Public Health and Welfare Part II – Depletion and Abundance Book Excerpt

Sharon May 29th, 2008

This is the second part of what will be a four part series, the excerpt on health care from _Depletion and Abundance._  You don’t have to read part one, but it will make more sense if you do:

http://sharonastyk.com/2008/05/20/public-health-and-welfare-depletion-and-abundance-book-excerpt/

 The section focuses on the third and fourth myths of high energy medicine.  The next two suggestions will be ways we can triage the health care system – so if you think I forgot something, it might be there.  Or it might not – this is hardly all there is to say about post peak medicine, but because so far there is so little on the absolutely essential topic, my goal is to give a broad overview and a set of broad strategies. 

 One thing I don’t talk about in the book, because I’m trying to present an overview, is strategies for relocalizing drug availability.  Obviously, there are natural alternatives, but for those for whom they are not adequate, we need a better alternative than “sorry.”  I certainly on’t tend towards an apocalyptic vision in which all medicine production disappears – instead, I tend to think that ordinary human poverty will price most of us out of the drug market, the way it already does for billions of the world’s poor.  Obviously, for those who are dependent on medicine, that’s a huge problem.  But one of the fascinating things I found in my research was that some medicines – not all, but some, could probably be made in college or high school chemistry labs, if the raw ingredients were stockpiled.  Later on, I do talk about making a couple of simple antibiotics that way (and both of them have huge downsides, so this is not a way to go unless you have to).  But several research chemists I discussed this with did say that a variety of older, simple drugs could probably be made if power were available to college or even good high school labs.  This suggests that prioritizing health care and education might be even more important, and that building relations with your local chem prof or high school chem teacher might be worthwhile for some people.  It won’t fix everything, of course, there are risks involved, and many medicines are simply not reproducable on those scales.   Which again, argues for collective action and strategies to make sure that basic medications are available.

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The Costs and Benefits of Modern Medicine

In considering the second myth, the first thing we need to do is establish what gains from modern medicine we have received. Our intuitive response to modern medicine is to exaggerate our need for its input in many cases, or exaggerate its benefits compared to the alternatives. By this I mean that modern medicine and modern industrial life do enable us to treat some illnesses better than others but also cause or enable other illnesses to occur more frequently. Were we suddenly to experience a catastrophic energy shortage (something I do not view as especially likely, but will use as a model here), like that which struck Cuba during the special period of the 1990s, we would likely see some illnesses increase and others almost wholly disappear.

Among the medical concerns we would not see, or would see infrequently in a low-energy, relocalized, sustainable society, would be death and injury from car accidents. Right now, 1 million people die annually worldwide from car accidents, and another 7 million are injured or disabled. Car accidents are the leading cause of death for people under 25

Illnesses we would probably see less of in a low-energy society include all communicable illnesses, including things like flu, colds, SARS, and other airborne diseases, particularly those originating in other nations (fewer people traveling means less disease transmission). We would also experience fewer “lifestyle diseases” such as high blood pressure, heart disease, strokes and type two diabetes. All of the illnesses brought on by poor diet and sedentary lifestyle would certainly be reduced. In fact, in the aftermath of the special period in Cuba, a significant rise in lifespan was seen because of increased exercise and better diets.

We would also probably see fewer medically induced deaths. A study released by Health Grades, a private medical quality control group, suggested that in 2000, 2001, and 2002, an average of 195,000 people died from in-hospital medical errors. The study suggested that this number is double previous estimates. In addition, the hospital environment, including inappropriate use of antibiotics is responsible for the spread of “superbugs” such as MRSA, which has now escaped the hospital environment and is showing up in schools. A recent study in the Journal of the American Medical Association suggests that the US has 95,000 MRSA cases per year, of which approximately one out of five is fatal. More people die in the US from MRSA than die from HIV. Though it is probably too late to eradicate some of the superbugs already created, a lower input health care system, used less often, would create fewer opportunities for superbugs to evolve and escape into the general populace.

Over the longer term, much lower emissions of pollutants, industrial toxins and carbon would make a huge difference [ad1] in reduced levels of cancer, autism, birth defects, neurological disease, asthma and lung disease, among others. As far as I know, no one has yet run the numbers to calculate the total net gains and losses here, but I mention this mostly to observe that we pay an enormous price for our lifestyle, and yet we tend not to think of it in those terms. We tend not to think of the sudden death of a family member from a heart attack or a child’s cancer as part of the cost of our society — we tend to think of it in isolation. But when we envision change, we tend to see the full costs of that difference[ad2] .

There would be costs, in terms of lives, in a lower-energy medical system. If we anticipate that we could manage many essential treatments, but that high-input items such as elective surgery, helicopter evacuations, defibrillators in every public building and other high-energy medical investments might be less available, some people would suffer and die. There is no question of that, and it is not something that should be minimized or elided. But it is important to remember that some people who would have died in a high-energy society would not suffer and die in a lower-energy one, and that too should not be minimized or elided.

Why Health Care Should Be At the Center of Things

The third myth is the one that says that we must focus on the economy, on rail systems, on everything but health care. Underlying this assumption is the belief that if we’re headed for disaster, it is self-evident that we can’t provide universal health care. After all, we don’t have that now. But we cannot allow that to be a barrier.

Instead, I wish to make the case that we absolutely must focus our energies on health care — to the exclusion of other projects, if necessary. The national discussion on universal health care has focused so far only on creating “perfect” modern models — that is, systems where everyone can have as much unconstrained access to treatment of illness as they want. In fact, when universal health care is proposed, the notion that any kind of constraint of access might occur is the single most effective negative argument. How many times has each of us heard the claim that if we had universal national health insurance, we might have to wait for surgery?

But if we imagine a national health care service [ad3] that focuses on maintaining health (as opposed to treating sickness), on delivering basic preventive care as widely as possible, and on investing in the health care measures with the greatest possible benefits for longevity and public health at low cost, we might be able to create a model that could co-exist with any national health insurance plan and, until/unless one is created, could serve the existing needs of the 40 million Americans currently without health care. Such a system would reduce the death rate from lack of health care access (18 million people die each year because of insufficient access to health care). Right now, many insurance programs simply will not pay for preventive measures. For example, my midwife friend Kathy Breault notes that she has difficulty getting insurance reimbursement when she vaccinates for the HPV virus, which causes cervical cancers, but no difficulty getting payment for expensive tests once a patient has an abnormal pap smear.

And if we were to look more carefully at the Amish, the Cubans, the Keralans, we might find a model of health care sufficiency that is an optimization of the best of the modern and the low tech, and we might begin to make decisions more wisely about how to expend our energy and financial resources to keep people healthy.

By “sufficiency” I mean the notion, advanced by Professor Thomas Princen, that instead of seeking out market-based efficiency solutions, we might find a principle of “enough” that can be widely applied. Some Americans have far too little access to medical care, and some have far too much. The notion of restraint and optimization in health care, up to now advanced only in the service of HMO bottom lines, might be used, instead, to create an adequate health care system that might serve people’s needs, rather than market needs. What Princen calls “enoughness” seems to be a real phenomenon in health care, available to us in the light of other societies that use less health care, use it differently, and still obtain the same positive results.

The examples of Cuba and Kerala, both poor places that have elected to preserve health care and social welfare above all else, even in times of crisis, should point out what is possible for us. Going into this crisis, our society as a whole is probably going to do some things to adapt while leaving others undone. I write this book in the hope that we will have a model to work on if we are left with the burden of doing the work that governments left undone, of making do from where we are, but also in the hope that we will begin to prioritize our remaining resources as Cuba and Kerala did, even if times get very difficult. Historically, that has not been the American way — when times get hard, we ration basic needs like food, shelter and health care by price, leaving a large segment of the population’s needs unmet. But we could alter that.

Now, both Cuba and Kerala have roughly socialist economies, and it would be easy to leap to the conclusion that I am calling for socialism here or that socialism is a necessary prerequisite to providing health care in an increasingly impoverished society. Neither is true — I believe all useful economic models are hybrids of multiple philosophies, and I hold no particular allegiance to a single economic model. Moreover, I don’t believe that using government resources to tend to the well-being of one’s populace is a socialist project — any more than using government resources to support a war machine is.

If we pay taxes for any reason at all (and sometimes most of us wonder), it is that government should meet the needs of ordinary people. Right now, I think most Americans of all political stripes would agree that it is not doing so. And any analysis of health care must begin, for example, with the fact that the American military budget is twice the military budget of all other nations together, and that what we have spent on the war in Iraq would provide lavish health care many times over. Yet I’ve never met an American who thinks that the war in Iraq is a better investment than health. It seems self-evident to me that this is not a question of Marx versus Adam Smith, but a question whether government should serve the people or the government — something I think we can get an easy consensus on.

28 Responses to “Public Health and Welfare Part II – Depletion and Abundance Book Excerpt”

  1. Cathy says:

    Absolutely brilliant! We already have a shortage of doctors. Just think how much more health care could be made available if all the doctors who specialize in “vanity medicine” could dedicate their efforts to helping regular everyday people. I wonder how they sleep at night with the knowledge that they could be helping people – as opposed to making the beautiful people and living a lavish lifestyle like their patients?

  2. Greenpa says:

    One of my favorite books is “Arrowsmith”; Sinclair Lewis. Largely because I never read it until I’d jumped the academic track, and moved to the woods. So I read Lewis’ final response to the idiocies and falseness of “big research” – sitting in my log cabin in the woods.

    For those not familiar- that’s where the brilliant but human researcher in “Arrowsmith” winds up- living in a cabin in the woods.

    But still doing his research – and funding it by producing some difficult and critical chemicals, which he and his partner sell to researchers still in the system.

    In the coming world- maybe that’s where we’ll get the complex medicines we need- qualified people, in the next town over, maintaining production; bartering it to your town, for – whatever.

    Makes sense, to me; and not impossible.

  3. Brian M. says:

    My brother works as a chemist, and I often think about what it would take to have distributed access to useful pharmaceuticals and such during a post-collapse re-localization phase. I think we’ll have labs and people that can run them. The problems are far more legal in nature. In many cases you would be stepping on patents, or producing competitors to existing marketable drugs. Even if your drug was lower quality, and cheaper than the market drugs, it would be a competitor, and the drug companies would have every incentive to squash you, if they could legally. There are LOTS of regulations on drug manufacture, and much of the job is jumping through all the legal hoops rather than anything trickier. Every business chemist is essentially a chemist-lawyer, spending more time documenting what they are doing for the authorities than actually doing it. Small-scale local drug manufacturers would have to jump through all the same hoops. Further, the same facilities can usually be used to make illegal drugs, so the authorities keep very close watch on them.

    Creating lots of legal hoops to jump through is a classic strategy for big companies to try to keep little businesses out of the market. My wife runs a cow-share which is essentially a legal-workaround to a lot of the pasteurization legislation. A small local business needs a business model, a way of coping with the regulatory environment, facilities to actually make the stuff, and a market to sell to. For drugs, the stopper is going to be the regulatory environment, not the model, market, or facilities. If there was some way to create a lower-quality tier for legislation, so that local drugs didn’t have to meet all the legal restriction put on regular FDA-regulated stuff, then those who could afford it would go for the FDA-compliant stuff, and those who couldn’t could at least get something! Otherwise, I think this vital sector my wind up being taken over by the black market. There already seems to be a thriving black market in smuggling non FDA-compliant drugs from Mexico. It isn’t hard to imagine a black market of small scale US labs producing pharmaceuticals for people that can’t afford legal ones. If it doesn’t already exist, it probably will. But it would be so much better for the population if we could take that out of the black market sector, but creating some kind of small-scale production loopholes, so that above board types could do this vital work.

    Similarly the herbal suppliments industry functions as it does largely because they fought for decades and eventually won some fairly powerful legal exceptions to the standard FDA rules. If you made a pharmaceutical grade drug, added it to a related herbal suppliment, and marketed it with “structure/function claims” rather than “health claims” would you fall under the suppliment laws rather than the drug laws? If so, then that might be viable. Maybe not. My point is that here is a place where a LEGAL work around, like cow-shares or co-ops, is what is needed. Maybe non-profits could be exempted, or educational facilities. Or maybe we could come to some kind of mix-your-own deal, where the small, local lab could sell two non-drug components to legal drugs, and let the consumer do the last step, thereby avoiding drug-manufacture for profit. I don’t know, maybe none of these will work, but something, … Anyone know a pro bono drug lawyer?

  4. Sharon says:

    Brian, you obviously raise a good point. In most cases, the drugs that would be easy to synthesize are often ones where the patents have long since expired – among the drugs I looked at were sulfa antiobiotics, thyroxin, insulin and other fairly simple compounds. But just because there’s no patent doesn’t mean that there won’t be regulatory excesses for quite a long time. I imagined that this level of production would most likely occur as the ability to enforce regulation declined dramatically because of lack of energy and money, but it would be even better if there were a legal work-around sooner, rather than later.

    Sharon

  5. Greenpa says:

    Brian M- so, you’re envisioning a future where the rule of law is taken seriously?

    … really? I hope it happens soon. It’s not taken very seriously in my neighborhood, now. (I’m being slightly silly here- but not entirely.) :-)

    Granted, patent law is currently enforced much better than laws against murder etc. Still. I have some doubts. Counterfeit drugs are already an international phenomenon and problem. I’d much rather buy my penicillin from some neighbor who has a record of not killing patients- and how could that be stopped?

  6. Brian M. says:

    I envision a future where gangsters and black markets control all sorts of things that ought to be part of the legit market. Counterfeit drugs, as I understand it, are not typically little local affairs, but big industrial black market outfits. I also think that small scale stuff being formed before collapse, helps build bridges to post-collapse realities. The local food-systems we have now can’t begin to carry the weight that they are going to have to soon, but they are the nucleus around which later local food-systems will form. If they had regulated the farmer-markets out of existence, building local food-systems would be even trickier, but it would happen eventually anyway because it HAS to. But maybe then the black markets would control them, when the food-systems finally materialized. The idea of local gangsters having a monopoly on medical supplies is not as pleasant as the idea of a resurgence in local apothecaries. If you force something necessary into the grey or black zones, then you are giving the gangsters extra power and slowing the process of change. The markets will find a way eventually one way or the other, it is just usually not as pleasant (or just) as a non-market solution would have been.

    The whole damn US medical system is in a similar boat, it has to adapt, but it is so interlocking, and tied in legal obstructions and red tape, that no single part of it can be allowed to adapt until the whole thing falls apart, and we aren’t even building secondary-backup systems yet. And again it isn’t model, or market, or facilities that is the problem, its regulatory control. Any doctor who offered cheaper but officially “substandard” care would be risking malpractice, as would any hospital or drug manufacturer. So we price people out of care rather than trying to create affordable options, and more and more suffer. We have to wait for the rule of law to end before anything medical can be fixed. If only we could start some of the adaptation before the rule of law breaks down… Herbal, midwifery (in some states), and chiropracty are about the only legal workarounds I know. Ah well, maybe I’m, just bitter, I’m still trying to think up ideas on this stuff.

  7. Daharja says:

    A lot of drugs are claimed to be necessary, but are not.

    For example, I’m epileptic, and am on anticonvulsants. However, I have not had a seizure since 1995, and the likelihood of seizures without medication is low (I went 4 years without medication when the 1995 seizure occurred) but present. In reality, I stay on medication so I can drive, and because I am a young mum at home with the reponsibilities of children by myself – if I had a seizure the results could be deadly with no-one but the kids with me, and me possibly holding a 1 year old at the time.

    There are lots of cases like mine. If my drgs ceased to be available, I’d go without. I’d possibly be healthier without them too.

    However, how type 1 diabetics would fare is another issue altogether.

    I suspect that simply some percentage of the population would die. However, and brutally honestly, the net gain might be better than the loss overall. When you factor in the road toll, and drug error, and side-effects of drugs (including autism and suchlike from pregnancy use etc. such as in the case of the anticonvulsant sodium valproate), we could end up with far more winners than losers. It just sucks if you’re a loser.

    Thanks for an interesting and insightful read. Once agian pointing out that the modern medical fraternity is not necessarily a great thing for all participants.

  8. Sharon says:

    That’s why I think that talking to chemists in local colleges and high schools might be the beginnings of a work-around. You don’t have to ask them to make drugs now, just talk about formulae and your concerns about supply disruptions, and perhaps your willingness to stockpile essential components. I know a couple of chemists who would take it as an interesting problem. And since they are likely, assuming the scenarios you propose occur, to be approached by black market sources, the idea of coopting them into community preparedness early seems like a useful mechanism to me. The same is true of doctors – they may not be able to set up a health care system now, but starting to talk to local nurses and doctors about community clinics and low energy medical infrastructure can make a big difference.

    Sharon

  9. Greenpa says:

    Brian- good answers. Your world has more gangsters in it than mine- and I have to admit history is on your side. But there might be ways to tip that tendency- like encouraging the Chinese version; tongs/ triads – where basically over the millennia they’ve learned not to steal too much, and not to be too destructive to the people; it just doesn’t pay, over time. Too bad they didn’t figure that out in Russia. There may be other ways, too.

    I guess I’m seeing (at 3 in the morning) something more like city-states; possibly republics, though feudal works well from the power/security standpoint. Then there could be some face-to-face verification of efficacy, and trade for specialties. Lots of advantages.

    One good difference to this collapse- if you can look at it that way- there are a HUGE number of people. So the opportunities for useful, functional variations in local governments to arise is high- and maybe, they can spread by example. I don’t see communication collapsing totally, and that will help.

    Interesting times. :-)

  10. Anonymous says:

    “Some Americans have far too little access to medical care, and some have far too much.”

    I guess I’m curious what you mean by “too much”. Cosmetic procedures? I thought these were generally not covered by insurance and paid for directly by the wealthy. Or something like my parent’s $180,000 hospital/doctor bill for a heart attack (of which insurance covered all but $100)? Should someone in this boat not be treated if he/she were old (say in his 80s)? what if s/he were younger (maybe 50s) but “responsible” for the condition (say, by having smoked)?

    I guess I’m having a hard time seeing how limiting medical care for people who can afford insurance would work practically (and ethically).

  11. Fern says:

    Anonymous – Yes, much costmetic surgery is “too much access”. It’s not a matter of who pays the dollars for it, it’s who pays the COST of it. The COST is that medical practitioners time and training, medical facilities and supplies, etc. are used for that and therefore NOT on those who don’t have, say, prenatal care.

    Medical practitioners, medical facilities, medical supplies are not unlimited resources.

    Fern

  12. dewey says:

    Brian M wrote: “If you made a pharmaceutical grade drug, added it to a related herbal suppliment, and marketed it with “structure/function claims” rather than “health claims” would you fall under the suppliment laws rather than the drug laws?”

    No! That is totally illegal. If a substance, even a natural substance, has first been approved as a drug before it is marketed in a dietary supplement, or even if it has just had an Investigational New Drug application approved (the means by which FDA gives permission to formally study its activities in humans for “disease endpoints”), then that substance is forever a drug and can never legally be used in a dietary supplement. Quite a few Chinese manufacturers do add drugs to herbals without declaring them, though, and they shouldn’t; it is NOT safe.

    Not only can you not make drugs without legal hoop-jumping, you cannot make dietary supplements. After long delay, FDA has produced Good Manufacturing Practices regulations for supplements that (in contravention of Congress’ expressed wishes) are not food-like but drug-like, or even more onerous, requiring multiple rounds of expensive testing for each batch and requiring that you hire extra people just to watch you measure and wash and record things, to confirm that you did it. These are now being implemented by company size; mom-and-pop businesses have another year or two, after which many will be put out of business, as FDA admitted and probably intended. (Herbalists making individualized prescriptions would technically have to spend several hundred dollars on each bottle, but FDA will exercise “enforcement discretion”…for now….)

    I have enough knowledge in this area to make some decent basic botanicals in my own kitchen, and plan to add more medicinal plants to my backyard as a reserve. But if I tried to sell such finished products even locally, I could face big trouble. One of the things I wonder is how long they will continue to enforce such regulations even as more and more of the population cannot afford prescription or OTC drugs. They certainly will not remove restrictions in anticipation of greater need; the question is how long they will force acute needs to go unmet. (I can, of course, GIVE my home-made botanicals to friends, just as I can legally give away home-baked cookies. However, I understand that a newly proposed Canadian law to increase supplement regulations defines “sell” as including “give.” One wonders why.)

  13. dewey says:

    Sharon – Very thoughtful as usual. I would argue that infectious diseases would be expected to increase, not decrease, as people began to live in more crowded conditions, probably dirtier, maybe less well-nourished, eating food stored without refrigeration – and in the worst-case scenario, unable to afford adequate water purification. Kerala’s life expectancy and infant mortality are excellent for a very poor developing area, but I still wouldn’t be in a hurry to drink the water. Lessened average individual mobility didn’t prevent plague from spreading in medieval Europe, either.

    Anonymous above – Half our medical costs are spent on people in the last year of life. “Too much medical care” could mean ultimately futile attempts to extend life at any cost, like artificially feeding the severely demented, or selling chemo in the last months of life to people with cancers known to be chemo-refractory. Or it could mean convincing people that they need to be prophylactically medicated throughout their lives for every condition they might possibly get when they’re 85. Or it could mean disease-mongering, persuading us that if we have restless legs, we must deal with this heartbreak by rushing to the doctor for a drug that causes, well, liver failure and gambling addiction… oops….

    Ethically, I think you have to let people buy any service they can personally pay for, even if the likelihood that it will do them much good is small. But public or private health care plans should not feel obliged to pick up the tab for services of dubious value.

  14. Steve says:

    you weren’t always such a watermelon Sharon, what happened?

  15. Sharon says:

    What does it mean to be a watermelon? It doesn’t sound like it is a compliment, but I have no idea what you are talking about.

    Dewey, I think it depends on how we manage our descent. It is true that disease could proliferate, as it did in Russia – or we could create the basic medical infrastructure to see lifespan increases, and people did in Cuba. It really depends on what we do.

    Others have covered the “too much medical care” and I’ll talk about how this applies specifically to end of life care and birth in a later part of the chapter, but yes, we do have too much medical care, and too much emphasis on treating, rather than preventing disease.

    Sharon

  16. dewey says:

    I used to be a strict libertarian too, but I have come to believe that public health care makes some sense. First, humans are adapted by nature to living in tribal societies, in which your tribe cares for you when you are sick, whether or not you have property to give them. Living in a society where your “fellow tribesmen” don’t care whether you live or die is not natural, and must contribute to alienation and resentment among those who can’t afford care. If charitable use of a small percentage of our income will make all levels of our society function better, we may benefit more than we lose.

    Second, in most of the world expensive Western medicine co-exists with often inferior, but much cheaper and more accessible traditional medicine. Our government and society have strictly limited who can practice and how, and imposed expensive regulations and litigation opportunities on all manufacture and practice of medicine. The least pecuniary motive claimable for this is that it’s for the protection of society at large. Well, if [the well-to-do portion of] society enjoys the safety benefits of suppressing lay practitioners and cheaply made drugs, or being able to sue when something goes wrong, then they should also help to bear the costs of these policies (the fact that they price the poor out of the market). Most conservatives can afford medical care and want it as safe as possible; they would not like to see regulation of medical care ended. So long as you allow government meddling for your protection, you can’t easily reject simultaneous government meddling to protect the poor from the consequences of the original meddling. Even if you personally would wish for an end to consumer protection laws, why is it always programs helping the poor that are targeted first by those wishing to “increase our liberties,” while programs that benefit the rich remain to be done away with “someday”?

  17. dewey says:

    “Watermelon environmentalist”: Green on the outside, red on the inside. He’s calling you a pinko commie.

  18. Fred says:

    Aye. much more watermelon-esque here lately. what does ‘righting the inequity’ of some kid not getting medical care in Africa have to do with how i can help to not-screw-up the world while I’m here ?

    Sharon, you used to be much much more on-message. these little digs on how un-equal and un-fair things are really tunes out a lot of people.

  19. SCM says:

    Had a chat with my other half – a research chemist – he reckons a lot of medicines could be made in a basic research lab with access to power (mainly the thing you need is heat). The info (recipes) is all there in a half decent university library. The kind of lab a small scale chemical company would have would be even better (can make larger batches).

    You could cover a lot of ground just by making basic anti-inflammatories, heart medicines (wafarin etc), insulin and basic antibiotics. Gas chromatography could be used for analysis (first built in the 50s) though with well-known products this shouldn’t be a problem.

    I work in x-ray physics and while most of what I do would not be possible (for long at least) in a drastically localised world I believe x-ray technology could be kept going on a localised basis (eg for medical applications – again assuming access to power). You would need the ability in the long run to manufacture x-ray tubes and photographic film, neither of which are especially high-tech (both were available in the late 1800s). I suspect high-value, low volume products will be available from further-field in any case.

  20. Sharon says:

    Thanks for the clarification, Dewey, I hadn’t heard that one.

    Ok, that is funny. You mean there are people out there who hadn’t noticed I was a pinko justice advocate?!?!?! Are you kidding me? Y’all should read back through my archives. I haven’t changed – you just weren’t paying attention. Wow, that really is pretty funny!

    As for the question of why should other people care about extending basic public health resources – well, assuming that justice doesn’t interest you, there’s the practical issue of population. The one consistent, solid way we know to reduce birth rates is to make sure that people’s first couple of children live to grow up. That is, most of the research out there shows that women make fairly rational choices in their short-term interests – in the poor world, children are the only kind of security there is. A woman in India has to have five kids to ensure that one of them will still be alive when she’s 60 years old – and there isn’t any social security there.

    The only way we know to stabilize birthrates – and it works all over the world (for example, there are several poor world nations with better TFRs than China) – is to make sure that women’s first and second babies live to grow up.

    There’s another reason – peak oil means most of us get very poor. So whatever minimal level of health care we’re talking about now may well be what most of us get – if you are ok with the idea that you might die because you can’t afford an antibiotic (happens all the time to the world’s poor), that’s ok with me. In Russia, life spans for men fell into the mid-50s after the crash – that sound good to y’all? Personally, I think we can do better than that as a minimum.

    Sharon

  21. Fred. says:

    Well I don’t plan to be given free anything after the crash, let alone free health care.

    I plan on contributing to society, building or creating value, and buying or trading for health care, medicines and doctor’s care.

    sitting back and hoping that the minimal health care given for free to everyone in some non-existing, crash resistant, entitlement program is good enough to keep my first two children alive so they can support me in 40 years when I finally can’t work anymore.

    Is that really what you’re advocating ?

  22. Brian M. says:

    Thanks for the info Dewey and SCM!

  23. dewey says:

    Fred – The world simply doesn’t have enough resources, sustainably or affordably extractable at the needed rate, for everyone to live the lifestyle of rich Americans. We can’t continue indefinitely to suck resources out of the Third World while telling its inhabitants that putting up with it will make them rich like us in the long run. They are starting to see that that cannot be true. If Africans see us wallowing in luxuries, not by any means limited to extreme medical care, while they can’t afford a $3 treatment to keep their kid from dying of malaria, how do you think they will feel about that? Do you think they will permit their governments to keep on making sweetheart deals to hand over the resources on which your wealth depends? Look at what minimal resistance in the Nigerian delta oil region alone has done for the price of oil. If you want “AFRICOM” to make that oil keep flowing, you had better want that kid to get health care.

  24. Fred. says:

    My wife was born and raised in the Philippines, child number 4 of 6 born and number 3 of 5 surviving. Just so you’ll understand this isn’t an theoretical argument for me. Sharon is advocating that if things were set right and health care in the Philippines was better my wife wouldn’t have been born and thus my family shouldn’t exist. So the very existence of my family is what’s wrong with the world; or what’s wrong with the world is why my family exists. Either way, it’s not often that you are told something like that. My daughter will grow up to hate and fear people like Sharon.

    But putting the abhorrences of corn fed rednecks falling for pretty Asian girls from big families aside for a moment; this discussion seems to be spurned on by the idea of what would be fair for people like my family-in-law in third world countries. Fair is that they had a daughter who could go to where things are better and support them by sending money home. It’s that simple, it sucks there and they can’t change that; and they can’t all get up and leave, but if one of them can make a better life for herself in the USA or Hong Kong or as a merchant marine, and everyone back home is a little better off, then they feel that they’ve been given a fair shake. This is from people who lost their homes and everything but their lives after Mt. Pinatubo blew and had to live as refugees for the better part of two years with 4 children to feed and no one but their family helping them out. Maybe you can continue to project your communal sensitivities onto their situation and perpetuate the myth that collectivism is what they’d find “Fair” but that’s not reality. These are proud people who have been through a lot, they’re a little better off than most of their neighbors but nowhere near as well off as rich people. if some government took from the rich and redistributed to the poor they’d worry that they were next and find the whole thing very unfair. And, if their poorer neighbors saw that the opportunity to have children who who could go and live a better life elsewere being taken from them, they too would find that unfair.

    So, I do care that my little brother-in-law and sister-in-law in a third world country get adequate health care and education for a better life, and I go to work and send them some of my earnings to make that very thing happen. But the question remains why should we care about some kid in Africa ? Why isn’t someone in her family doing the same for her ? You’re right that everyone on earth can’t live like rich Americans, but you’re wrong to assume that they’d only be happy if every last one of them was.

  25. dewey says:

    Fred – I’m glad that your wife is able to help support her family. The reason why someone in every African family is not doing the same is that the rich Western countries would not allow anywhere near that many Africans to immigrate (in the U.S., increasingly, even developing-country citizens who marry Americans are not guaranteed permanent residence and have to spend years begging for it).

    I do not think that “collectivism” is the way to go, but humans are social primates, and like other great apes, they will probably be happier if they live among a group of people who seem to care whether they live or die. Also, if Randian sociopathic individualism is combined with a legal and economic system that makes it very easy for the rich man to get richer while the poor man bears the burdens, you cannot expect the poor man to be thrilled about it forever. The Filipinos did eventually stand up and kick Imelda and her shoe collection out.

    Probably all of us have ancestors who had ten kids. Yes, maybe if your wife’s mother had had access to birth control she would not have existed, but so what? Every time a woman chooses not to have one more child, some potential person does not come into existence. Are you arguing that women should feel morally required to produce as many children as possible? Unless you think the rapture is coming real soon, or have plans to return the death rate to historically high norms, you apparently don’t understand how fast the planet would fill up with human beings. And if you are teaching your daughter to “hate and fear” people who simply want to place decisions on women’s fecundity into women’s hands… well, I feel sorry for the girl, but you may be surprised to find that she doesn’t hold to that ideology when she’s old enough to decide for herself.

  26. Fred. says:

    Honey, there are people out there who wish your mom and you never existed. They think you are what’s wrong with the world and that you’re going to ruin us all. When they find out that you are real and not some faceless number in a population study, they say “your grandma should have been on birth control after two kids, but so what?”. Oh, and when you grow up they think that the government telling you if, when, and how often you can have sex with your husband is going to make you really happy! Because they think that you really only want two kids and your grandma actually listens to what they say in church and has already proven to be too dumb to take birth control pills or use condoms with grandpa. These people have been working for years to convince a majority of the people in this country that two kids is sustainable but three is the end of us all so that they can pass laws to tie you to a table and cut into your stomach and tie your ovaries off. And by explaining to you that these people hate and fear you they think I’m teaching you to hate and fear them so they want you to realize they they can hate and fear you but you can’t have any bad feelings about them. And they think that when you grow up dumb and believe in God, you should just expect them to ridicule you for your beliefs because they think it’s dumb to believe God has a plan for us. And all this is because they think they’re our betters and they’re sore that people like us are too dumb to see that, and they’re sore that they aren’t making all the right decisions for us instead of all the dumb little decisions they think we each make every day and of course the really big dumb decisions that come along, like your grandma wanting a family and a fourth daughter like your mom. They want you to make up your own mind because they think it’s not right for a father who disagrees with them to have any influence on the beliefs of his own child, because they think you’d grow up and disagree with them too.

    what’d ya think? probably I’ll wait to have this conversation with her until after the state mandated sex education she’ll have forced on her two years before puberty.

  27. Rebekka says:

    I think there’s a pretty pertinent difference between talking about stabilising birthrates by making sure that if women have one or two kids they can expect to see them grow up, and saying people who are third or forth or fifth children should never have been born. They’re so not the same thing!

    Nor does having a universal health system mean you’re a bunch of communists, or even socialists – Australia’s medical system means everyone has access to hospitals when they need them, and yet – strange as this may seem – we’re not a bunch of pinkos. Last week, my partner was rushed to hospital with a problem with his heart. He doesn’t have any insurance. He spent four days in the cardiac ward, and when he came home on Saturday, we didn’t get a bill. You know what? That’s a good thing. Why on earth should someone only be treated if they can pay? Is a poor person’s life somehow intrinsically worth less than a rich person’s life? Seems to me money isn’t a very good way of working out someone’s value as a human being.

    Yes, sometimes you might have to wait for an operation – if it’s an *elective* procedure. If you have a life-threatening condition – something wrong with your heart, or a burst appendix or something like that, you’re whisked straight into hospital and operated on straight away. Without being presented with a giant bill at the end of it.

    I fail to see why Americans keep arguing against universal health care, when it works so well elsewhere in the world.

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