Ian Welsh

The horizon is not so far as we can see, but as far as we can imagine

Category: health care Page 1 of 35

Yes, Denial Of Care Improves Profits For Health Insurers

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On December 5, 2024

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Insurance companies generally have a loss ratio: a percentage of income from insurance policies they must pay out. In health insurance this percentage varies: it’s lower for individual plans, and higher for group plans. Most commonly it’s 80%.

If they pay out less, in many cases they have to return the difference to policy owners. (Not always though. Often with Medicaid, for example, this isn’t the case.)

This doesn’t mean that they have no reason to deny care, however. They want their health care costs as close to that bottom number as possible without going past it.  If they spend, say, 83% rather than 80%, that will cost them billions. Denial of care is meant to get the margin as close to to loss ratio as possible.

This also means that the best way to increase gross profits (not the percentage, but gross) is to sell as much insurance as possible. Eighty percent of a 2X is more than 80% of X.

So the incentives align such that the best way to make money is to sell as much as possible, then deny the necessary amount of care to get as close to the loss ratio as possible.

It should not need to be pointed out that Americans, as a group, are a very sick people: lots of obesity and chronic illness and in this age of Covid, long Covid and the rise of illness caused by post-Covid, more and more denial of care will be required to hit numbers.

Insurance company profit ratios hardly move in percentage terms. But making more money is still better, and the more money they make in gross terms the larger executive salaries, bonuses and stock options can be.

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Why Assisted Suicide Bills Will Proliferate & Deaths Will Increase

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On November 25, 2024

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Nothing saves money on people who are old, disabled and unable to work like just killing them.

Covid killed mostly old people. That saved the government money in the long run, although in the short run it was expensive, except for Sweden where they just euthanized their old people with Covid instead of treating them. (Gave them opiods even when they had enough oxygen and drugs.)

Since Covid, however, there’s been an unfortunate increase in people who can’t work because they’re chronically ill.

This isn’t hard to understand. Britain is massively importing young people who can work, or older people who have lots of money, but at the same time the number of people who are liabilities, financially speaking, is exploding. If you have a liability the easiest way to get rid of it is to… get rid of it.

Canada’s in the same boat, and these bills will spread.

Assisted suicide isn’t automatically a bad thing, mind you. If people were properly supported and cared for I’d support it. People who are in a ton of pain and won’t get better ought to have the option.

But when the government is whining about benefits and cutting them, as in Britain, one doesn’t expect this is being done from a humanitarian impulse. And the medical and social workers, in hospitals and palliative care centers that are overstretched and don’t have enough nurses or doctors or beds, well, convincing someone who’s taking up time or a bed to just die already will have to be pretty tempting, sometimes even with somewhat good motives: to free up resources for people who can be cared for.

But, of course, what will often happen is that chronically ill people or homeless types who could live for quite a long time and with proper care could be fairly happy will wind up dead because in Britain and Canada we don’t help them enough: to get enough housing, food, help and pain meds (given the way we’re so scared of opiates.)

Wikipedia lists some known cases of abuse of the law:

  • In 2017, a mother of a young woman with cerebral palsy was told by a doctor that not applying for MAID was “selfish”. Her daughter was in the room when the conversation took place and described the experience as traumatic.[71]
  • In 2018, Roger Foley was being treated for cerebellar ataxia at an Ontario hospital. Foley alleged that his only options were to be forcibly discharged from the hospital and then treated by an organization that had previously failed to provide him adequate care or apply for MAID. Foley hired a lawyer for a charter challenge.[72]
  • In 2019, Alan Nichols successfully applied for MAID while being hospitalized for suicide ideation. The reason given on his application was hearing loss.[1]
  • In September 2021, Rosina Kamis, a 41-year-old Malaysian woman, applied for MAID citing fibromyalgia as the reason. However, in conversations and recordings shared with friends, she mentioned financial hardship and social isolation as additional factors influencing her decision.[73]
  • In February 2022, an anonymous Torontonian suffering from extreme chemical sensitivity syndrome with the pseudonym Sophia had a medically assisted death after failing to find affordable housing that was free from tobacco smoke and other chemicals.[74] This case was addressed by her health care provider in testimony provided to the Special Joint Committee on MAID, and was referenced in their final report.[75]

One can safely assume there are many, many more. The fact is that even doctors and social workers think some lives are worth more than others. No one who’s spent time in the medical system believes otherwise.

The West is in decline. Our elites are wedded to austerity as a “solution”. They often, probably usually, feel that people who are non-productive are useless eaters and a burden on the state.

That combination is going to lead to a truly vast expansion of measures intended to get people off benefit rolls.

In a way assisted suicide, or euthanasia, is the most honest of those policies and maybe even the most merciful. There’s nothing honest about deliberate policies which make people homeless, leading to most of their deaths, after all. Politicians know that winding up on the street long term is essentially a death sentence, they know that policies like mass immigration without increasing the housing supply to match will cause homelessness, so they know their policies cause homelessness and death but they can pretend it’s an unintended side effect.

Just killing people is at least not hypocritical.

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The Most Important Issues Facing Humanity

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On November 19, 2024

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There’s been a lot of attention, much of it apocalyptic, paid to Trump’s election, but Trump is just a symptom of one of our three main issues.

In order of importance, they are:

  1. Climate Change and Ecological Collapse;
  2. Mass disabling, largely due to Covid; and,
  3. The End of the Western Era, and the collapse of American hegemony.

If we manage a nuclear war during the collapse of American hegemony, it’ll turn out to have been the most important issue, but I’m betting we’ll avoid it. If I’m wrong, you won’t be able to tell me so.

Warming continues:

But just as important as warming is the collapse of biodiversity, loss of habitat and species. We are able to live and live well because other species form the network of life, which keep the atmosphere breathable, soil fertile and feed us. Worse, we just don’t understand these systems, we can’t create the simplest of biospheres: if it goes awry, we will have a hell of a time fixing it, and the loss of genetic diversity means a vast swathe of scientific advances will be cut off, especially medical advances.

(The below are from 2018, the situation is accelerating, and will be worse now.)

Average case scenarios for climate change and ecological collapse mean billions of deaths for humans a world with a significantly reduced carrying capacity. Recovery, especially of species, will take so much time that on the human timescale, it might as well be “never.”

Meanwhile, the Covid epidemic continues and we’re at risk for other viral plagues. If Covid just killed people, that would be bad, but the mass disabling is a huge problem and even people who aren’t symptomatic have suffered real damage.

This chart is from 2023, so it’s behind the curve, but it indicates the issues. (UK)

There’s no particular reason to expect this to end. We aren’t doing anything about Covid. Here’s a projection chart:

Having to care for large numbers of disabled people at the same time as everything else is going to shit is… bad. Very bad. There’s a reason why assisted suicide is becoming legal.

We could do something about Covid. Many things. But we refuse.

The End of the European Era is probably a good thing, but world hegemonic transitions are nasty. The last one led to two world wars. The Chinese are striving mightily to avoid “Thucydides trap.”

The Ukrainian and Gazan wars, plus the Yemen blockade which is part of the Gaza war are best seen as part of the death throes of the American empire. But it’s not just America which is losing power, Europe is shedding industry, has fallen behind on technology and is in serious, probably terminal decline.

The Western era, which is four to five centuries old, depending on how you count it (the case for 4 centuries is that in 1500 the Ottomans and Chinese were still vastly powerful) is coming to an end. China is re-taking its place as the most important nation in the world. I’d argue it has already done so. Russia, which has been Europe facing and European aspirational for centuries now looks East and is a junior ally of China’s.

China doesn’t want war with America. It doesn’t need a war. Absent a war, it’s already won, it just has to sit back and watch America continue its decline. Trump is not going to “make America great again”, that ship has sailed. What needs to be done to make it happen are policies (including real industrial policy and a collapse of asset prices and rent, plus increases in real wages) which are anathema to most of America’s elites, and which, in any case, they are incompetent to implement.

But hegemonic powers rarely go easy into that long night, and a world war is entirely possible. American elites don’t want to lose their pre-eminence, and they still have a powerful military (or think they do) and a lot of nuclear weapons.

So this transition period is one of great danger, potentially for everyone in the world.

These are the three big issues, everything else is trivial in comparison. Trans rights, wokeism, AI… whatever, are all rounding errors on these three issues.

 

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***

The worst of it is that we’re not going to handle the first one: climate change and ecological collapse. We’ve already made that decision. Even if we immediately started doing everything right, they’re now self-reinforcing, and we aren’t going to do everything right. Trump, after all, ran on drill, drill, drill. The Chinese are doing more than anyone else, with a massive build-out of renewable energy, but their system is still an extractive and polluting industrial economy with massive freeways and so on.

The only “good” sign is one that many are bewailing: collapsing birth rates. Human population is in clear overshoot, and it needs to be reduced. Yes, in theory we could increase Earth’s carrying capacity so that a massive population decrease wouldn’t be necessary, but we’re not going to.

Ecological issues are in the bucket of “fix them or nature will fix them for you” and we’ve chosen not to.

Keep these three issues at the forefront of your mind, your analysis and your planning for your personal future. Compared to them, everything else barely matters.

Pharma Charges 80K to cure Hepatitis C. The Manufacturing Cost is $78

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On September 6, 2024

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Yeah.

Unlike many other drugs that treat viruses, Sovaldi does not suppress hepatitis C, a virus that kills roughly 250,000 people around the world each year. It cures it.

“Normally you have a virus, and your body fights it off or your body fights it to a standstill and you just have it forever, basically, and hope it remains dormant more or less,” Laufer said. “The holy grail for every virologist is to find a way to drain the viral reservoir, and Sovaldi does this. You take one pill of Sovaldi a day for 12 weeks and then you don’t have hepatitis C anymore.”

The problem is that those pills are under patent, and they cost $1,000 per pill.

“Literally, if you have $84,000 then hepatitis C is not your problem anymore,” Laufer said. “But given that there are other methodologies for managing hepatitis C that are not curing it and that are cheaper, insurance typically will not cover [Sovaldi]. And so we’ve got this incredible technology and it’s sitting on the shelf except for people who are ridiculously wealthy.”

So Four Thieves Vinegar Collective set out to teach people how to make their own version of Sovaldi. Chemists at the collective thought the DIY version would cost about $300 for the entire course of medication, or about $3.57 per pill. But they were wrong.

“It’s actually just a little under $70 (83 cents per pill), which just kind of blew my mind when they finally showed me the results,” Laufer said. “I was like, can we do the math here again?”

So, the laws should be changed and every pharma exec, board members and so on who prices like this should be locked up for life.

Next, all laws need to be changed to end the doctrine that only profit maximization for shareholders matters.

Third, pharma needs to move a bounty system. According to WHO there are 58 million people with Hep C around the world. Put up a bounty of 1,000 times that: 58 billion, for a cure, minus the cost per cure. Research costs can also be added to the bounty, once the cure is certified, not before. A consortium of rich governments can create the bounty funds, with poorer countries allowed in for free. A UN org reporting only to the general assembly should probably administer it.

Fourth, end pharma patents. All of them. All information, including manufacturing information is shared.

Fifth: for all palliatives, profits must be capped at 5% max.

Sixth: move most research to government and non-profits. Real non-profits, none of the Chat-GPT nonsense.

Seventh: remove further monetary incentives to just research forever: everyone involved is capped at a salary of 2xmedian income in the G-20 or something similar. You want the big pay off? You have to actually cure the disease.

Eighth: Force scientists and technicians to be “in on the bounty.” Some sort of fairly even split between people who worked on the cure.

There are other actions which should be taken, but these are the basics. Right now we aren’t curing people we can, and companies prefer palliatives to cures because they can charge until the person dies. We need to emphasize cures and make sure no one gets rich selling palliatives.

In the meantime the right to make your own medicines needs to be 100% legal and supported.

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Apparently Covid Didn’t Get The Notice That’s It’s Cancelled

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On July 12, 2024

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I sometimes think the defining characteristic of our age is reality denial:

I suppose 1.37% may not seem high, but the point is that Covid just keeps rolling along. Each time you get it, odds are that it’s doing some damage to your organs, including your brain. Most of that is sub-perceptual, it doesn’t qualify as “Long Covid”, but it’s there. Then you get it again, and again, and again.

Meanwhile, in Britain:

I’m sure Labour’s program to get the back to work will do nothing but make people miserable. That chart doesn’t suggest “malingering.”

Spain’s numbers are particularly interesting

Now what’s visible here is that the numbers keep increasing. The long Covid continues to circulate, the higher the disability numbers. This is exactly what I’ve been predicting for years: as time goes by, people get Covid again and again. Eventually that causes enough damage to cause long term illness or disability.

I shudder to think what it will mean for kids, since those in school get Covid the most often. Since they’re young they have more resistance, but I’m willing to bet (and will not be wrong) that this will show up in very high illness and early death numbers as they age.

The solution to all this is fairly simple: we need to clean our air up: filtration, UV and so on. This isn’t that expensive, although it has to be done in all buildings. Numbers drop, once they’re fairly low, stop all non-essential travel for three months or so and track and trace. Do this is a group of countries and permanently ban travel from any country that hasn’t done it, until they do.

Yes, there is a cost to this, but it’s a lot less than the cost of having more and more disabled and sick people.

Covid is still a big deal, the only thing that’s a bigger deal (unless we have a world war) is climate change/ecological collapse. And we are failing to deal with an issue which is relatively simple because we won’t take a small percentage of our manufacturing and building capacity and refit all buildings to clean the air, then make such air cleaning permanent going forward. This is exactly what we did with water, in the past, to stop disease spread, but our current society is sclerotic and stupid.

This is true everywhere. China’s ZeroCovid policy was the right thing done STUPID. If any country had the capacity to clean air it was China, but they just stuck to shut-downs till the public lost patience.

It’s dismaying to live in societies where we know what’s wrong, we know how to fix what’s wrong and we simply refuse to do what is necessary.

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How To Stop Half-Assing Drug Policy & Actually Reduce Overdoses

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On April 9, 2024

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Oregon recently ended a law which made drug possession for use a ticketed offense with a fine of no more than $100. The reason claimed is that overdoses have been soaring.

No surprise. The modern drug supply is a mess: in most cases users don’t know what they’re buying and it’s often cut with fentanyl, which is incredibly potent. It doesn’t take much to throw a user into an overdose and kill them. (Black tar heroin is often an exception, if it’s available where you are and you use, use that.)

The dirty supply, plus increasing use due to economic despair and social alienation, are behind increasing drug deaths. You can’t solve that with half-assed decriminalization.

Instead you have to offer a clean supply, which means thru government and government approved and inspected suppliers. That has its own downsides, but it’s the only way to make sure people know exactly what drugs they are taking and in what amount.

When articles are written about legalization, they’re almost never actually about legalization: they’re about de-criminalization: there is no clean supply.

The other problem is that stronger drugs replace weaker when they are criminalized. This is a well known, well studied sociological fact. Pot in the 60s and 70s was FAR less potent than it became over decades of illegality. Fentanyl, though invented legally, is so much more potent than heroin by weight that it’s far easier to smuggle: but also far easier to overdose. (And heroin is more potent than morphine, which is more potent than codeine and so on.)

Treat drug use as a medical issue. Sell it thru pharmacies, over the counter. Keep the information on drug use 100% confidential, so that people are willing to be honest about it, and make it illegal to fire someone for drug use that isn’t effecting their job performance.

If you want to keep some drugs illegal, make them the harder ones: meth and fentanyl, for example. If you offer morphine, codeine and opium, you may find that many people don’t move up the scale. And manufacture properly: I’ve never tried Meth, but I’m told by old timers that before it was made illegal and hard to buy the precursors, it was a lot less harsh: one might go back to that type of meth, or back to older forms of “uppers.”

People will have their drugs one way or the other. If you want to reduce deaths, especially in the current environment, you need to keep the supply clean or you need to go full totalitarian, Maoist style.

Since that isn’t happening, give legalization a shot. Start with simple uppers, codeine and morphine. No weird pills, just clean and simple.

If it doesn’t reduce deaths, well, you can criminalize again. But the current methods aren’t working, and we’ve been trying the “war on some drugs” for almost fifty years now: longer for opiates (which were legal throughout the 19th century.)

Oh, and if you actually want to reduce the number of addicts fix the economy so that ordinary people have good jobs they can live well on. If you insist on running the economy to make people miserable, many of the will reach for drugs.

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Why Every Society Failed The Covid Test

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On January 22, 2024

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I’m going to keep this one brief.

At the start, Covid could have been stopped with travel bans, track and trace, mandatory isolation and lockdowns.

The problem with how everyone did lockdowns is that they did them too late. Instead of starting lockdowns when hardly anyone had Covid BUT R was over 0 (one case of Covid was spreading to more than one person) they would wait until the numbers were high. As a result lockdowns were long, but never actually crushed Covid and over time support for lockdowns was lost.

But the real problem is that controlling Covid spread required travel bans. Western Australia, which controlled Covid almost completely for over a year, did so by shutting down all non-essential travel. If this had been done worldwide, Covid could have been ended early.

I remember that the first lockdown where I live in Canada happened two weeks after I expected it. I kept looking at the numbers and wondering why weren’t in lockdown already. The only people wearing masks were asian-Canadians. All through the pandemic lockdowns happened three to four weeks after they should have, based on the numbers.

Vaccines were oversold (I’m not getting into the rest of the vaccine debate), economic support of businesses and often individuals in countries was insufficient and organizations like WHO and the CDC bungled their advice over and over again, starting with first claiming people shouldn’t wear masks and then later saying that Covid wasn’t airborne, but was spread by droplets.

The large country which handled Covid best may have been China, with their zero Covid policy. (Which I praised at the time), but they did the right thing stupid: zero-Covid could never continue indefinitely and even when it was done much of it was not done intelligently, like not moving to n95 masks. Most importantly, though, there had to be a transition plan.

China is the premier world industrial power. Covid is airborne. The trifecta of proper ventilation, cleaning air with HEPA filters, and UV light, along with air quality monitors, can be used, should be used and should have been used to make buildings safe again. (In China’s case they also needed to improve their plumbing. Most Chinese buildings don’t have the U curve (P-Trap) which traps smells and gasses.)

So the correct plan is to put air quality monitors everywhere, and to refit all buildings with proper ventilation: air filtration and UV light. Entirely do-able, if a big project. When you put all this in, and your building is inspected, your workers can come back to work even during outbreaks.

China could have done this easiest of all the world’s countries and didn’t.

Now, this is a collective action problem. It requires a correct diagnosis of a problem, a correct prescription of the cure, then taking unified social action. In other words, Covid is:

  1. Airborne
  2. Therefore we need to clean the air
  3. So let’s mass produce the necessary filters, ventilation, sensors and UV and then install them.

Every society failed this.

Now if we can’t do that, what are the odds of us tackling climate change or environmental collapse? Those problems require us to reduce our consumption significantly (possible to do without large hits to standards of living, but that’s another article), which will require us to revamp our economies away from capitalist consumption and figure out how to keep everything running without an economy of planned obsolesence and everyone running on hampster wheels working, buying, selling and dying.

The transition is a hard problem to manage, while Covid was a simple problem with very few moving parts. We couldn’t even manage Covid.

Covid was a test. We failed. We can pass any time we want, its still a solvable problem. Until we do pass the test, there is zero reason to believe we can pass any harder tests.

Some countries did better than others, but none passed the test. When you’re running from a fire it doesn’t matter if you run faster than everyone else if you don’t out-run the fire.

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The Second Most Important Story In The World

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On January 19, 2024

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If you pull way back and take the historical perspective, a lot of stories, aren’t.

I stand second to few in my abhorrence of the Israeli project to ethnic cleanse and genocide Palestine, but it’s been ongoing for a long time and involves about five million Palestinians plus various supporters of genocide and people trying to stop genocide. It’s moving towards the end-game, as Israel loses deterrence because of its military’s sheer incompetence and changing military technology, but it’s playing out more or less as expected: the tiny colonial enclave surrounded by hostile natives is in decline as its super power sponsor is in decline.

The Ukraine war is important because it’s another indicator of the end of the American century and Western hegemony and the first major war which shows how new battlefield tech works in practice. But, pull back a bit and well, it’s just a sign of something inevitable, which is the end of Western hegemony. And that was signed when the US decided to send its industry to China: the actual decision was made back in the 90s.

US internal political shenanigans, like Texas illegally defying the Federal government over immigration and attempts to keep Trump off the ballot and so on are important: but they’re just the logical consequence of American economic decline and of neo-liberal ideology. Don’t decide to become a plutocratic oligarchy by electing Reagan, and none of this happens. Again, the decision was made a long time ago, but also, whatever, the US was never going to be number 1 forever.

The rise of China is also a sort of semi-story. The place that was the technological and economic leader for most of the last 2,000 years is regaining is prominence after a period of decline caused by an unevenly spread technological renaissance. This isn’t a surprise, it’s almost an inevitability. though when and how it happens matters to those of us around when it does.

But Covid is a real story. It’s probably a black plague level story. A virus that badly damages immune systems and which leaves many people crippled but alive. That matters, because it’s changing the cycles. Empires rise and fall, tech breakthroughs happen, are clustered and give an advantage then disperse, and military tech changes in ways which change war, often for centuries, but major major plagues, well, they’re hardly unknown, but it’s been a while and Covid is a big one.

It’s not the deaths that matter so much. It’s the disabling. This lovely chart runs to the middle of 2023.

As for Covid, well, it’s a pandemic. That means it runs in waves.

Ain’t that something? Turns out declaring the pandemic over and the pandemic being over are two different things.

Increasing levels of people not being able to work and needing to be supported is a big, big deal, for reasons I assume are obvious.

We’ll talk more about this soon, real soon, because Covid was a test and we failed as a species, no one handled it properly even though doing so would have been fairly simple. And why we couldn’t handle Covid is why we can’t handle anything else, including the most important “story” or problem in the world.

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