Why You Die

[GGT]

(Companion thread to Choob's When You Die)

I've been thinking about this for a long time. Apparently, it's important WHY we die. If you're a soldier or cop and you're killed in the line of duty, you're a hero. You'll probably get a medal and parade. If you're a victim of random or domestic violence you might get a blurb on the local news, and some philanthropic group will take up your cause to raise money for similar victims.

If you die because genetic factors gave you X disease, people feel sorry for your genetic 'death sentence'; no fault of your own. Pediatric cancers fall into that category. But if you're poor, your demise becomes your own fault...

While I'm glad for scientific breakthroughs, and the reliance on medical professionals that can prolong life......I'm fed up with the US "health care" system that determines WHY you die is largely based on your ability to pay

[Dreadnaught]

Is there something happening that's making you think about this?

[EyeKhan]

Tabulating why/how someone died seems to be wrapped up, quite a lot, in blame. Unhealthy living, reckless behavior, live by the sword, die by the sword sort of stuff...

EDIT:

And safety. Knowing why people die, or get injured, has probably been helping humans live long enough to breed for a couple hundred thousand years. Evolution ==> Modern Disaster Reporting.

And why, really why, do we die? Everyone dies. If you avoid accidental death and you live on into post-breeding years, well, you get in the way of follow-on generations. And there have to be many generations, over some reasonable stretch of time, with plenty of room and resources to thrive, or evolution won't work. So the species needs the individuals to die off in order to survive, that's the Big Why. The little whys, they're the injustices, the neglect, bad luck and horrors, the crushing losses. But they're all wrapped up in one way or another, somehow, into the Big Why. We die because we have to, eventually, somehow.

[GGT]

Is there something happening that's making you think about this?

Yes. The state of our US healthcare system: from rising medical costs to unaffordable insurance premiums/copays (which led to the ACA), and now the AHCA proposals that will drastically reduce federal funding for Medicaid, it's a big stinking mess. Something like 20% of all Americans rely on Medicaid to pay for care, including children with expensive medical problems, seniors in nursing homes, and the working poor who don't get employer-subsidized insurance. The House Bill was a big turd, and the Senate Bill isn't much better.

If WHY you die is because you live in a state that can't replace federal Medicaid funds with state funds....that means Neonatal ICU's, specialty clinics (like outpatient chronic dialysis), and long-term care facilities (like nursing homes) will close.

If WHY you die is because your employer doesn't offer group insurance, you can't afford a private comprehensive insurance plan, and/or you don't qualify for a government subsidy....AND the Patient Protections from Obamacare (that regulated the insurance industry) are repealed as planned....then the big stinking mess becomes a hot pile of shit.

If WHY you die is linked to your inability to pay for medical care....when that can mean even a simple prescription for necessary antibiotics is unaffordable....it should be obvious that our fee-for-service healthcare model is outdated, even dangerous. We've gotten hyper-focused on the insurance industry and lost focus on healthcare. Both have political elements, and since we're also politically polarized, the whole thing has become unhinged.

[GGT]

Tabulating why/how someone died seems to be wrapped up, quite a lot, in blame. Unhealthy living, reckless behavior, live by the sword, die by the sword sort of stuff...

EDIT:

And safety. Knowing why people die, or get injured, has probably been helping humans live long enough to breed for a couple hundred thousand years. Evolution ==> Modern Disaster Reporting.

And why, really why, do we die? Everyone dies. If you avoid accidental death and you live on into post-breeding years, well, you get in the way of follow-on generations. And there have to be many generations, over some reasonable stretch of time, with plenty of room and resources to thrive, or evolution won't work. So the species needs the individuals to die off in order to survive, that's the Big Why. The little whys, they're the injustices, the neglect, bad luck and horrors, the crushing losses. But they're all wrapped up in one way or another, somehow, into the Big Why. We die because we have to, eventually, somehow.

Of course everyone dies. The WHY I'm talking about is mostly related to the evolution of medical science and our growing expectations. We expect that food we buy is "safe", that water we drink isn't full of heavy metals (lead), that safety features in our cars won't actually cause our death (defective air bags), or that complicated pregnancies/deliveries don't mean automatic death. I don't think we're wrong to expect those things.

The gap is in who pays, and how, and why. Have our expectations exceeded our abilities, or have we lost the concept of The Greater Good, or what?

[GGT]

One of the best medical movies ever made: The Hospital

Unfortunately, not much has changed

https://www.youtube.com/watch?v=HftRP0NAJYg

[GGT]

We have established the most enormous medical entity ever conceieved, and people are sicker than ever. We cure nothing, we heal nothing

[wiggin]

We have established the most enormous medical entity ever conceieved, and people are sicker than ever. We cure nothing, we heal nothing

This is demonstrably false. We cure and heal plenty. Certainly we have issues with access and cost and quality but people are NOT sicker than ever.

[Nessus]

This is demonstrably false. We cure and heal plenty. Certainly we have issues with access and cost and quality but people are NOT sicker than ever.

You cure those with money, while there is plenty of preventable death (and illness) to go around.

[wiggin]

You cure those with money, while there is plenty of preventable death (and illness) to go around.

Absolutely, there are lots of things we can do better. Some of them can be fixed through better access to quality healthcare, a lot can be fixed through us making healthier choices (which can partially be helped through money/government intervention), and big chunk of it is stuff that we don't have the technology or knowledge to fix yet. But on any reasonable metric we are living longer, healthier lives than at any recent era.

A former mentor of mine has a nice spiel about this with cardiovascular disease. He looks at the healthcare provided to POTUS, on the reasonable assumption that in the last century POTUS has probably had access to the very best healthcare available in the world. And not 60-odd years ago, Dwight Eisenhower had a heart attack and there was precious little medicine could do for him - according to one report, he was recommended to 'cuddle more with his wife'. But the strides made since that period are truly astonishing (in the punchline to his story, he shows the hilariously long list of cardiovascular interventions that have been used on Dick Cheney). We can not only do much more to diagnose and delay and prevent heart attacks, but we have much better tools to treat them and minimize the damage to the patient's quality and length of life. This is one of the two biggest killers in America and we are, inexorably, conquering it.

On behalf of the massive effort by the many brilliant people before us who worked their butts off to make this a reality, I took exception to GGT's words.

[Nessus]

Absolutely, there are lots of things we can do better. Some of them can be fixed through better access to quality healthcare, a lot can be fixed through us making healthier choices (which can partially be helped through money/government intervention), and big chunk of it is stuff that we don't have the technology or knowledge to fix yet. But on any reasonable metric we are living longer, healthier lives than at any recent era.

A former mentor of mine has a nice spiel about this with cardiovascular disease. He looks at the healthcare provided to POTUS, on the reasonable assumption that in the last century POTUS has probably had access to the very best healthcare available in the world. And not 60-odd years ago, Dwight Eisenhower had a heart attack and there was precious little medicine could do for him - according to one report, he was recommended to 'cuddle more with his wife'. But the strides made since that period are truly astonishing (in the punchline to his story, he shows the hilariously long list of cardiovascular interventions that have been used on Dick Cheney). We can not only do much more to diagnose and delay and prevent heart attacks, but we have much better tools to treat them and minimize the damage to the patient's quality and length of life. This is one of the two biggest killers in America and we are, inexorably, conquering it.

On behalf of the massive effort by the many brilliant people before us who worked their butts off to make this a reality, I took exception to GGT's words.

Isn't it kind of telling that your wonderful anecdote focuses on the POTUS? You're setting me up perfectly to use my favourite quote in response, "And yet we knew, for a certainty, that when the first emissaries of Earth went walking among the stars, other sons of Earth would not be dreaming of such expeditions, but about a piece of bread."

I don't think those people in wheelchairs who got brutally assaulted by police outside Mitch McConnell's office last week were out there for fun. Do you?

[wiggin]

Isn't it kind of telling that your wonderful anecdote focuses on the POTUS? You're setting me up perfectly to use my favourite quote in response, "And yet we knew, for a certainty, that when the first emissaries of Earth went walking among the stars, other sons of Earth would not be dreaming of such expeditions, but about a piece of bread."

I don't think those people in wheelchairs who got brutally assaulted by police outside Mitch McConnell's office last week were out there for fun. Do you?

So? I acknowledge the issue of access, I just also acknowledge that in aggregate we are living healthier, longer lives than before. They are not mutually exclusive challenges.

There's some interesting analysis done by the NBER and other groups about the effects of the ACA on public health. Surprisingly, they have not shown a big effect (yet). It's still early years, and I am confident that there will be an effect, though I doubt it's on the order of what those on the left are currently suggesting. It's clear that it has already made a fairly substantial effect on how those who used to be uninsured view their financial stability, and that is indeed a good thing. But the immediate effects on health have not been obvious.

This isn't to say that we shouldn't strive for everyone to have access to quality, affordable healthcare. Obviously we should. But it does suggest that the problem of access, while substantial, is not the only determinant of public health, and that the remarkable strides forward in public health in the last few centuries (largely in the absence of even close to universal access) should be ignored.

[Nessus]

So? I acknowledge the issue of access, I just also acknowledge that in aggregate we are living healthier, longer lives than before. They are not mutually exclusive challenges.

There's some interesting analysis done by the NBER and other groups about the effects of the ACA on public health. Surprisingly, they have not shown a big effect (yet). It's still early years, and I am confident that there will be an effect, though I doubt it's on the order of what those on the left are currently suggesting. It's clear that it has already made a fairly substantial effect on how those who used to be uninsured view their financial stability, and that is indeed a good thing. But the immediate effects on health have not been obvious.

This isn't to say that we shouldn't strive for everyone to have access to quality, affordable healthcare. Obviously we should. But it does suggest that the problem of access, while substantial, is not the only determinant of public health, and that the remarkable strides forward in public health in the last few centuries (largely in the absence of even close to universal access) should be ignored.

I can't be assed to look up a cite for you right now, but I'm fairly sure the anti-smoking campaign in Europe has had some positive effect on mortality over the past 2 decades, or at least that smoking as a whole has become far less popular. Things other than directly shoving needles in people helps too, I'm with you there.

I think it was during the Rmoney campaign that the popular sound-byte was how medical costs were the number 1 reason for personal bankruptcy in America. I'm not saying you guys haven't figured out new ways of alleviating heart disease, but rather that people are pissed off that it's only available to a select few. I'm from a "single payer" system and frankly yours seems abhorrent. I am still free to drink myself to death, of course (cheers!), but at least in theory I have access to basic medical assistance that wouldn't set me back a year's wages. And those people in wheelchairs outside Mitch's office probably have even more urgent concerns.

Edit: What I mean to say is, it doesn't seem like a controversial position that people are legitimately upset about lack of health care options in the US when you have wheelchair-bound people willingly taking one on the chin from capitol cops.

[wiggin]

Nessus, I have never disputed what you're saying; I just disputed GGT's claim that we are 'sicker than ever' and that we neither heal nor cure anything. It was obviously wrong. Aggregate health has indeed increased by leaps and bounds - through medical technology and practice, public health interventions (e.g. smoking cessation campaigns), and modern civil engineering (e.g. water treatment, sanitation, etc.), and much more. To ignore that is to be guilty of this:

[Nessus]

Why would you do that (Louis CK) to my health

[EyeKhan]

I agree humanity is healthier than ever. Incredibly, our longevity has actually lead to the discovery of the new, and very expensive, age-related disease category.

And Louis CK is great. His show Louis was great. I'm bummed he quit making it...

I think GGT's complaint isn't really about the state of human health overall, and at the heart, it's not about healthcare at all. The rich have more and better healthcare access than the poor. Really? They also have more and better access to food, clean water, adequate housing, reliable transportation, education, technology, employment, entertainment, and on and on. And, oh by the way, this very human social arrangement isn't a hell of a lot different today from what it has been through the entire history of humanity, all the way back to when the tribal leader got to eat the best parts of the mammoth before anyone else.

As long as humans are in charge, I don't see this particular social arrangement changing.

[GGT]

Nessus, I have never disputed what you're saying; I just disputed GGT's claim that we are 'sicker than ever' and that we neither heal nor cure anything. It was obviously wrong. Aggregate health has indeed increased by leaps and bounds - through medical technology and practice, public health interventions (e.g. smoking cessation campaigns), and modern civil engineering (e.g. water treatment, sanitation, etc.), and much more. To ignore that is to be guilty of this: snip

Dude, George C. Scott was saying that in the movie! Sorry if the lack of quotation marks confused you about my point. I was lamenting the fact that all of our advancements aren't available to all the people, and that even the 'aggregate gains' from public health and civil engineering are at risk because they're linked to an American aversion to taxes. (The same can be said for transportation infrastructure.)

I'm sad that "The Greater Good" has been so politicized that we can't agree on how to pay (tax) for things that benefit the general public, knowing full well that only the top tier can pay out-of-pocket cash (or bypass anything 'public'), but everyone else needs some type of subsidy. Whether it's a private employer or a state, those workers all get a subsidy and/or a special group rate that's not available to anyone else. Let's not forget WHY the PPACA was enacted in the first place: millions of people couldn't get group health insurance, and the private insurance market was exploitative.

I agree humanity is healthier than ever. Incredibly, our longevity has actually lead to the discovery of the new, and very expensive, age-related disease category.

And Louis CK is great. His show Louis was great. I'm bummed he quit making it...

I think GGT's complaint isn't really about the state of human health overall, and at the heart, it's not about healthcare at all. The rich have more and better healthcare access than the poor. Really? They also have more and better access to food, clean water, adequate housing, reliable transportation, education, technology, employment, entertainment, and on and on. And, oh by the way, this very human social arrangement isn't a hell of a lot different today from what it has been through the entire history of humanity, all the way back to when the tribal leader got to eat the best parts of the mammoth before anyone else.

As long as humans are in charge, I don't see this particular social arrangement changing.

Compared to other developed nations, the US is losing ground on quality of life and longevity metrics, yet we pay more. None of our (US) shortcomings can be viewed as the "natural" result of human behavior, since other societies have done better.

[GGT]

Also, I'm confused how legislators can claim being "pro life" means de-funding Planned Parenthood (which helps pay for family planning and birth control) and cutting Medicaid (which pays for a large percentage of seniors living in nursing homes) is in the public interest.

Wasn't that argument lost when McCain/Palin ran - and lost - on the notion that you could barter medical care for a chicken?

wiggin, as an academic working in the medical science field, you surely know about budget constraints. Your education, and your job, are heavily linked to public investments (ie policy and consequent taxes). While I think it's great that we're living in the greatest era ever....that doesn't preclude me from criticizing our faults and flaws.

I don't mind paying your salary, if I can benefit from your work. What I don't like is paying your salary, plus your golden parachute retirement plan, for things I can't afford to buy outright or don't have a defined benefit plan, and don't qualify for subsidy relief. In other words, what might be your bread-and-butter, studying things like genetic related renal failure (for example), might mean my demise. If I can't afford your "services" but I've paid taxes for decades that helped you get your skills, what's up with that disparity?

Getting older happens fast. Every year now seems like 5 or 10 when I was younger. I don't mind dying....but I DO mind if it's because of income disparities. See rural hospital funding.

[Lewkowski]

Also, I'm confused how legislators can claim being "pro life" means de-funding Planned Parenthood (which helps pay for family planning and birth control) and cutting Medicaid (which pays for a large percentage of seniors living in nursing homes) is in the public interest.

Are you serious? Pro-life is a marketing slogan for being against abortion. This sounds even worse than the juvenile 'how can you be for the death penalty if you are pro-life!'

[EyeKhan]

Compared to other developed nations, the US is losing ground on quality of life and longevity metrics, yet we pay more. None of our (US) shortcomings can be viewed as the "natural" result of human behavior, since other societies have done better.

Come on, is it really a mystery to you why other developed nations are doing better both on cost and results in their health-care systems? Part of it is, broadly speaking, that in America the Right is getting more right every year and has successfully dragged the majority along with them - that means less socialized everything/ less redistribution of wealth from the haves to the have-nots/ less taking better care of those who can't properly take care of themselves. (But taxes are LOW LOW LOW!) I suspect this trend has a lot to do with how we view free speech -- the lack of any standard requiring even minimal truthfulness from those in a position to influence masses of people. And when money = speech, those with the money have a bigger voice, and they tend to guard their money jealously.

As for the high cost of health care, it could have something to do with the huge inefficiencies of our for-profit multi-payer system, fee for service doctor compensation, and an unwillingness to set restrictions on super-costly services that provide minimal societal benefit. And these are set in stone, seemingly, in part because there's a LOT of money behind them and that money speaks loudly on the political stage.

Or, I could be wrong.

[wiggin]

wiggin, as an academic working in the medical science field, you surely know about budget constraints. Your education, and your job, are heavily linked to public investments (ie policy and consequent taxes). While I think it's great that we're living in the greatest era ever....that doesn't preclude me from criticizing our faults and flaws.

I don't mind paying your salary, if I can benefit from your work. What I don't like is paying your salary, plus your golden parachute retirement plan, for things I can't afford to buy outright or don't have a defined benefit plan, and don't qualify for subsidy relief. In other words, what might be your bread-and-butter, studying things like genetic related renal failure (for example), might mean my demise. If I can't afford your "services" but I've paid taxes for decades that helped you get your skills, what's up with that disparity?

Getting older happens fast. Every year now seems like 5 or 10 when I was younger. I don't mind dying....but I DO mind if it's because of income disparities. See rural hospital funding.

GGT, let's see how many things are wrong in this post:

1. I'm not in academics.
2. You don't pay my salary; for a few years in grad school my $26k/year stipend was covered by a competitive government grant, but that was a long time ago and hardly qualified as a 'salary'.
3. I don't have a golden parachute retirement plan. Where the hell did you get that idea? I save for my retirement like any other joe schmoe, and it ain't funded by the government. If you mean the piddling defined benefit plan I qualified for, it's a drop in the bucket and was funded by a private source.

Do you know who does pay for my salary, and my research? Corporations, funded either by the stock market or venture capital firms. And they actually need to make money to, you know, make more awesome stuff.

There are very valid critiques of the way our healthcare system works - and indeed firms that develop medical technologies should not be exempted from such criticism. But it's important to note that there are no free lunches. It's hard, and complicated, and expensive to make people better - everything from the initial technology development to the diagnosis to the treatment and later management. We could do a whole hell of a lot better, but at some point we're going to have to ration things. All of these debates come down to how it's best to structure the system and ration in the most fair manner.

None of this, however, detracts from the fact that despite all of these problems things have gotten much better for the vast majority of people. Even the poorest people in the world now have access to care and technologies that were unheard of just a few decades ago. We've still got a ridiculously large amount to do to make things even better, but let's have some perspective here. Things are, in general, getting better.

[GGT]

GGT, let's see how many things are wrong in this post:

1. I'm not in academics.
2. You don't pay my salary; for a few years in grad school my $26k/year stipend was covered by a competitive government grant, but that was a long time ago and hardly qualified as a 'salary'.
3. I don't have a golden parachute retirement plan. Where the hell did you get that idea? I save for my retirement like any other joe schmoe, and it ain't funded by the government. If you mean the piddling defined benefit plan I qualified for, it's a drop in the bucket and was funded by a private source.

Do you know who does pay for my salary, and my research? Corporations, funded either by the stock market or venture capital firms. And they actually need to make money to, you know, make more awesome stuff.

I thought you do research, which I consider 'academics'. And I likely help pay for your salary, whether it's through gov't grants or the stock market, or simple consumption/demand. There's no way to disconnect public-private because they're symbiotic. Which is why I mentioned retirement benefits, not directed at 'you' personally, but as a general example of things available only to certain groups of people.

There are very valid critiques of the way our healthcare system works - and indeed firms that develop medical technologies should not be exempted from such criticism. But it's important to note that there are no free lunches. It's hard, and complicated, and expensive to make people better - everything from the initial technology development to the diagnosis to the treatment and later management. We could do a whole hell of a lot better, but at some point we're going to have to ration things. All of these debates come down to how it's best to structure the system and ration in the most fair manner.

But that's not the debate being had in DC by our legislators writing healthcare laws. And that's not what Trump promised his voters.

None of this, however, detracts from the fact that despite all of these problems things have gotten much better for the vast majority of people. Even the poorest people in the world now have access to care and technologies that were unheard of just a few decades ago. We've still got a ridiculously large amount to do to make things even better, but let's have some perspective here. Things are, in general, getting better.

The poorest people in the world, especially children, still die from diarrhea! All the best medical technologies don't matter when drinking the water can kill ya, huh. Yes, things have improved greatly for the vast majority of people, but even in the US there are places where the water isn't safe to drink (Flint, MI).

Your perspective is optimistic but I'm a skeptic: if extending life with advanced medicine is only available to certain people, or through a for-profit system with multiple middlemen, then we're doing it wrong.

[GGT]

Are you serious? Pro-life is a marketing slogan for being against abortion. This sounds even worse than the juvenile 'how can you be for the death penalty if you are pro-life!'

Yes, I'm seriously criticizing the "pro-life" movement that's infiltrated the Republican Party with crappy policy ideas (like a Personhood Amendment that would extend rights to an embryo) while undoing coverage for Family Planning (ie birth control) or subsidies for pregnant women or children living in poverty.

If WHY you die is because you're born to poor parents, or you can't afford to pay OOP for good medical care, then shame on us.

[GGT]

Another angle comes from UK's Charlie Gard (the baby born with incurable, lethal birth defects). Some American conservatives have been all over this, as an example of how SSSocialized medicine means gov't death panels withholding experimental or expensive treatment. And they somehow got baby Charlie expedited US Citizenship, so he could be transported to the US for 'possibly life saving' medical treatment.

What a crock. And what an exploitation of that baby and his family...by people with a political agenda. Including Trump. Shame on them, and shame on us for allowing the Why You Die dilemma not just devolve into party politics, but pitting freee market healthcare against a NHS in such a disingenuous way.