No Country for Old Men

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Wendell: You think this boy Moss has got any notion of the sorts of sons of bitches that’re huntin’ him?

Ed Tom Bell: I don’t know, he ought to. He’s seen the same things I’ve seen, and it’s certainly made an impression on me.

No Country for Old Men (2007)

A personal note on Covid-19, healthcare consumption, and  … pain. Three things that have certainly made an impression on me.

For the past five months, ever since I published this note about the biology of the virus and the lies China was publishing about its spread in Wuhan, Covid-19 has been a daily companion.


Body Count

China is fighting nCov2019 exactly like the US fought North Vietnam … with policy driven more by narrative control than by what’s best to win the war. That was a disastrous strategic mistake for the US then, and it’s a disastrous strategic mistake for China today. … Continue reading



My other daily companion has been pain.

I’ve got the genetics for varicose veins, and unfortunately mine manifest themselves in a nerve-rich area of the body – my ass. I have terrible hemorrhoids.

There’s nothing for it except surgery. I’ve tried every non-surgical therapy my doctor can suggest. Ditto Dr. Internet. None of them provide meaningful relief. As for medical intervention short of an __ectomy, banding was successful in the past, but I’m way past that now.

There’s nothing life-threatening about this. It’s not an emergency.

There’s only the pain. Intermittent … excruciating pain.

It’s exactly like having a red-hot poker stuck up your ass. Or so I imagine. Sometimes the pain is so bad that the entire situation becomes incredibly funny to me and I just start laughing.

Opiates scare me to death, plus they have digestive side effects that you really don’t want in my condition. So I “manage” the pain with Advil, ice packs, and traditional central nervous system depressants – tequila, mostly. Cannabis helps a bit. Nothing helps much.

The worst part is not sleeping for more than an hour or two at a time. Hmm. Actually, the worst part is literally blinding pain. Though not sleeping is the most health-damaging part, I suspect. The weirdest part: as I write this, I can feel tissues moving inside my body. Like a worm.

We’ve all got crosses to bear, many a lot worse than mine. This note isn’t for sympathy (although now you know why I’m on Twitter so much – it’s all I can manage much of the time). This note is for what my situation means for healthcare consumption. Because I’m not alone. We all know someone who is in urgent-but-not-emergency need of some medical procedure that can’t be scheduled while Covid-19 is storming the hospital ramparts.

Connecticut is opening up a bit, so I’ve got an outpatient surgery scheduled at the big local hospital (specialty clinics are still closed) next Friday. I feel lucky to get on the calendar so soon. I also feel nervous. My dad was an ER doc. My brother is a healthcare lawyer. Again, these are things that have certainly made an impression on me.

To be clear, my lack of healthcare options today and over the past 3 months isn’t because of the lockdown. That’s how a child would see this.

My lack of healthcare options is because of the virus.

In its acute phase, Covid-19 shuts down non-emergency healthcare provision entirely.

In its endemic phase, Covid-19 forces enormous and costly changes in healthcare provision. There is no “v-shaped recovery” for medicine.

Covid-19 is now in its endemic phase.


Self Assured Destruction

Our leaders have botched the Covid-19 war, and we are defenseless against a now endemic disease. The free world does not easily survive a globally endemic Covid-19. … Continue reading



The enormous and costly changes in healthcare provision that Covid-19 requires and the resulting impact on healthcare consumption lead me to three conclusions about the healthcare industry and national politics.

Conclusion #1: Endemic Covid-19 permanently dents healthcare provision (and consumption). The days of “efficient” (i.e., insanely lucrative) specialty medical clinics where docs go through 3 knee replacements or 10 lasik procedures in an afternoon are GONE.

Conclusion #2: Although both acute and endemic Covid-19 sharply reduce my healthcare options and healthcare consumption, my healthcare insurance costs have not gone down. They’ve gone up. Healthcare payers (insurance cos) are a public utility. They should be regulated as such. #BITFD

Conclusion #3: For the past 30 years, US fiscal policy has been largely driven by Boomers’ insatiable demand for more and more healthcare, to the advantage of both the Dems AND the GOP. Covid-19 destroys that cozy political dynamic, but neither party realizes this yet.


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BostonDad
BostonDad
3 months ago

sorry to hear of your condition – i’m sure sitting at a computer is THE WORST !!

I also think many have come to similar conclusions over the last 3 months to 3 years, about HC, but particularly the cost side (esp relative to the rest of the Developed World).

Just a reminder: Bernie wanted $2T to be printed out of thin air to pay for HC for everyone, over the next 10 years. Congress approved of $3T (and counting) to get us to August). Not hearing the cries about how we are going to be Venezuela anymore.

And we’re still going to move toward HC for All (in some form).

feel better . . .

M.Aurelius
M.Aurelius
3 months ago

Ben, my sympathies. As I know only too well, it is not just the pain that debilitates, regular pain grinds one down and even affects the ability to think coherently. My good wishes for an early resolution.

As for the failure of those at the top to foresee and prepare for the advancing pandemic and its effect upon healthcare provision, it is hardly a surprise. The health of a nation has been sacrificed on the altar of dogma … and of course profit. Any healthcare system that is based on profit, will inevitably be inequitable and potentially unstable. The shedding of a single tooth by one small cog of income generation and the machine fails. Single payer systems such as those in the U.K. and Canada are imperfect, but they do not have a dual aim, the healthcare of all individuals is prime … and don’t start me on the total failure of preventive care, and the perverse drivers for the pharmaceutical industry.

Kimpton Bradford
Kimpton Bradford
3 months ago

Imagine for a moment, if you will:
Floating about in your kayak with your Inuit hunting buddy out in the high Arctic Ocean. You said to him, in response to some deep insight, “that’s just the tip of the iceberg!”
Now you’re trying to explain to him what the hell that means! He knows icebergs. He knows most of them are underwater. He looks around and sees hundreds, and hundreds of them.
What’s the point of saying that something ‘is just the tip”?

You’re conclusions about healthcare provision Ben, are just the tip of the iceberg.
We are about to find out that almost everything that defines us in N.America in the 21rst Century is or will be up against the same conclusions. Except maybe friendship and community. Car repairs, education, vacations, eating out, little league, shopping, even drinking – they are all there but 90% of it is missing!

I think we are about to find out that our hyper-efficient hyper-available modern economy was actually built on the small efforts of many, many millions of us. Hyper-socialism if you will.
That is going to roast more than a few tostadas!
The argument that the underlying fundament of our modern economy is free and independent capitalism is belied by the reality all around us.

Martin Cunniff
Martin Cunniff
3 months ago

I am sorry to hear about your medical difficulties. I hope the surgery works out well. It’s amazing that you can generate the brilliant work product you do while suffering so much.

Tanya Weiman
Tanya Weiman
3 months ago

Ben, I know you said this article was not seeking sympathy and I respect that, but please allow me to say I’m so sorry for what you’ve been going through, and I hope your upcoming surgery brings relief. Also:

HELL YEAH regarding Conclusion #2. BITFD.

Regarding the medical field, obviously there have been huge strides, and there ARE great people doing great work, but I feel unless it’s something blindingly obvious (broken bone, cut, etc.) they’re just guessing. And the solution is throwing some drugs at it and seeing if that alleviates the symptoms, with little regard to what’s actually causing the symptoms. And I still say that as someone that pays out of pocket to see the GP I have, because he treats you like you’re actually a human being.

But again, I hope you’re feeling better very soon!

Michael Taillon
3 months ago
Reply to  Tanya Weiman

“…but I feel unless it’s something blindingly obvious (broken bone, cut, etc.) they’re just guessing.”

There’s a reason they call it “practicing medicine”. Often it IS just (educated) guessing.

And while the entire HC industry (I use that term literally) is a mess of cross linked conflicts of interest, please don’t let the health insurance industry (again, literal use) slink away unscathed. Ask any medical professional who’s really running the show and, if they are honest, they will point to the insurance companies. For it is often they who determine who, what, when, where, why and how a patient receives treatment.

I can’t tell you how many times a doctor has told me they need to get this or that approved before we can go forward with treating some chronic issues I deal with on a daily basis. Some known good treatments will not be approved until I suffer thru ineffective (read cheaper) procedures first.

BTW….Ben, I always knew you were a pain in the ass. Just not in the real sense of the term.

Please….get well soon my friend.

TyB
TyB
3 months ago

Ben, very sorry to hear about your condition. But, I am concerned. Will I like the jolly, happy-go-lucky, pain-free Ben nearly as much as the cranky, suffering, tweeting Ben? I look forward to finding out. Get well!

Sam Calabrese
3 months ago

Please get a sleep study. Your condition may be related to upper airway resistance syndrome or apnea. It’s a chicken or egg approach.

Punk1981
Punk1981
3 months ago

Ben,
Sorry to hear about your troubles. It sounds To me like it may be an anal fissure rather than thrombosed hemorrhoids, but either way it is serious pain. Good luck with your treatment.

Victor K
Victor K
3 months ago

Ouch! But, now the tip of the iceberg has two meanings! Speedy recovery and hope you feel better soon!

Daniel Thomason
3 months ago

I know you’re not fishing for sympathy with this post, and you’re certainly not in the market for free medical advice from internet commenters, so all I’ll say is that my thoughts are with you, and that you’re a role model to me for pushing on with what you believe in despite personal hardship.

K
K
2 months ago

Ben, I really hope the pain is better now!

While reading this I was reminded of Christopher Walken’s wristwatch scene from Pulp Fiction.

I’ve also been living with pain, but on a much lesser scale – some type of sciatica pain, I think kicked off by sleeping on a recliner for a few weeks after my daughter was born. The crushing pain shooting down my right leg every time I stand up, and while trying to care for a newborn, has been hellish, so in my small way I can relate to living with pain during covid quarantine.

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