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Upcoming Health and Healthcare Issues

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  • Thu, Feb 19, 2009 - 01:50am

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    ccpetersmd

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    Upcoming Health and Healthcare Issues

 

Not unlike the burgeoning problems with the economy, energy and the environment so cogently presented in Chris Martenson’s Crash Course, we are potentially facing equally challenging issues in another basic necessity, our health. By the way,I tried to think of an “E” for this item, but failed. One disclaimer, before I get started: while I am a physician and have been following these issues for some years, my background is as a thoracic surgeon, so I do not pretend to have expertise with regard to all aspects of medicine, preventative care, health administration, etc. I fully expect that I will be incorrect in some of my assessments, incomplete in others, and welcome any feedback. These are simply the concerns that I have been following, and there may be others.

 

To oversimplify, our health is threatened basically on two fronts, injury and illness. The success of our response to injury and illness depends upon several factors: the underlying state of our health, the severity of the injury or illness, the potential benefit of specialized treatment, and our access to such treatment. The definition of injury is fairly obvious, whether it be mechanical, thermal, radiation, etc. For my purposes, illness would include any "natural" or traditionally “medical” diseases, to include hypertension, diabetes, etc., but would also include malignancy (cancer), and a primary focus here, infectious diseases. Specialized treatment consists of anything a lay person could not accomplish on their own, whether that be antibiotics, surgery, etc. 

 

Taken in order, I will discuss injury, illness, and access to healthcare, as I see these as the most important issues we are likely to face. I will not discuss wellness or disease prevention beyond this sentence, except to state that the healthier you are now, the more likely you will be to recover from future insults.

 

I’m not certain whether or not to classify malnutrition and dehydration as an illness or an injury, as it seems a bit of both. Nonetheless, access to water and food will become an increasing issue in the years to come, even in "developed" countries, as it already is elsewhere. Perhaps the most important aspect of dehydration and malnutrition is that it makes one more susceptible to either injury or illness, and will likely be a prevailing underlying theme in all that follows. 

 

I would expect the incidence of injury to increase markedly in the coming years, as a direct reflection of the worsening economic crisis. Some of this injury would be obvious, in the forms of penetrating (firearms, knives) and blunt trauma due to domestic violence, civic unrest, suicide, etc. Some, however, might be less obvious, to include hypothermia (unpaid heating bills) and hyperthermia (unpaid cooling bills). To be clear, not many in the healthcare community are currently discussing this issue, but I believe it is a foregone conclusion.

 

Historically, illness, and in particular, infectious diseases, have had the most significant impact on human survival. With the insights of Lister, Pasteur, and others, that gradually shifted, and people survived long enough to ultimately succumb from coronary artery disease, cancer, or simple senescence. I fear that reversal in fortune may soon be lost.

 

As has been typical even in most wars, infectious diseases will easily trump injury in the coming years or decades, even in the “developed” world. Without going into great detail regarding each disease, my chief concerns are Influenza, the plague (Yersinia pestis), enteric pathogens (Vibrio cholera, Salmonella, Shigella, E. coli, etc.), multiple drug-resistant tuberculosis, particularly scary viral infections (HIV/AIDS, Ebola, Marburg, etc.), and some of the more common ailments we felt we have “whipped” due to vaccinations (Measles, Mumps, Tetanus, etc.).

 

Influenza deserves special mention here, as most virologists feel it only a matter of “when”, not “if”, that another major pandemic will occur. “Avian flu” gets a lot of attention in the media, and that attention is relatively well deserved, as it is highly lethal to the birds and humans it comes to infect. If it were to become more transmissible from human to human, it could be devastating. However, “avian flu”, or H5N1, is a variant of influenza A, and there are many subtypes of influenza yet to be discovered that could be the source of our next pandemic. As devastating as was the influenza outbreak of 1918, it is sobering to think of the effect of another pandemic now, with increased population density, frequency and speed of human travel, etc. Again, it is not a matter of “if”, but “when”.

 

Enteric diseases also deserve special mention, as I believe this will be an increasing problem in the years to come. Water quality, especially, will be important if there is a breakdown in community services. Food quality, also, will become an increasingly important issue, as we have seen with regard to the recent Peanut Butter contamination (Salmonella spread, I call it, even as I continue to eat it). If the quality of our consumer goods suffered even during the prosperous past decade, imagine how it might suffer with continued cutbacks in federal funding.

 

Finally, and I apologize for the long post, but access to healthcare will become more and more critical in the years to come. Even in the U.S., which has a relative overabundance of physicians compared to the rest of the world, physician and nurse shortages are continuing to worsen. Primary care (internal medicine, family practice, pediatrics) is most affected, due to low reimbursements that steer potential physicians to more lucrative specialties, or out of medicine altogether. Even in my specialty, thoracic surgery, a physician shortage is expected by 2010. For many other specialties, that shortage already exists. The situation is even worse in elsewhere in the world. And, with declining reimbursements and the worsening economic crisis, there seems to be an increasing trend in hospital closings. This also is not being talked about much in my circles, but I think the trend is real, and likely to worsen.

 

I apologize for not having any good news here. Some will reply that an influenza pandemic, or some other process, is just what we need to re-shift the balance with regard to economy, energy and environment. I will not say they are wrong, as that might indeed be exactly what is necessary. Like the “three E’s”, we may have lived beyond our means in terms of health, also. A resetting of the balance may be necessary. I just hope the reader does as much as he or she can to maximize the health of their families, educate themselves about potential risks, and maintain access to any healthcare that may be required.

 

In closing, I will provide a few  links that I feel might be of particular value to the lay person. Most of the sites below have abundant information on a number of the topics touched upon above, and I haven’t made the effort to link to each subheading, so you are encouraged to research as much as you see fit. As a physician, I really enjoy seeing a patient who has educated themselves, and knowing this audience, I expect that you will do the same!

 

http://cdc.gov/

http://www.pandemicflu.gov/

http://emedicine.medscape.com/

http://www.webmd.com/

  • Thu, Feb 19, 2009 - 03:56am

    #2
    Peak Prosperity Admin

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    Re: Upcoming Health and Healthcare Issues

Christopher…

 

Thanks for your thoughtful post.  Offer another perspective. 

My concern w/r/t Health Care is it…along with Education are examples of a relationship between the government and Health Care special interest institutions that are part of the problem.  

In a broad sense, using data from US government, plus OECD; the percentage of USA GDP spent on Health Care rose from 4 percent to 19.5 percent from 1962 to 2007.   This by any reasonable measure I look at is not in any of our best interests and reduces our quality of life.

If were dealing with dwindling resources, how can this continue? 

We must develop systems of good management and leadership principles that incentivize and reward (i.e. prevention, lifestyles, etc) while dealing with inefficiencies, poor results that are tolerated, if not indirectly rewarded.

Example:  What are the 5 areas from other countries health care experiences that have shown limiting costs while providing and/or enhancing quality health care we don’t do?

As a Health Care user…hard not perceive this is an area that institutionally and collectively doesn’t want to deal with challenges and/or make real change.  Never hear this from key decision makers as ways to solve part of health care issue.  

So, if you partially agree the system is part of the problem to where were at today, won’t they in many ways make things even worse?

 

 

Nichoman

  • Thu, Feb 19, 2009 - 09:49am

    #3
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    Re: Upcoming Health and Healthcare Issues

This is one of the most important systemic concerns, but which sometimes gets lost among the more sexy specters of depression, hyperinflation, Mad Max scenarios and such.

This health care system looks unsustainable even without the Triple-E crises which loom. Add those in, and we can see how prudence demands that each of us (1) preventively looks to our personal health and that of our loved ones, and (2) prepares for a future where health care is going to be far more localized and deindustrialized, and perhaps based more on barter.

Even the relatively moderate Peak Oil writers like Greer are expecting a near-future collapse of the existing health care system.

I’m not a health care professional and can’t add specifics to Christopher’s excellent overview, but I can add one recommendation to his list: Dan Bednarz is a medical doctor who writes on Peak Oil and energy descent with special reference to the health care implications.

Christopher says: "I tried to think of an "E" for this item, but failed." 

 

How about "health care Entropy", as part of a general terminology of the looming entropy of all sorts of industrial, hyper-centralized, hyper-technologized systems?

  • Thu, Feb 19, 2009 - 01:06pm

    #4
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    Re: Upcoming Health and Healthcare Issues

Nichorman,

I agree that the U.S. healthcare system has significant problems, with or without the upcoming crises in other areas. Reimbursement is uneven, with specialty physicians earning more for their procedures than the primary care physicians who should be instrumental in wellness and disease prevention. Reimbursement is also cumbersome, with multiple payers, to include the government, with different rules, reimbursement rates, etc. Physicians tend to order too many tests, whether from a "defensive medicine" standpoint of not wanting to leave any stone unturned for fear of a lawsuit, an unwillingness to trust in their clinical skills and instincts, or other reasons. Many procedures are performed unnecessarily, especially toward the end of life. Patients, too, are culpable, as many generally prefer to get problems "fixed" as they arise, rather than attending to basic "maintenance" on an ongoing basis. The pharmaceutical industry, obviously, has concerns, and physicians and patients are too often complicit, wanting the "new best thing" rather than an old, and usually cheaper, standby that will still adequately address the concern at hand.

We are seeing changes in healthcare, but they are coming slowly. "Pay for performance" reimbursement programs are growing in popularity, in which, hopefully, better physicians will be rewarded at a higher rate. Similarly, some insurance companies are going to stop reimbursing hospitals for complications that occur during a patient hospitalization, if those complications are felt to have been avoidable. Numerous individual physicians, including one of my partners in nearby Cedar Rapids, are looking at new ways to measure and promote quality care. This is a big, complicated machine, with lots of problem areas, so it is a very difficult to imagine and implement comprehensive changes that will address all problems.

Russ,

Thanks so much for the reference to Dan Bednarz! I hadn’t heard of him, but have since read one of his articles. I’ll give him a call! 

  • Thu, Feb 19, 2009 - 04:35pm

    #6
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    Re: Upcoming Health and Healthcare Issues

very good post

i have a medical travel facilitation business. i arrange for people to travel overseas for medical and dental care.

i work in india, thailand and costa rica. costa rica is the preferred destination for most people as it is much closer. 

the facilities i work with are JCI accredited and are among the finest hospitals in the world. most people initially use this healthcare option because of price but after having gone overseas they discover that in many cases the care they get is far superior than what they can receive here in the u.s.

jerry lee your bilateral knee operation would have been less than $20k (total for hospital and surgeon) at one of our facilities. costa rica has a unique feature in that there are a number of medical recovery inns which are hotels dedicated to recovering surgical patients.

it is well  to remember that dental health is an incredibly  important part of your health. low grade infections in your mouth can have a sytemic impact on your health.

if anyone would like more info my website is http://www.globalmedicalreferrals.com

prevention is the best healthcare…………..clean food, water and exercise.

  • Thu, Feb 19, 2009 - 07:36pm

    #5
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    Re: Upcoming Health and Healthcare Issues

Thanks so much, Christopher, for keeping these concerns before us!

As you recall, I raised some of these issues a few weeks ago which elicited your first post.

Today it is 3 weeks since my bilateral knee replacement surgery. The knees are working amazingly well. I get around on a cane mostly and can even manage without it for short trips around the house. Pain is now minimal although I’m not ready to give up the meds completely. I’m 60 and I still feel I’m in recovery from the overall trauma of surgery. I can’t imagine going through this at an older age or of having other health issues to contend with.

I appreciate your admonition to maintain one’s overall level of health as high as possible.

I recognize my own good fortune at having the opportunity to receive the care I’ve been given thanks to my wife’s employee benefits. I am appalled at the cost and of the resources that I have consumed. The hospital bill alone was over $66,000. We’re still awaiting bills from doctors, physical therapy and visiting nurses, not to mention Rx. I guess i did my part to stimulate the local economy. When I went for my appointment with my family doctor this weekk, I had the opportunity to ask him several questions.He is a good listener and always takes the time. When he asked me if I had any more questions, I looked him in the eyes and said "How’s the economy treating you?" he smiled and said, "I’m doing fine…thanks to people like you."

I’ve been reflecting on what I can be doing to contribute to the emerging health issues in my community…wondering what simple skills I might learn such as First Aid etc. the growing of medicianal herbs as a small offering to my family and neighbors.

Perhaps there are some advocacy issues I need to be aware of that might have some ‘bang for the buck’ – not so much in terms of  fixing the broken system but more along the lines of how can we  maintain and improve accessibility to basic care? Can person to person or neighborhood  health networks be developed and/or strengthened?

If you ever decide to do a seminar on these topics, I’ll gladly participate.

Let’s call it "Primum non nocere" for the layman and the provider.

Jerry Lee Miller, Lancaster PA

  • Thu, Feb 19, 2009 - 07:54pm

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    Re: Upcoming Health and Healthcare Issues

Joe2baba

 I visited your site before. Most eye opening! Thanks for the info on what my surgery could have cost.

On the issue of ‘prevention is the best healthcare….clean food, water and exercise."……I was visited by one of the hospital’s food service managers on day 6 of my stay.(I was in 7 days). He asked me if I was pleased with the quality of food. But, I was not at all pleased. I follow a vegan diet and found few options on the daily menu. Also, for several days I was on an all liquid diet. The choices then were abominable! Half of them involved high fructose corn syrup with fruit flavoring. It made me wonder just how many acres of corn are being planted just to provide this insane thrist for corn syrup!?

I limited my comments to the manager, who didn’t seem to understand the difference between vegetarian and vegan. However, I asked him if I could send him some information. He gave me his card and said he would welcome my input. I still need to follow up with him.

 

 

  • Fri, Feb 20, 2009 - 05:40am

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    Re: Upcoming Health and Healthcare Issues

Christopher,

That was a most excellent post. Thank you for your insights.

I am fortunate to be a member of Kaiser NW and my wife and I have received excellent treatment across the years. Naturally, except for small co-pays, everything has been free – a great deal for us if not Kaiser. This included my cancerous prostate operation done with the DaVinci robot in January 2006. Been clean and clear ever since, happily.

From what I read about the expensive health care others are burdened with, I wonder where you see managed health care going in our future? Do you think it will continue to function or collapse or something in between?

I would appreciate any thoughts you might have in this area.

  • Fri, Feb 20, 2009 - 07:25am

    #9
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    Re: Upcoming Health and Healthcare Issues

Dr. Peters,

I finally got around to reading your post and I think it is one of the most important posts on this site. I say that because I believe it will be an unforeseen event that will most likely send our very vulnerable economy into a tailspin, if not chaos. What that unforeseen event will be, I have no idea – but top on my list is an influenza pandemic, along with a terrorist attack and a dollar collapse caused by outside forces. So as I was reading your post – I kid you not – my high school-aged son came home and told me that one of his fellow students (in a small school) has been diagnosed with a MRSA infection. Sure enough, I got onto my email and found a warning from his school that one of his classmates has been diagnosed with MRSA. MRSA is a dangerous infection; even in a functioning health care system, it is an infection to be reckoned with. As your post so clearly amplifies, in a weakened economic system, health care is another front that will go down for the count. I shudder to think what would happen if this MRSA infection spread among others in my son’s school and we had an inadequate health care system to turn to.

  • Fri, Feb 20, 2009 - 01:44pm

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    Re: Upcoming Health and Healthcare Issues

Dr. Peters, thanks for sharing your thoughts. You have provided me with some deep subjects to consider.

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