"He has erected a multitude of new offices and sent hither swarms of officers to harass our people, and eat out their substance".

There was once a time when American professionals believed that their choice of work was a response to a calling. In the origin of the word “vocation” is the implication that the call comes from a noble place beyond the self, perhaps from God. That belief implies that fiduciary duties attach to the service provided to clients. Such quaint notions have been, sadly, expunged from the motives of those who toil in what, today, passes as professional practices of most all kinds. Caveat emptor now applies to you doctor, lawyer, as well as your priest, minister, rabbi or imam. Would that we could refrain from buying the sundry outputs of the state and its monopolist co-religionists like big tech, but choice is not involved, rather compulsion. It’s what lawyers call “a contract of adhesion”. You take it or leave it.

The organizations of such professionals, in turn, once expounded on the pinnacle of what America could create - the best of the best. Professional associations looked to the ethics and performance aspirations of their constituents so as to assure continuation of superb practice in service to clients - even as generations passed. That was before these associations were co-opted, became toadies of the state and finally threw in completely with leviathan so to effectively merge themselves with authoritarian state bureaucracies. The hallmark of these latter, even as they function to a small extent as pale remnants of professional organizations of yore, is that they no longer actually serve the public. Rather, notwithstanding high - sounding mission statements of service to the public, these Lilliputian tyrants indeed work furiously, but at propagandizing and terrorizing the public to convince it of the latest prevented threats to their wellbeing by additional rules. In reality, they act to implement their own ever more Byzantine internal algorithms with a two aims in mind: power and fulfillment of their ever - metastasizing political directives. These agencies have been incrementally bloated by hasty accretion of every passing political fad and fancy plausibly pertaining to their bailiwick. The day of actually serving the needs of clients as fiduciaries or even as customers, honestly, is over. Any question as to who serves whom can be instantly answered by an interaction with, say the DMV in any state or the IRS with the feds.

That malignancy which is politics, we have been painfully schooled, has been eternally incapable of containing itself when it comes to power. Its incontinence in grasping for ever more has overflowed into every single bureaucracy - even as it continues to erect ever more of them. Taken together, these comprise the pulleys and levers of our rule - the omnipresent, omni-incompetent corruption of what was once a decent, self-critical and improving society. It is of such a magnitude as the founders never dreamed possible when they made the above observation of HRH King George III. Unlike our rulers, kings of old at least had some natural incentive to preserve the sound function, productivity and satisfaction of their subjects for his heirs - his family. We should be so lucky, under the “consent” we now give our rulers. “Of the people, by the people and for the people” is a pitiful, hollow joke.

Examples of corruption of government “services” abound. Mere mention of, “the legal system” the department of justice” (sic) or “a nation of laws” evokes cynical disbelief at the suggestion anything vaguely resembling service to the public is afoot. The ongoing Trump “prosecutions” signal then end of even pretense that this is a system of laws. Most now understand that this this misbegotten, corrupt assembly of power brokers, exploiters and users in every branch of government at every level - who pass themselves off as principled “public servants” - are little more than automata, small parts of a vast Rube Goldberg machine, whose only real output is self - aggrandizement. My own recent experiences with my wife in the health “care” system, is a clear example of how America the corrupt now works. The tale will show how “Tracking With Closeups” is a technique of context analysis which gives great insight into the “big picture”. In this case, we will see how, when it comes to “healthcare”, the system is bereft of actual caring. It , like every other “regulated” system, has been redacted, to use a current term - i.e., surgically excised by our betters.

This small example is a close up which stands for much that is wrong with the original system by which human beings offered their services to others. Before the state stepped in to “improve” the relationship between doctors and patients, the individuals had what the law called a contractual relationship. In service contracts, the doctor offered his expertise in to patients - diagnosis and/or treatment - in return for compensation in terms of money or goods or even a return of services of some sort. State inclusion in this contract stemmed from the difference in knowledge between the parties. English Common Law took note of this differential and added a legal requirement of consent. This imposed upon the physician a duty to obtain the express consent to any physical interaction or “touching” to use the legal term of art. Touching another without consent is a battery, for which damages accrue. more could be said, but that suffices here.

Now, American law extended this legal duty in the early 20th century by adding a requirement that the physician - having far greater knowledge than the patient - inform the patient of sufficient fact that the patient can make a decision while armed with facts as to his condition, diagnostic procedures and proposed treatment. Naturally, this being America and lawyers being lawyers, much litigation ensued as to the requisite information necessary and what evidence is required of its having been given.

English Common Law courts in cognizance of the American shift to the doctrine of informed consent, declined to “go down that path” for a period of several years before succumbing. The only inquiry in England, at first was “Did the patient consent”? Yes or no. All the case law regarding consent was over the years, gathered into statutes and regulations at federal and state levels. The compendium of regulation (the Code of Federal Regulation or CFR) has expanded in size over the years. The number has grown since 1951 from about 5000 to nearly 200,000 pages! Anyone surprised? Many have severe criminal penalties attached and these were mainly created and enforced by the executive branch. So much for division of powers.

I mention this codification of law in light of their having been completely ignored regarding Covid. There are pages and pages of high-minded requirements for ordinary citizens working in any medical field, who have contact with patients. They sound highly ethical and proper an require that much information be offered before any diagnostic or treatment procedure may be legally performed. Do you recall any such process before receiving your jab?? These ethical rules were ignored by the very state charged with their enforcement. no consequences to anyone. One reason there are no consequences is that side effects and bad outcomes have been (and are still being) ignored and/or hidden by the very authorities charges with protecting us from harmful medical treatments - like “vaccinations”.

So thorough is official propaganda regarding Covid (and everything else about which you might want information), that finding anything not supporting the official “narrative” has become remarkably difficult. Once upon a time, Google gave unbiased search results. For example, finding the number of pages in the Code of Federal Regulations (CFR) or their rate of growth, used to be quick and results prominent in any search engine. Since it is an irrefutable measure of the growth of state intrusion, it is no longer easy to find. Like every single fact or opinion (Google et. al. make no distinction, to the extent it promulgates the official narrative), search results are highly slanted. Any fact or opinion which is not consonant with “left leaning” (89 degrees or less counterclockwise to the left of vertical = 0 degrees) displays prominently in search results. Opposing opinion is most often completely absent from search results or, if eventually found, categorized as “conspiracy theory” or “right leaning” (1 degree of more to the right clockwise from vertical). This is the approved “new normal”.

So this exposition of “tracking with closeups” was precipitated by a meeting with my wife’s gynecological surgery oncologist to plan a “de-bulking” operation for her abdominal cancer. This will be an open laparotomy for removal of any visible cancer. This malignancy originated in the peritoneum - the thin membrane which lines the inside of the abdominal wall and the surface of all the abdominal organs. The cancer, too, is a thin coating and is described like “icing” coating the peritoneum. It’s not like a solid tumor which can be separated from normal tissue and cut out. Most of this is removed with laser or electrocautery. Based on the PET scan and markedly decreased blood levels of cancer antigen, the surgeon is optimistic there won’t be a lot of cancer to remove. I pray she is correct.!

Near the end of the discussion, we talked about management of post op pain. She (the surgeon) said my wife would probably be in the hospital 3 days with IV opioids and that the prescriptions for post op pain after discharge would be sent to our pharmacy so we wouldn’t need to scramble to get them on the way home from the hospital (as was usually the case until recently). Then came the politics which caused me to grit my teeth. The surgeon will prescribe acetaminophen (Tylenol), ibuprofen (Motrin) and only a limited amount of opioids! Here is a perfect example of political decision making in patient “care”.

Now I have 50 years experience managing post op pain of all kinds. In my experience, acetaminophen and ibuprofen will not touch most types of post op pain - particularly the severe pain after an open laparotomy with an extensive incision from top to bottom of the abdomen. So why would a surgeon - who surely knows the inadequacy of those two medications - resort to such an order? Answer - because somewhere, someone, somehow has abused opioid medications! The state, via the captive medical profession, is thus doing something!! and more importantly it is doing so on the record, with official orders for over-the-counter medications already present in the medicine cabinets of most everyone.

They’re demonstrating with this evidence on the record that they’re telling the patients they must take Tylenol and Motrin (these prescription medications are exactly the same as the over the counter ones - only it’s about 10 times the price and wastes pharmacist time and effort!! No matter. The state and their captive “providers” can say they are doing something - although everyone knows it will make zero difference in the “fentanyl epidemic” or its associated deaths. Non-enforcement the open southern border is of no consequence in this regard, we are told. Instead of cutting off some of the illegal fentanyl supply, lets get tough with law-abiding surgical patients who are legally prescribed these medications and deny them pain relief. See?? We are such good guys acting to reduce fentanyl OD’s and deaths!!

And what are they really doing? They are denying adequate opioids to the very patients who need them and for whom they are entirely appropriate. I have witnessed this kind of thinking in action and can tell you the results are serious post-op complications, unnecessary pain and suffering and preventable deaths. You’ll never hear that truth from the MSM. These practitioners completely ignore the well known fact that not only does pain tolerance vary among individuals, but so does the dose of required pain medication vary among patients for adequate relief. The only way to find the necessary dose is empirical. It is to give a dose to a patient in pain, observe the result and adjust the dose accordingly. This means that to adequately relieve pain in 95% of patients (a reasonable goal from the patients’ point of view), doctors must prescribe more medication than required for those who will adequately respond to the mean dose.

So, not only is this the usual meat-fisted state response we a expect from the state. It is stunningly incoherent compared to its “safe and effective chorus” when it come to any other medical or especially vaccine cheerleading. In cheerleading favored medications and doses the state approves of, we are forever told we must err on the side of “safety” or “best practices”. Does the state adhere to it own cheerled advice? Like its advice to the little people as to the essential nature of “fully informed and knowing consent” (above) in our dealing with each other and that to “save a single life” demands that everything imaginable must be done - the state ignores its own principles when it see fit to just ignore its own rules.

It is not harmless to deny adequate pain relief, however great the political optics of “doing something” about opioid abuse. Beyond the obvious pain and suffering of the affected individual, their lives are actually and unnecessarily put at risk. Most of the risks of major surgery actually occur in the post op period - not during surgery or in recovery room. That’s because their vital signs are continuously monitored and aggressively kept at safe levels in the OR and PACU. The stress response does not become maximal, though, until 24 - 96 hours post op.

And guess what? That’s exactly when the authorities - you know, the omniscient ones who are incessantly telling us what’s good for us (with the active acquiescence of the doctors and hospitals who were once fiduciary patient advocates) and insurance companies want to throw the patients out of the hospital and send them home, completely unmonitored with intentionally inadequate pain relief for the sake of optics!

This post op stress phenomenon is neither my invention nor new. It has been well understood for decades and can be managed safely - beginning most simply and easily with adequate pain relief. You don’t need a medical education to know that uncontrolled pain is bad for your heart and blood vessels, which may burst under the stress. Any major insult or bodily injury results a stress response - in high levels of cortisol, epinephrine, nor-epinephrine among other mediators. These, in turn, cause an increase in cardiac output required for healing.

This increase in cardiac output is accompanied by increased heart rate and blood pressure, all of which greatly increase stress on the heart. Inadequate pain treatment is well known to be a - if not the - primary cause of preventable myocardial infarct, a stroke, or a bleed anywhere in the body, but especially in the brain or surgical site and especially around the time of discharge with intentionally inadequate pain medication. Oh, and this is all not to mention that fact that many surgeons will not allow their patients to use ibuprofen in the early post op period because - like aspirin the original NSAID - it interferes with platelet function and risks early post op bleeding! So, this order for ibuprofen functions as a sort of litmus test for those surgeons who knuckle under and toe the state’s absurd and harmful opioid line! Patients wo do bleed post op are net told the cause. Just - “You didn’t heal right”. There’s the remnant of patient advocacy by physicians on display.

This is less than the tip of the governance/harms iceberg. Such “unintended” consequences of purportedly well meaning policies and decisions, are actually known and hidden by our betters and that is the main point of this entire exercise. Despite the representations endlessly spouted by our superiors and their media henchmen, they actually care not one whit for us, outcomes, health, wellbeing, happiness or even sanity. All that is defined away by process measures designed to exclude big picture results. Rather, check off what we say you should have done. Like “prescribe Motrin for post op pain” “Check”. end of inquiry. They care about one thing: POWER and the continual acquisition of more. I am reminded of the ethos of our governance every time I watch a documentary about supermax prisons, with perfect regimentation, total control of inmates and zero possibility of unpredictable behavior - ever. Similarly public school process measures look perfect on the screen; there are check marks in every data field. No matter the graduated children are illiterate, innumerate or unable to think. We can’t or don’t measure that! “You vill own nutting”. “You vill eat ze bugs”. “You vill be happy”.

I have described here a small cause of morbidity and mortality and how it results from decisions intentionally made by our betters for the sake of mere appearances favorable to the media-preferred ruling party - that is, in furtherance of the blatant lie that they care about us and must keep us “safe” - in this example, “safe” from opioids - at any cost, regardless of whether they can actually accomplish such safety on our behalf or whether or not we even want them to “help” us in that way. The MSM, of course, blares the government line (Soviet Pravda was never even close to this performance). Finally, you can be sure you will never learn of the preventable morbidity and mortality among post op patients - however many there are. It just doesn’t fit the narrative. Truth dies amidst “hate facts” like these.

How many other harms are covered up for optics sake - direct results of our self-touting beneficent government? How many do you suppose there are - hidden by the state, with the collusion of the democrat media arm - the MSM. For instance, how many harms and excess deaths do you suppose have been covered up resulting from the Covid tyranny? From “gender affirming” “care”? From the “global warming” hysteria? From the unlimited money printing? Or the intentionally divisive identity politics? This is precisely what a complete failure of governance looks like, just before the whole house of virtual cards collapses.

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Absolutely. In recent years I’ve developed an interest in ophthalmology due to several of my family members and close friends having eye conditions that required various surgeries and treatments. In particular, I’m fascinated by the sub-specialty that deals with the issues surrounding the retina and vitreous. The sub-specialty of retina really came into its own at the beginning of the 1970’s and the following two decades was a period of remarkable innovation in terms of surgical instrumentation and technique. The American Society of Retina Specialists (ASRS) has a series on their YouTube channel entitled “Leaders and Legends” where they interview the people (most of whom are now in their 70’s and 80’s) responsible for all that great innovation that saved and continues to save the sight of millions of people around the world. Now, these guys are the crème de la crème in their field—total rockstars—and I was struck by the fact that they all had the following attributes in common:

  1. Brilliant and creative mind (obviously)
  2. Great humility (which surprised to me)
  3. Quiet confidence (again, this surprised me)
  4. Willingness to freely share their insights and discoveries with anyone and everyone and work with others to push their specialty forward
  5. An almost religious passion and commitment to their profession and to their patients

I think the field of retina “back in the day” was a great example of modern medicine “gone right”. That period was before my time, but I have a sad sense of nostalgia when I think about the greatness that once was.

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It is worth noting how the State does its “something”. A faceless unaccountable bureaucrat (or more likely a room full of faceless unaccountable bureaucrats) in a conference room far away takes a decision – and that decision becomes the reality that we peons have to live with. What is the name of the responsible person? What data did she analyze to reach that decision? We will never know.

The answer in a sensible society would be the names of the individuals who made each decision on medical protocols being publicly disclosed – with public floggings for the individuals who are found to have made poor decisions. That would certainly change the behavior of bureaucrats!

Or one could move to a country like Saudi Arabia, where essentially all medications are available over the counter. That evil Saudi government trusts its citizens to act in their own best interests. Who da thunk it!

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Oh, man! You are preaching to the choir!

I recently tried to take advantage of a sale by Ray-Ban and purchase a set of prescription sunglasses for a young boy in my parish who I think is being raised right and so deserves a treat. I ordered a set of aviator frames with mirrored lenses and sent in the prescription his father provided to me. It was a standard eye lens descriptive Rx. I got asked to provide the person’s name, date of exam, and signature of the refractionist. I wrote back that I had provided them adequate information to make the glasses I had paid for, and that the rest of the “information required was private and none of their business. THEY cancelled the order!

Refraction is, as you are quite aware, a mundane skill. In my old military clinic we had techs (enlisted personnel) doing refraction testing. There was no insurance involved; they had been paid in full by credit card. ?So why did they cancel. No clear answer other than some virtue signalling about “forms”.

My second-to-last ED assignment had an episode where I ordered a dose of Toradol at 60mg IV. The nurse refused to give it, stating, “It’s a dangerous dose.” I countered with, “That’s OK. Just give me the med and I will administer it to the patient.” She refused to do that either, then bugged me about giving the patient something for pain! I said I had written my order and whenever she was prepared to do what she was supposed to do, the patient would get her med. Patient went home with an Rx for some narcotic instead. I quit working there as of that shift. I refuse to be second guessed by some nurse on a dose we have used in the ED for years with no consequences. But somewhere some clown decided that much Toredol was not necessary - and it became “law”. NONE of your observations about the variation in dosage needed for decent pain control in certain circumstances is followed, because we are in the throes of “casino medicine” - otherwise known as Best Practices. Or, in other terms, ANECDOTAL MEDICINE.

These are areas you and I are familiar with. But the attitude prevails all over. society. If something bad happens, a LAW is passed - as if that will cure all ills. We have had a law prohibiting homicide for over 4,000 years - still get murders. That in itself ought to circumscribe the extent of laws’ ability to “prevent” anything.

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You should send this piece to JAMA and Pennsylvania Medicine! It deserves a wide audience.

I’ve so often heard my BMD say the same thing you nd @Devereaux are saying here. Incredible. We wouldn’t let an animal suffer like that.

Funny they never thought this way about tobacco and alcohol: some people get addicted, some people kill themselves with these substances!—so therefore, NOBODY can have these pleasures!
(Well-I reckon we did try that once, with booze—but it didn’t work and it didn’t last long…:grimacing:)

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Yes, indeed. It is part of “don’t be judgmental” and this absurd admonition makes for chaos. Now, there is one important category to which this does apply: the value of another human being. It does not apply to that person’s behavior. Some behaviors are better than others, whether in the practical or the moral dimension. We make such judgments or (gasp) discriminations all day every day. The left as usual has destroyed language so as to make the word “discrimination” to always subsume “racial”. It has thus succeeded in creating an amoral, timid, diffident, now blatantly suicidal civilization. The lights will go off before the end the final whimper will be in the dark. Nobody will need to turn out the lights.

Interestingly, most organizations like medicine eliminate the need for any human judgement by making algorithms- like “one size fits none “ dosage, as you described. The original fear was negligence allegations. The irony is that an error in judgment is - in law - NOT negligence. So that’s not the real reason for medicine by algorithm. It’s about control and making “providers” interchangeable (= merit free).

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Ha! So right! AND ?do you remember when this seismic shift occurred. When the military stopped calling you and me “doctors” and. started calling us “providers” - and then made PA’s and NP’s equivalent to doctors by referring to them ALSO as “providers”.

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Hypatia

6h

You should send this piece to JAMA and Pennsylvania Medicine! It deserves a wide audience.

I’ve so often heard my BMD say the same thing you nd @Devereaux are saying here. Incredible. We wouldn’t let an animal suffer like that.

Funny they never thought this way about tobacco and alcohol: some people get addicted, some people kill themselves with these substances!—so therefore, NOBODY can have these pleasures!
(Well-I reckon we did try that once, with booze—but it didn’t work and it didn’t last long…:grimacing:)

Hyp - they don’t want to hear it! The AMA has been wholly bought and paid for since when Christ was a Lance Corporal. They have been beholden to leftist ideas and big groups all along. They hardly represent the solo practitioner or even the solo doc in a group. Your BMD is merely an income point to them; his concerns are inconsequential to them.

I was an administrator in a moderate sized ED group. WE had little sway, even in ACEP, our home board, and nothing to mention concerning the AMA. If you looked at who sat on those boards, it was the heads of the big national groups - the ones no one wanted to work for unless no other alternative existed. They paid poorly, didn’t give you a voice - even in issues that potentially involved patient safety, and hardly about patient charges, etc. I was an FACEP but quit that crowd when it became obvious they did not represent democratic groups.

You can’t avoid them. They’re everywhere. The ONLY way to affect them is to have physicians wholesale quit. Leave. Deny them the dues AND the numbers. Rather like how to affect Congress - take away their money.

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You’re right, I know.
So then, I was thinking @civilwestman should submit the piece to American Thinker. The people who read that site would agree, be very impressed— but that’s preaching to the choir, too.
I don’t read or write on Lefty sites. So how can I expect Lefties to read the sites I read?
There just IS no forum, any more, where people “cannot choose but hear” . CW and you are the kind of doctors everybody wants. By the time they find out there aren’t any more, it’ll be too late.

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Kind words Hyp. But let’s face it - CW and I are in the “were” column. I quit because I got tired of all the BS. I got tired of nurses telling me what to do. I got tired of administrations mistreating worthy patients. Once upon a time, in the group I worked in, any doc had the authority to make a patient “insurance only” or even to drop all charges (you had a chart made, you got charged for seeing a doc). Today’s MD’s are far better versed in the economic side of medicine. I recollect working with 1st year residents rotating through the ED in Peoria. ALL of them knew just how to fill out a charging statement for max reimbursement. I had no clue - and I was the “attending”.

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And as an aside, I strongly advised my kids NOT to go into medicine. Dead end profession, the way it’s going these days.

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I call the process “para”-lyzing. Medicine as you say has morphed into “providing”. The attitude of the NPs is like, ‘So you think you’re smarter than I am, just because you have an MD?”

Actually, yes. I do.

Y’know, back in my father’s day,all the docs worried about “socialized medicine”. And what did we get instead? Capitalized medicine.

I don’t know if it even would be possible to do what my BMD and his peers did: just rent office space and start a solo practice.

Americans had the best health care in the world. They used to know it. They let Hilary Clinton convince them otherwise.

Then the HMOs came in. What a gig! The physicians’ office secretaries had to do all the paperwork!

The point is: people are getting what they damned well deserve.

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Never, in a million years would they publish it. They are as on-board as it gets.

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Respectfully, may I disagree? What we got (what we have today) is bureaucratized medicine – largely driven by government over-regulation. Yes, insiders are making money off the medical system, but since they do that through their close contacts with bureaucrats & politicians, that kind of money-making is more properly described as fascist rather than capitalist.

Let’s not let lawyers off the hook either. Go to a doctor (more likely a Nurse Practitioner) today, and he barely looks at your face. He spends the time with the patient filling in data on his computer screen – mostly so there is a record when the predatory ambulance-chasing lawyer comes to feast on some unfortunate patient’s misery.

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Certainly it is in America, but I wonder if becoming a doctor is still valuable in the sense that it could be a pivotal part of a “plan B” (what I now call a “plan A”) to move to some saner part of the world?

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Maybe we had the best health care in the world, but even during the best of times, that great health care, unfortunately, didn’t result in us having the best health in the world.

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This fact has been widely cited as part of the left’s eternal scheming for control. Population measures of things like life expectancy are heavily influenced by infant mortality. A high infant death rate disproportionately (and often misleadingly for political purposes) diminishes life expectancy. How this is measured and reported varies and can have a big impact on the result when comparing countries’ life expectancy. Do they begin with live births? Do they count 24 hour survivors? One week? One month?

A better comparison would be life expectancy for 1 year olds, because this excludes children born to high risk mothers who had poor nutrition/personal health, no pre-natal services or infant wellness monitoring and vaccinations. The fact countries like the US want to hide is the infant mortality due to maternal behavior - i.e. those who are part of the permanent underclass who do not avail themselves of free health services. Of course, this group includes drug addicted women and the mentally ill. So, if you start with live births, you can argue the need for more money and power to save the babies whose mothers’ behaviors have condemned them to early deaths. Also, if you look at survivorship for things like cancer in the elderly, the US is (probably) near the top. Of course, like measuring inflation (or any other measure of state malfeasance), there’s lots of room to massage the inputs in calculating statistics.

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By not having the best health I was specifically thinking about our epidemic levels of obesity and diabetes. After travelling to other countries (in Europe and Asia), it’s embarassing coming back to America and seeing how fat and generally unhealthy we are (and as someone who has struggled with controlling their weight, I’m not trying to put anyone down).

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To your question about Plan B, I have no idea. My kids are firmly emplanted in America. True they seem somewhat clueless - and unwilling to engage in political discourse - but I see some hopeful signs in that department.

As to having the best health care in the world, we did. Statistics on that have often been misleading because of different ways of measuring. So,eg, the oft quoted “disparity in newborn mortality” is a function of measuring that. Were we to use the standard used by the rest of the world, we would be the best or almost so.

But with government intervention, like all things, healthcare has become expensive. Wasn’t like that before. Among other things, Medicare almost guarantees fee increases by how they “allow” you to modify your fees.

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If I could go back in time and talk to my younger self, I’d tell myself to work on getting a second or thrid passport.

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