EclectEcon

Scarcity and Death Panels: the economics of medical care

We absolute must face the reality that because of scarcity, we will not all receive "the best medical care possible". There simply is not enough to go around. Jonathan Kay nails it:

 Even the wealthiest societies, no matter what the funding model for their health systems, have finite resources available to treat the human body’s potentially infinite medical needs. Someone, somewhere has to make a decision about where those finite assets go.

Such decisions seem horrifying to most of us because life, in most contexts, is too precious to be captured with dollars and cents, or even with the ordinal rankings used to assign transplantable organs. And utilitarianism can, indeed, be taken to monstrous extremes on the fringes of bioethics. But where the day-to-day business of critical-care medicine is concerned, some measure of soulless cost-benefit analysis is an absolute necessity — because every dollar (or organ) used on one patient within a public or private insurance network usually is, in effect, taken from another.

If we don't understand this simple truth, we are doomed to misallocating health resources.

A summary of too many people's view of the Canadian health care system is:

Better that one rich person be denied care so that 50 poor people can stand in line hoping to get it.

... which of course completely ignores both supply effects and the beneficial rationing effects of the price system.

Related articles

Scarcity, Economics, and Medical Care

Would I Look Younger with Dark Hair? (as if it matters)

People who have seen me with dark hair tell me it takes years off my appearance.  Here is one example:

So maybe there's hope? From Gabriel,

"For generations, numerous remedies have been concocted to hide gray hair," said Dr. Gerald Weissmann, the editor-in-chief of The FASEB Journal, "but now, for the first time, an actual treatment that gets to the root of the problem has been developed. While this is exciting news, what's even more exciting is that this also works for vitiligo. This condition, while technically cosmetic, can have serious socio-emotional effects of people. Developing an effective treatment for this condition has the potential to radically improve many people's lives."

I expect none of this stuff will be commercially viable while I'm alive. Or if it is, I'll probably be too old to care. Oh well, the rest of you have so much neato stuff to look forward to.

Related articles

Aging and Life Expectancy

Gray hair and vitiligo reversed at the root

Graying of hair can now be reversed - Zee News - Zee News

Paradise by the Dashboard Light

I recently saw a television commercial for some car (I honestly don't remember the brand) in which a young-ish couple is driving down the road, singing along with the song "Paradise by the Dashboard Light" [the classic hit by Meat Loaf]. 

At one point the woman starts to caress the man's thigh. And as the two are singing along, suddenly we see their two kids in the back seat going "Yuk" "ew" etc.

"Paradise by the Dashboard Light" is an absolutely hilarious, eight+  minute send up of teenage love, sex, and romance in the 1950s. Parking the car by the lake, describing petting and teen sex as "getting to second base" etc., made even funnier with the play-by-play done by Phil Rizzuto.

But what demographic group are they targeting with this ad? Seniors who remember what it was like back in the 50s and 60s? Or people who were teens in 1978 when the song came out? Or young families of today who might remember their own parents' antics and songs? 

 

This Youtube version has the lyrics but horrible spelling, which just adds to the humour.

Short-Term Memory Test

Some time ago, Jack sent me this message and link. It's a short-term memory test having to do with pictures of people -- when and whether you saw each picture.

I did okay (which is reassuring), but then I didn't wait between the parts nearly as long as they say you should, so maybe my results aren't valid. This is a hard test. Try to remember which photos you have seen in which part of the test. Good luck....

Short Term Memory Test

You'll be shown 12 photos in the first part,  You'll be shown another 12 photos in the second part, You'll be shown 48 photos in the third part and asked if you saw them in the first part,  the second part - or never saw them at all. When you have finished the third part, your results will be given to you. Click here to begin. .... My scores were reported like this: Recognition score ( if you saw it ) Your score: 100% Average score: 92% This is a measure of your ability to remember the photos you've seen, regardless of the part in which you saw them. From all 24 photos shown in Parts 1 & 2, you recognised: 24 photo(s).     Temporal memory score  ( when you saw it ) Your score: 79% Average score: 68% This is a measure of how often you recognised a photo and matched it to the correct part, instead of just remembering which ones you'd seen. From all the photos you recognised, you matched: 19 photo(s) to the correct part.

 

On Adding Years to One's Life

MA sent me this link to a NormBlog posting. Here it is, in full:

Adding on years

Here's a guy, on the letters page of the Times, who has the right idea (£):

Sir, I was excited to read... that eating mackerel will add two years to my life, because I'm a collector of added years. I added ten years when I stopped smoking, two when I gave up white sugar, three when I began eating bran for breakfast, six when I began going to the gym.

Anthony Calder-Smith - for he it is - hopes these added years will run consecutively rather than concurrently. I have a different worry. My ten added years for giving up smoking way way back - when do I get them? Or have I already had them?

Hilarious, the thought that all those added years might run concurrently rather than consecutively! Maybe that's what enables all those athletes to give 120%?  I just thought they were innumerate buffoons, but maybe they are right and I'm just being snobby about numeracy.

Aging and Life Expectancy

As I have aged and as my body has continued to remind me of that fact, and as friends younger than I have died recently, like many seniors I have become increasingly intrigued (some might say obsessed) with data on life expectancy. Jack recently sent me these tables from Statistics Canada (males and females). 

Ms. Eclectic is older than I am, but according to the tables, if we were average, she'd outlive me by about half a year.

How long do we have? Well, there's no point in being explicit. Last fall when a young actress asked me, "How old ARE you? Really." 

I gave my standard response (which I now use on forms asking my age): "Less than 90."

That means I probably can expect (if I'm average) to have another 5+ years.

You know what? Aside from the (comparatively minor) aches and pains and having to slow down a tad, I'm loving it and looking forward to it.

What Do Old People Talk about?

Mostly we compare medical conditions and stories about who died recently. It's bizarre. And at first it seems maudlin, but now it seems almost routine.

I was laughing about this over lunch last week with former colleague, Ed Saraydar. We compared back exercises, diets, and the feelings of creakiness that just seem to come with old age. We had a good time, and we made plans to get together next week. Just two days ago we were corresponding about low-carb diets. Ed died yesterday. He was 87.

This comes on top of news of the deaths of others recently, including one friend's dad and another friend's brother. And today news of the death of Jazz great Dave Brubeck, about whom MA and I had been corresponding over the previous two days. And while I know it's all part of the process of life and death, it sure hits hard sometimes.

 

On Death and Dying

The other night, Ms. Eclectic and I were speculating about how long we expect to live. She's a cancer survivor, and both my parents died of heart disease; so we figured we'd both probably be below average. 

The sudden death of my friend, Alan Adamson, caused me to think more than just idly about the question. So I took this test. The results indicate I might live a little longer than I expected, but then the 50% confidence interval spans a tonne of years, too. Ms. Eclectic had similar results, so we are guessing we still have quite a few years together ahead of us. My results:

Life Expectancy Results

Life Expectancy: 88.47 years
Lower Quartile: 81.08 years (75% chance you will live longer than this)
Median Lifetime: 88.59 years (50% chance you will live longer than this)
Upper Quartile: 95.60 years (25% chance you will live longer than this)

Another life expectancy calculator, which insists on registration (and hence which seems likely to be more commercial) is this one. Unfortunately, it provides only a point estimate instead of a range, but it says I'll live 'til I'm 95. I took it a second time, giving slightly different answers, and it tells me I'll live to the age of 87. And Jack sent this one, which says I'll live until I'm 83.

With results like these, we'd better reorganize our spending to make our pension savings last a bit longer. And if I'm going to live that long, I sure hope low-cost, effective joint and muscle care/repair become available soon!

From a different perspective, my friend Jack says that at our age we must accept the fact that there is a non-negligible probability we can go at any time. I understand that, objectively. But I'm having so much fun, I'm really not ready to go yet.

Alan Adamson

As we age, death makes increasingly frequent visits. The most recent death to affect me was of Alan Adamson, a good friend and co-blogger.

We met through blogging. I had posted some extreme remarks about some outrageous event being hosted in the Faculty of Arts at UWO; his wife saw my posting, and she sent it on to him for his amusement. He started following my blog and making the odd comment. From there we struck up a correspondence and began our blog about curling before we had ever met each other. 

The curling blog was fun for a few years. Even more fun was working together to cover the Scott Tournament of Hearts when it was in London, including doing play-by-play of one of the morning draws on the radio. Alan was a thoughtful, fun-loving guy. You put those two characteristics together, and you have a person who is fun and interesting to be around. 

We continued our curling reporting when the Brier was held in London in 2011, and then at the World Championships out in Regina that same year. 

Alan had been a math prof at Waterloo, but left academia to work for IBM. He enjoyed teaching but didn't enjoy the meaningless research that was expected of him. After many years at IBM, he retired, but was still active in ongoing industry standard-setting conferences.

Through Alan, we met his sister, Rondi, and his wife Melitta. Rondi and I have continued to correspond off and on, and we always enjoyed getting together with Alan and Melitta once or twice a year. 

Alan was younger than me. His sudden death has stunned and saddened me.

On Looking One's Age

I’m old. I’ve finally accepted that.  But the thing is, I  have  always looked older than I am.

When I was 17, my friends used to send me into the liquor store for them because I didn’t get carded. People often mistook me for being in my mid-20s. I liked looking old then.

But during the summer when I was 51, three incidents occurred that brought me up short:

• One day my daughter said, “Dad, I can’t remember. Are you going to be 53 or 54 on your next birthday?” I told her in no uncertain terms that I was going to be 52. And just to make a point, for the next many years we continued to celebrate my 52^nd birthday.

But I naively didn’t chalk that up to my looks. I just thought she had forgotten my age. The next one really hurt, though:

• I was at a bus stop and decided to chat up an attractive young woman who was there, too. “Are you a student at the university?” I asked her.

“Yes,” she replied. “Are you?” Well I knew I looked older than the typical undergraduate stud, so I wasn’t really flattered. I merely smiled and said, “No, I’m a prof.”

But then she added, quite unnecessarily I think, “Oh. Well the only reason I asked is there are lots of seniors in some of my classes.”

Seniors? Me, a senior? Sure, you can get an AARP membership at age 50, and, sure, some life insurance companies urge you to fantasize that you can retire at age 55, but senior? Me? Hmph.

• I’d have written that off as an isolated incident, but a month later when I was ordering a steak at a semi-fast restaurant, I thought I had been undercharged by several dollars. When I graciously pointed out the mistake, the young woman at the cash register smiled, “Oh no, sir. I just gave you the seniors’ discount.”

Seniors’ discount? I was in my early fifties!

For several years after that I used Just For Men.

Ms. Eclectic says that now, many years after those incidents, my age is finally catching up to my looks, and I was beginning to think maybe she was right. But just last weekend, someone asked me, “How old are you?” and guessed numbers in a range about five years older than I really am.

I exhaled deeply and  hung my head in resignation. So now, when people ask my age, I just tell them, “Under 90”.  

Gobekli Tepe

Jack sent me this last week. It's fascinating.

Gobekli Tepe:
The structures on this site were built about 12,000 years ago (10,000 BC) and perhaps intentionally buried with sand about 8,000 years ago.  No one knows who these people were, what the massive buildings were for, or why they were buried.  Just for reference, these structures were built during the last ice age and are more than 7,000 years older than any other structure we have yet discovered on our planet. 

        http://www.wimp.com/unexplainedstructure/ 

I wondered if the whole thing was a hoax, but apparently not. Snopes has no entry for it, and the Wikipaedia entry treats it as legitimate. So does the Smithsonian magazine. What a blow to the common anthropological explanations about human evolution! I realize this probably isn't new for many people, but it is really fun to think about.

More Costs Being Imposed on Younger Generations by us Oldsters

• Social Security in the US is completely shot and actuarially broke.
• Medicare/Medicaid are going to be massive drains on the public fisc as the baby boomers age.

And while the gubmnt-funded pensions are somewhat better funded in Canada, the medical commitment of the gubmnt will likely cause serious problems in the future.

And now this from the BBC [h/t Jack]. The abuse of alcohol by Baby Boomers is imposing even more costs on the health system:

More NHS money is spent treating alcohol-related illness in baby boomers than young people, a study says.

The Alcohol Concern report found the cost of hospital admissions linked to heavy drinking 55 to 74-year-olds in 2010-11 was more than £825m.

That was 10 times the figure for 16 to 24-year-olds.

Ten times! Holy cow! It appears that in addition to having to deal with the baby boomer effect on pension commitments and general aging-related health commitments, gubmnts will also be addressing the fact that we're all a bunch of lushes. 

Is it time, now, to raise the Pigou tax on alcohol even more? Please, no....

(aqua velva or anti-freeze anyone?)

SkyDome Hotel (or Whatever It Is Called These Days)

Ms Eclectic and I first stayed at SkyDome Hotel to watch a baseball game over 20 years ago when we took adjoining rooms with her parents to celebrate their wedding anniversary. We've been back several times since then and enjoyed our stays every time.

We're going to the hotel again today (Monday), this time for a two-night, two-game stay. We're taking the train there later this morning and returning home Wednesday morning. While there, we are also going up the CN Tower for lunch on Tuesday; neither of us has been up the tower. We are SO looking forward to this outing.

The Trono Blue Jays have just lost three straight games in Texas and will be hosting the division-leading Baltimore Orioles while we are there. It would be nice to see a couple of wins after that disastrous road trip. 

Photos from The Twiddle Plays

During our dress rehearsal, Ross Davidson took a steady stream of photos, which are spectacular. Here are just a few that I've cropped into quasi-headshots:

 

 

 

Age and De-conditioning

I know better. At least intellectually/academically I know better.

I'm getting old. And I haven't maintained a state of physical fitness that I might imagine I have. 

So when I engage in physical activity, it is not unexpected that my expectations are sometimes way out of line with reality. I sometimes over-reach. A lot.

Example #1: last summer, I lifted a 150lb electric bike to put it into a storage unit. The first two lifts to get it into position were fine, but the third one involved twisting, and I wrenched my back. I'm still working on getting over that.

Example #2: As I slowly recovered from the back injury, I was unable to do as much walking as I had been used to doing, and so my weight began to creep up. Late this past winter and early this spring, I was delighted to be able to begin walking increased distances (e.g. 4-5 miles between Masonville and downtown London). A few weeks ago while doing that walk, I hoofed it along an uneven path at a "smartish pace", wrenched my knee, and was barely able to walk for a couple of weeks. Fortunately, the tendinitis seems to have eased considerably. Vitamin I* helps.

Example #3: As a result of not being able to walk much, I began swimming semi-regularly in the pool in our building. Vigourously. Of course, I overdid it, and now my shoulders are not just sore, but have minor strains.

What a doink! I'm such a slow learner.

So here's the lesson to me (and others who may need to [re]learn it):

• John, you are no longer 25 years old. You are not even as fit as you were when you were 40. 
• When you see young people engaging in physical activities and think to yourself, "I can do that", think twice: Odds are that you can't.
• Warm up slowly and considerably before doing strenuous things, especially those that you haven't done for awhile (e.g. I had a life-saving certificate nearly 50 years ago, and I just imagine/pretend I can still swim that well).
• Get your expectations and beliefs about your abilities back in line with reality.

and to all of you who see grumpy old men, there's a reason we're grumpy, and it isn't always all that funny.

*Vitamin I is our euphemism for ibuprofen.