mentioned in the first paragraph.

Today I ground out 4 miles.  I lost a lot of speed.  Before I retired I could mindlessly churn out 9:30 minutes-per-miles and I could do it for 9 miles.  That is still not very fast but it is faster than I can go now.  Today I managed 11:20 minutes-per-mile.

I anticipate picking up speed as I lose weight.  Right now I am holding steady for weight but my body composition is changing.  I can poke my thigh and tell the difference.  I like that.

Friday

I pick up my daughter on Friday.

This was my last run before picking her up.  I am sore and stiff.   I have a couple of recovery days before boot camp starts. I might be able to survive if I can get her talking while we run.  Maybe she won't notice I am gasping for breath if she is yacking away.

I just hope she runs with me rather than following me with the truck.

College degrees

Number of students who received a Bachelor's degree in the United States for specific displines

Source of data

It was my intention to include a visual that linked discipline to typical pay but that proved impossible.

In some cases there are solid linkages between the name of the discipline and the Bureau of Labor Statistics labels.  Business is a good example of this.  Perhaps most of the people who graduate with a Bachelor's in Business find a job in Business.

In other cases a Bachelor's degree has almost zero brand value.  Two or three results are likely to occur.

One is that the student pursues a Graduate degree.

Another path is to pursue jobs outside of their field.  That artificially inflates the averages wages reported by graduates.  Psychology majors working at fast food restaurants do not get listed in the statistics as "Psychologist".  That statistical quirk is sometimes called "survivor bias". This path is often combined with the first path.  A Psychology major might easily decide to pursue a Law degree after being exposed to the withering job market for Psychology majors.

The third path is to nibble away at part time gigs until they have a fat Curriculum Vitae and land a job.  My closest friend from high school pursued a career in Fisheries and Wildlife.  He landed his first full-time job with benefits at the age of 37.

Follow your heart

I sat through Belladonna's commencement ceremony.  Yup, nearly every speaker advised the graduating students to "follow their hearts."

This advice would be OK  if the student first filtered their probable paths based on

• Job availability 
• Starting wages
• Availability of fall-back professions

The last bullet refers to the fact that there are not many alternative careers for students who are tracking for tenure in Romance Languages at an Ivy League University.

Most tragic are first generation college students who simply do not know better.  They lack family who have been-there/done-that.  They are poorly served by the Education community.

A few pictures from the day

Sometimes it sucks to raise animals.  Losing one to a predator is one of the suckiest parts.

Something dragged him 40 yards from the pen which had not been secured.

Potato patch before tilling

Potato patch after tilling.  Many of the taller weeds are milkweed. I have a weakness for milkweed.  In my eyes, not all weeds are created equal.  Milkweed makes a pretty fair pot-herb and is the larval food for Monarch butterflies.  The flowers smell delightful.

The bench is coming along.  Mrs ERJ seems to be happy with how it is coming along.

A close-up of one of the slats showing the grain.

One of the ends looks a little tipsy and it might be bowed to boot.  I will deal with that tomorrow.

What does the Bible say about "Blogging"?

As an active reader of the Bible I know that there are many issues that the Bible is silent about.  Some actions are morally neutral and do not merit commentary from the Bible.  Examples might include favorite sports teams, drinking from the bottle verse decanting to a glass, shaken vs. stirred.

There are other issues that, while not explicitly mentioned in the Bible, are subject to its guidance.

One of the factors that makes the Bible a robust instrument for guiding moral behaviors is that it includes enough context so that its guidance can be extrapolated to technologies that did not exist in Biblical times.  The Bible often tells us WHY in addition to WHAT.  In other instances, the objects being discussed are sufficiently distinct that one can safely generalize.  An example of this is Deut 20:20 Rules of siege....trees

Are the trees of the field human beings, that they should be included in your siege? However, those trees which you know are not fruit trees you may destroy. You may cut them down to build siegeworks against the city that is waging war with you, until it falls.

A fruit tree is an element of critical, durable infrastructure.  It might take half a generation to come into bearing.  It would be easy to destroy those trees in the passion of war...camp fires...war engines.  But then the livability of the besieged city would be vastly diminished by the damage inflicted upon the city's resource base.  It would become a prize not worth having.

That verse can be generalized to something like:  "Even when in the grip of anger, do not inflict damage that will impair any person's long-term ability to feed their family"  Don't destroy his tools.  Don't diminish his professional credibility.  Don't email his computer a virus.

History rhymes

I am currently chewing my way through the book of Ezekiel.  The following text is very heavily trimmed to eliminate redundancy and to make it easier for the casual reader.

From Chapter 7, starting about verse 10...

The day is here! Look! it is coming! The crisis has come! Lawlessness is blooming, insolence budding; the violent have risen up to wield a scepter of wickedness. But none of them shall remain; none of their crowd, none of their wealth, for none of them are innocent.  The time has come, the day dawns. (Does this sound like any of the cities that have been in the news?)

The buyer must not rejoice, nor the seller mourn, for wrath is coming upon all the throng....They fling their silver into the streets, and their gold is considered unclean. Their silver and gold cannot save them on the day of the LORD’s wrath. They cannot satisfy their hunger or fill their bellies, for it has been the occasion of their sin. (Sometimes interpreted to mean that commerce will cease with a minor riff on gluttony.)

In their beautiful ornaments they took pride; out of them they made their abominable images, their detestable things. For this reason I will make them unclean.(Tats and piercings?)

I will hand them over as spoils to foreigners, as plunder to the wicked of the earth, so that they may defile them. I will bring in the worst of the nations to take possession of their houses. I will put an end to their proud strength, and their sanctuaries will be defiled. (Who owns US debt???)

From Chapter 9

...and the LORD said to him: Pass through the city, through the midst of Jerusalem, and mark an X on the foreheads of those who grieve and lament over all the abominations practiced within it. ("...grieve and lament"  Sounds like bloggers to me.)

To the others he said in my hearing: Pass through the city after him and strike! ... do not take pity. Old and young, male and female, women and children—wipe them out! But do not touch anyone marked with the X.

So, there you have it.  Only bloggers will be spared in the coming apocalypse.

It depends on whose ox is being gored

One of my coffee drinking buddies suggested that all of the arguments used to restrict and criminalize gun ownership can also be applied to cell phones.  In case you have not been paying attention, cell phones are the number one cause of "distracted driving", a condition that kills many innocent, young children.  Unlike firearms, cell phones are not mentioned in the Bill of Rights to the United States Constitution.

The point I liked best was that the POTUS should criminalize texting or calling any time a cell phone is in motion.  Nearly all of these devices have GPS and acceleration sensors.  They are "smart" devices and the function can be embedded within them. There should be an executive order mandating that all cell phone should shut off when in motion.

The fact that many people on the East Coast use mass transportation  and *could* safely use their cell phones while moving is irrelevant.  The chances of incorrectly activating a phone is simply too great.  They should also be shut off, just in case.  They will just have to suck-it-up for the greater good.

It is for the children.

Grafting season is done

Mrs ERJ is happy to have her refrigerator back.  I have one or two small bags squirreled away in there but I am calling an official end to the 2015 grafting season.

As noted earlier, I had no takes on my "Davidson" Black Walnut grafts.  So I followed up with scion wood that I think is a variety called "Sparrow".

Hope springs eternal

Hope springs eternal in the gardening game.  I left the "Davidson" grafts in place and I used "approach" grafts to place the "Sparrow" lower on the stem.  Everybody does things a little bit differently.  These pictures capture how I have been doing approach grafts.

Tree with "Davidson" graft on top.  Paper bag was to improve warmth.

Tree after bag and sprouts were stripped away.

Looking down on the cuts made in the rootstock

Not a very good shot.  Looking down on graft.  Tree is light gray.  Scion is chestnut brown.  The stem of the rootstock is a couple of years old as indicated by the light gray color of the bark.  The bark on the rootstock is thicker than the bark on the scion.  That is why the scion is slightly off-set inward relative to the rootstock.  The grafter attempts to match up the interface between the outer bark and the wood.  That is the only portion of the tree that will knit together.

Wrapped with a rubber band.  Righty-tighty.

Then a wrap of masking tape.  The tape is primarily for UV protection.  Sunlight shreds rubber bands within days when stretched tightly.

And then the exposed portions of the scion were covered with ParaFilm.

I had a pleasant surprise on one of the trees.

It looks like this "Davidson" scion might take off and grow

That is one reason to leave the original graft undisturbed and to add the approach graft.  I might still get lucky with the "Davidson".  If I can get one good graft to go then I will have a source of scion wood for grafting in future years.

My initial impression is that "Davidson" has exceptionally dark bark...almost the color of fudge.  I may have been mistaking that darker color for dead.

To be continued.

After care

 

A tree tube with a grafted persimmon (H-120) inside.

The persimmons are pushing now.  The red-white-and blue metal at the bottom of the photo is a beverage can that is an ID tag.  Beverage can material embosses when placed atop a stack of newspaper and written upon with a ball-point pen.

All of those little, green boogers have to be stripped off and then the tree tube installed.

Each of those green boogers produces auxins that inhibit the buds on the scion from pushing.  They also short-stop moisture and nutrients that could be growing that graft.  And, in time, the sprouts would out-run the graft and shade it.