The United States, Pro-Life as Sickness

When visiting Brussels, Belgium, Engelhart speaks to Wim Distelmans, an oncologist and euthanasia proponent, about whether assisted death should be offered to more people in the United States. “It’s a developing country,” he tells her. “You shouldn’t try to implement a law of euthanasia in countries where there is no basic healthcare.” A reader wonders, then, what it means to assert dignity within circumstances that do not do the same….

The Inevitable is interested in dignity and how people define it, but it does not ask so explicitly whether the state, and the laws it creates, can recognize people’s dignity in the first place. If our systems of governance fail to care for so many — and kill others on death row and in the streets — can they be trusted to control the choice to die? If a “developing country” without universal health care did offer wide access to assisted death, one wonders whether its use could make that country’s ills more obvious, more urgent, less ignorable…

…“Philip came to think that efforts to suppress rational suicide were ‘a sign of an increasingly sick society,’” Katie Engelhart writes. “They were a sign that, maybe, society wasn’t so confident in its reasons for insisting on life.”

-Elena Saavedra Buckley, “The Dignified Exit.Los Angeles Book Review. July 23, 2021.

Open Question: What is dignity, and what does it mean to die with it?

Open Question: Is the United States a developing country, from a moral, maturity or other perspective?

I has never occurred to me to think of the United States as a developing country. But, really, when you say something like “American Taliban”, you know exactly who that refers to and what that means. What is the difference? Does living in the “richest country in the world” make any difference if you can’t afford to see the doctor you need? How is that different than having no doctor to see at all?

Thinking Different About This Rigged Game

040204-N-3122S-004 Davis-Monthan Air Force Base, Tucson, Ariz. (Feb.4, 2004) Ð An aerial image of the Aerospace Maintenance and Regeneration Center (AMARC) located on the Davis-Monthan Air Force Base in Tucson, Ariz. AMARC is responsible for the storage and maintaining of aircraft for future redeployment, parts, or proper disposal following retirement by the military. U.S. Navy photo by PhotographerÕs Mate 3rd Class Shannon R. Smith. (RELEASED)

“We should ask ourselves, our communities, and our government: if a business can’t pay a living wage, should it be a business? If it’s too expensive for businesses to provide healthcare for their workers, maybe we need to decouple it from employment? If childcare is a market failure, but we need childcare for the economy to work, how can the government build that infrastructure? If the pay you provide workers doesn’t allow them to live in the community, what needs to change? Collectively, we should be thinking of different funding models, different ownership scenarios, and different growth imperatives. Failure to do so is simply resigning ourselves to another round of this rigged game.”

-Anne Helen Peterson, “The ‘Capitalism is Broken’ Economy.” annehelen.substack.com. April 21, 2021.

Might be prudent to also ask about the entire lifecycle of what we are doing. Does the above look normal to you?

Elusive Waste

“Health care in the United States has its own version of the Fermi paradox. It involves the strong evidence of massive waste that is updated in the Special Communication by Shrank and colleagues in this issue of JAMA. The authors recalculate the proportion of US health care expenditures that is waste. Their estimates, which they suggest are conservative, are similar to other major reports of the past decade, which came up with median estimates of waste amounting to 30% to 35% of total health expenditures. Shrank and colleagues estimated that waste represents 20% to 25% of US health care expenditures, but they explicitly did not include some extrapolations from Medicare data to the population at large. The authors further reviewed the literature on efforts to reduce waste, which, they claim, suggests that about 25% of that amount—approximately 5% of total health care spending—could be reduced with implementation of well-documented, current programs.

-Donald M. Berwick, “Elusive Waste: The Fermi Paradox in US Health Care.” JAMA. Octover 7, 2019.

Amazon Health – Stratechery by Ben Thompson

“At the same time, the U.S. healthcare system is inextricably tied up with the post-World War 2 order; indeed, the entire reason employers are so important to the system is because of World War 2 regulations that instituted price controls on wages, incentivizing employers to use benefits as a means of attracting workers (this was further enshrined by making healthcare benefits tax-exempt)…

…My expectation, then, is not that the Internet methodically disrupts industry after industry in some sort of chronological order, but rather that the entire edifice lasts far longer than technologists think, only to one day collapse far quicker than anyone expected.

The ultimate winners of this shakeout, then, are not only companies that are building businesses predicated on the Internet, but just as importantly, are willing and able to build those businesses with the patience that will be necessary to wait for the old order to collapse, particularly if that collapse happens years or decades after the underlying business models are rotten.

There is no more patient company than Amazon.”

—Ben Thompson, “Amazon Health.” Stratechery.com. January 31, 2018.

An American National Weakness

“…As a nation, we are relatively intolerant of long waits, and we’re not sufficiently focused on the long-term solutions of exercise and good diet. We love the quick fix, we want it on our terms, and we hate being told no…

I do think these tendencies reflect a kind of American national weakness, and that we would be better off if we had a less consumerist, more philosophical, and indeed more spartan approach to our health and well-being. That would lead to less overtreatment, less strain on health-care resources, and in the longer run a healthier nation with a sounder fiscal position for the federal government.

—Cowen, Tyler. “Spending a Lot on Health Care Is the American Way.” Bloomberg. July 20, 2017.