I think this is the beginnings of an economy based on perpetual growth and fossil fuel energy running headlong into geological energy constraints. Basically I see an undulatory downward path for the rest of my life. From here out, I think any rallies in our economic condition are going to be met with spiking commodity prices that knock us right back down.
Posted: Fri Jul 01, 2005 8:15 am Post subject: What will happen to the healthcare industry?
I live in a town that is HEAVILY dependent on the medical industry. I personally have no affiliation to the medical industry whatsoever, but living here has opened my eyes to it. I wonder what will happen to the medical industry in the forthcoming years. There is a common belief (fallacy?) that as the baby-boomers continue to age (and hence, become sicker), that the medical industry will continue to boom. Much like the tech sector in the late 90s, I also believe this market has been artifically inflated and certainly can't go on like this forever. Look at the costs of healthcare these days, just for a simple ailment. It's ridiculous! Increases in health costs have grown atrociously in the past 10 years, and, likewise, insurance costs and premiums have risen as well to absorb these costs.
Although we have the greatest healthcare in the nation, many Americans (something like 20%) don't have health insurance, and with changes in Medicare, our older generation is certainly not getting the care that they may require.
It's foolish to think that medical costs will continue to soar as energy and oil continue to rise and people's incomes become tightly crunched. However, as humans we have this fallcious belief that somehow life is sacred, and people will spend just about any amount of money to keep themself or loved ones alive.
I'm happy that I have a healthy genetic history in my family, with no serious ailments. I rarely go to the doctor and take good care of myself. Unfortunately, many people don't have this luxury.
As peak oil nears, what will we see happen to the healthcare industry? Will costs go down? Will alternative medicine become more popular? Will people live in pain and die instead of forking over expensive healthcare costs? Will the government subsidize costs? Will salaries of healthcare professionals go down to a more realistic level, thereby lowering costs? Or... will people, regardless of how hard they're hit financially, continue to fork over dollar after dollar to keep themselves alive?
I think there will be a certain decline in healthcare, especially for the most costly treatments. It will all be a matter of budgeting. Expensive machines will not be repaired, and therefore will stop being used. You can't ask your doctor to do a scanner if they don't have one, can you?
Joined: Mar 20, 2005 Posts: 46 Location: Australia
Posted: Fri Jul 01, 2005 9:51 pm Post subject:
At some point suing doctors will not be on the table anymore. If a doctor purposely sets out to hurt people they will be arrested. Other than that though the results you get will be largely dependent on how good of a doctor you can pay for. All payments will be made in advance and after that you get what you get. _________________ If I wish hard enough this problem will go away!
As someone whose mother is dying of Alzhiemers Disease, I can tell you it is projected that this disease alone will bankrupt the health care system as the baby boomers age..sans peak oil.
The health care of the future will be what it always should have been, diet and exercise. _________________ A Saudi saying, "My father rode a camel. I drive a car. My son flies a jet-plane. His son will ride a camel."
Live in Arizona? Check out: http://sustainablearizona.org and read my blog.
I have been wondering about that my self (and I am a health care professional). Couple of clarifications on current health care cost/organization of the US health care system and how it might be affected or not affected by PO:
1) What you pay for any service is not equal to what the health care provider gets. For example an MRI scan is prized ca $2000-$2500 across the Midwest (statistics from the following hospitals Indiana University/ Univ of Chicago/ Nortwestern/ Univ of Illinois in Chicago/Ohio State/ Univ Cincinniti/ Univ Kentucky/ Wright State) BUT the combined fee to the doctor and technician who will do the test is at best 20%. Evertyhing else is for "technical fee" i.e. a euphymism for management/insurance companies/litigation cost/ risk management and all that crap. The same test in European systems using the same scanners is anywhere from 50% to 85% less depending on the complexity of the system crap that stands between patient and the healthcare provider (MD or non-MD). In fact, these countries can have a much smaller cost in spite of a lower scanner per capita number. This monstrous overhead IS what makes the healthcare industry big in this country since money can be allocated to support other unrelated jobs in the industry (in reality, it all goes to the companies that run the hospitals). However that means that there is potential to cut back and decrease cost but no one is willing to do that (John Kenneth Galbraith wrote about the self expanding nature of beaurocracy in "The Cultrue of Contentment"). So as lay-offs start, prices might actually go down
2) Even by reducing the number of scanners and other high tech gizmos to 1/10th of what they currently are in North America, you could still deliver good (21st century) care. Why? The quality of medical care across this planet SUCKS and it is not due to any resource scarcities. The current medical education system has proved to be unable to incorporate major research and shape the way we teach medicine to our students. In reality the majority of patient cases can be handled without access to multimillion dollar machines for scanning or gazillions of blood tests. All it takes is to talk to the patient for more than the allocated 15 minutes to gather an idea of what is going on, do very simple ,if any, tests and start them on simple medications or non pharmacological (not alternative medicine crap). Instead, we destroyed basic medical skills (i.e. history taking, examination skills) and never really advanced the cause for decision support tools in medical education and health care. Hence we do a lot of unnecessary stuff and even if PO takes out 90% of current technology infrastructure deployed in NA it would make absolutely no difference ... because it does not really contribute or advance health care (it just consumes more energy). Is there any evidence that doing away with technology is not all that bad ? At a personal level I have practised in high -tech and low tech settings both in the US and Europe. The UK NHS (even though totally Fark by Thatcher/Blair) can deliver much better care in "benchmark" diseases i.e. hypertension, diabetes and deliver better outcomes inspite of the chronic underfunding. They do that in the expense of Vaginal Rejuvenation SurgiCenters or Booboplastie Operating tables ... but it is only in the US that access to these things is equated with better health care. By the way, by far the system with the potential to be the BEST in the whole world is the Veterans Affairs here in the US even though it suffers from chronic underfunding, has absolutely the sickest patient basis and an outdated physical infrastructure.
3) Disease Treatments: the greatest achievements of 20th century medicine WAS NOT antibiotics or other oil based stuff (contrary to what is commonly assumed). It was the public health movement which ensured basic hygiene, vaccinations sanitation and running (and clear water i.e. by boiling). So even though it is commonly assumed that modern medicine "enabled the weak to survive" , it was actually these simple interventions I alluded to. Practising again what exists in our mainstream (not alternative) medicine textbooks can help with preventing a fair number of common diseases thus doing away with the need for expensive intervention. However even if intervention is needed in a PO world there are good and bad news ( I will use examples of high profile diseases, because they are the ones of concern for the majority of us):
- antibiotics for common infections are actually products of microorganisms or simple chemical modifications of them that do not require chemical Mcfactories to synthesize.
- bugs that cause common antibiotics have become resistant which means that a % of those infections cannot be treated regardless of what we use. However this is irrelevant to PO (since we have nothing to use even now). As with many other stuff ... discontinuation of inappropriate use of antibiotics can bring back the easily killed bugs (i.e. the superbugs are diluted out, because the only think that keeps them around is the evolutionary pressure of our antibiotic misuse). Is this fantasy? Nope. Example is France and South Corea where antibiotics are over the counter. Because of that ... people would buy them and use them like candy and hence in the mid 80s to 90s they had resistance problems ... Ministry of Health intervened ... restriction of customer choice enforced ... and they do much better the US now
- hypertension: this is the "silent killer". When PO hits, lack of all this processed salty food (have u seen Supersize Me?) will go away and problem will go away by itself. Most effective treatments? drugs available since the 50s synthesizable by low intensity chemical reactions of simple chemicals (obtainable i.e. by biofuels)
- heart attacks, strokes etc: Aspirin was found before OIL! The obligatory weight loss of postPO will make them much less of a nuisance. S o will vegetarian diet (no more Angus beef). Simple artery opening drugs can be synthesized from bacterial products (in fact the first such drug was synthesized by the bacterium that causes sore throat) or can be genetically engineered into bacterial (and cloning genes etc is an extremely low intensity and high tech endeavour). However this means that more people with scientific skills knowledge need to be around and this translates to all of us asking more questions about the quality of higher educations (i.e. why are there so many business and not molecular biology schools etc)
- organ replacement therapies (i.e. chronic kidney/liver/heart/lung disease): Bad news is that people who need high intensity treatments will probably not fare well because the energy / manufacturing to support such therapies will be scarce. People with chronic kidney failure who need dialysis will be especially in trouble. The situation will be akin to Africa or India where people cannot afford those treatments and die. However ... low intensity treatments i.e. organ transplantation are actually extremely easy to perform (at least for kidneys) and living donation is an option (safe for the donor). This is why buying a kidney from a living donor is semi-legal in india/Africa ... there is no other choice. A mandatory opt-out system for organ donation (similar to the one that exists in a couple of Western European countries) where ALL organs of brain-dead or deceased patients are used without asking for consent from the relatives will also be an option. The opt-out system is actually seriously discussed today and I believe Oregon came pretty close to passing a state low a few years ago . Again the surgeries for transplantation will be feasible unless we go back to stone age (but I seriously doubt it). Even with a 18th century infrastructure they will be technically feasible but some high tech gizmos will be required.
- overall health care outlook: look at Cuba. They went through their PO in the 90s ... the average life expectancy did not drop ... in fact is is higher than the US but they practise effective and sound medicine focusing on disease prevention and deploying effective low tech interventions. Biotechnology boomed in Cuba after the oil crash of the 90s enabling them to produce vaccines to prevent infections and antibiotics. In addition they had extremely proficient medical and affilitated health personnel with sound theoretical and practical knowledge. Their problem is availability of consumables (i.e. gloves, syringes, needles etc) and for this we might have to go back to the days of sterilization of glass syringes and needles ... but at least know we have hepatitis vaccines.
Cheer up ... the game is not lost yet. Get up, consume less, educate others and fight for a better tomorrow
Joined: May 20, 2005 Posts: 204 Location: Austin, Tx
Posted: Fri Jul 01, 2005 11:42 pm Post subject:
Phage therapy, the use of bacterial viruses to kill infectious bacteria, will also be available in a low energy world. It's easy to do, cheap, and low tech--which is exactly why we don't use it in the West, but why it has been used more widely in Russia/Georgia and other parts of the former Soviet Bloc. Also, since the viruses self-replicate, it's not really a big seller here since you can't make money from a medicine that self-replicates. And it is more time consuming--doctors will actually have to type the strain of bacteria infecting you since bacterial viruses are often species specific. But, they should have been culturing infections for a long time before handing out antibiotics like candy. But we'll at least have that tool available to treat some bacterial infections.
Joined: Oct 12, 2004 Posts: 1647 Location: Davis, California
Posted: Sat Jul 02, 2005 12:54 am Post subject:
What's actually scary is that a lot of new bugs are antibiotic resistant and also are as vigourous as non-resistant strains. So those strains can survive even without anti-biotic selection; normally, removing anti-biotics leave those strains at a disadvantage, usually metabolic, so that non-resistant strains will reproduce faster. Some, not all, resistant strains can grow just as well in the presence of anti-biotics and in the absense as well. That's scary crap. _________________ Joseph Stalin "It is enough that the people know there was an election. The people who cast the votes decide nothing. The people who count the votes decide everything. "
I have wondered why the cost of health care has gone thru the roof in the past couple decades. I have a theory the reason why is because people are actually using medical services much more.
Back in the days people didn't go to see their doctor unless they were sick....but not just sick but very ill. The idea of getting a preventive maintenance check up was weird and rarely done. In other words the health care industry was getting a free ride. They were collecting money but didn't have to provide much.
But social attitudes and values have changed. If you have health insurance and are alotted a check up every year and you don't use it then people think you're stupid for not using what you paid for. Now that the medical industry actually has to "provide services" their expenses have gone thru the roof and so has health insurance.
To piggyback on what others have stated, I quote an excerpt from a Washington Monthly article of two years ago, "The Health of Nations" by Phillip J. Longman.
"To get an idea of how wildly ineffective our health-care system is, consider this: The United States spends roughly $4,500 per person on health care each year. Costa Rica spends just $273. That small Central American country also has half as many doctors per capita as the United States. Yet the life expectancy of the average Costa Rican is virtually the same as the average American's: 76.1 years.
How can that be? According to public health researchers, the biggest reasons are behavior and environment. Costa Ricans consume about half as many cigarettes per person as we do. Not surprisingly, they are four times less likely to die of lung cancer. The car ownership rate in Costa Rica is a fraction of what it is in the United States. That not only means that fewer Costa Ricans die in auto accidents, but that they do a lot more walking, and hence they get more exercise. Thanks to a much lower McDonald's-to-citizen ratio, the average Costa Rican thrives on a traditional diet of rice, beans, fruits, vegetables, and a moderate amount of fried food--and therefore enjoys one of the world's lowest rates of heart disease and other stress-related illnesses."
So, assuming Mr. Lomngman is correct, we all will adapt. The big problem will be repairing the bodies of those presently in their middle age, who have done major damage to thie bodies already.
One part of this quote puzzles me. Unless medical professionals make far, far less than in the U.S., how can the per capita cost be so low in Costa Rica? They still have half the number of physicians as the U.S. per capita, but their spending is only 6% of the U.S.
Joined: Oct 04, 2004 Posts: 5664 Location: Body in OK, Heart in TX
Posted: Mon Jul 04, 2005 10:31 pm Post subject:
Denny wrote:
One part of this quote puzzles me. Unless medical professionals make far, far less than in the U.S., how can the per capita cost be so low in Costa Rica? They still have half the number of physicians as the U.S. per capita, but their spending is only 6% of the U.S.
Our public health care already has a crisis of a first order magnitude. Check out Betrayal of Trust: The Collapse of Global Public Health by Laurie Garrett. As we have slipped down the Energy Per Capita slope, we have massively cut spending on public health. Peak Oil will put a nail in the coffin of an already dying system. And given our population size/density and the rise of drug resistant bacteria... Things don't look good. _________________ EntropyFails
"Little prigs and three-quarter madmen may have the conceit that the laws of nature are constantly broken for their sakes." -- Friedrich Nietzsche
Our public health care already has a crisis of a first order magnitude. Check out Betrayal of Trust: The Collapse of Global Public Health by Laurie Garrett. As we have slipped down the Energy Per Capita slope, we have massively cut spending on public health. Peak Oil will put a nail in the coffin of an already dying system. And given our population size/density and the rise of drug resistant bacteria... Things don't look good.
A simplistic explanation and PO most likely had nothing to do with it ... public health spending was reduced in response to
1) decreasing need for vaccinations and other goodies that were missing when the public health movement started (initiated in England in the mid 19th century). Many of the diseases that fueled the public health movement (i.e. variola and polio) were defeated leading to a decreasing social motive to continue with the movement. BTW variola vaccine and polio vaccine need no oil based input, they are live viruses and that's why the vaccination programs worked in Africa.
To throw an interesting piece of info, ancient Roman and Greek cities (and quite likely Babylon) did have sewage systems AND running water and none of the epidemics indigenous to Western Europe pro-industrial revolution. There was literally crap everywhere leading to cholera etc
2) Free market apostles perceived it as a threat to another super dupper market. The market of hospitals, designer drugs etc. Note that if public health measures are implemented many of the killer diseases (not just infectious, things like diabetes, hypertension, many types of cancer) will see a drop in their impact in terms of morbility which translates to reduced income for the health care industry
3) Drug resistance does go down ... when antibiotic pressure is relieved. This is the basis of rotating hospital formularies (they work at least marginally which is BIG news when you deal with patients in the Intensive Care Unit). France which in the 80s had been an antibiotic resistance hell (bugs from hell etc) saw a drop in the resistance when they tightened the system. Alas ... when CDC warns us to do the same here ... we fail. My patients when I refuse antibiotics cause it is not necessary simply go the Emergency Department or go the Black Market (btw a pill of augmentin can be more expensive than tylenol #3 in the black market in the midwest)
So ... Peak will hit us ... but not everything under the sun is peak
Joined: Jun 12, 2005 Posts: 4189 Location: 1st territorial capitol of AZ
Posted: Tue Jul 05, 2005 7:40 pm Post subject:
Don't get started talking about the US's cost of health, life expectency, etc because I think the US comes out worst of the industrialized countries and is outdone by quite a few socialist backwater banana republics too.
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leading to cholera etc
