Inflamed Labyrinth

A dizzying week calls for steady remedies. We’ve got the great Larry Elder, who’s hoping to save his home state by taking on Gavin Newsom in California’s upcoming recall election. Next, we bring back our pal Dr. Jay Bhattacharya since CoViD wants to stay in the news. Should the Delta variant motivate you to encase yourself in plastic wrap before leaving the house? You’ll have to listen to find out. Plus Rob tells us about his recent bout of vertigo, the guys chat healthcare (both human and canine) and not-so-petty crime.

Music from this week’s podcast: Scene D’Amour from Vertigo by Bernard Herrmann (Original Motion Picture Soundtrack)

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There are 35 comments.

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  1. kedavis Member
    kedavis
    @kedavis

    Getting your hair washed is pretty standard at many haircut places, especially after the cutting to get leftover hair bits out so they don’t fall down your neck and cause itching, etc.

    • #1
  2. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    Have not listened but if Rob is having vertigo that really sucks. 

    • #2
  3. kedavis Member
    kedavis
    @kedavis

    Bryan G. Stephens (View Comment):

    Have not listened but if Rob is having vertigo that really sucks.

    He was, but it seems to be pretty much gone now.

    • #3
  4. Henry Castaigne Member
    Henry Castaigne
    @HenryCastaigne

    kedavis (View Comment):

    Bryan G. Stephens (View Comment):

    Have not listened but if Rob is having vertigo that really sucks.

    He was, but it seems to be pretty much gone now.

    I hope he is doing well. 

    • #4
  5. ParisParamus Member
    ParisParamus
    @ParisParamus

    Wonderfully entertaining interesting podcast. You guys have recovered from a low period. 

    • #5
  6. BillJackson Coolidge
    BillJackson
    @BillJackson

    I just dropped in to compliment @jameslileks on his segues — smooth, effortless … it made me feel like it would be a crime to skip over the ads, so I didn’t. Well done! 

    [Also I hope @roblong feels better, because his interplay with the intro to the segues is, weirdly, one of the things I really enjoy about the podcast.]  

    • #6
  7. ericB Lincoln
    ericB
    @ericB

    About the healthcare conversation, a possible guest?

    Sean Masaki Flynn Ph.D. is the author of

    The Cure That Works: How to Have the World’s Best Healthcare — at a Quarter of the Price
    Pub. Date: 06/18/2019

    Economics for Dummies author Sean Flynn explains that simple things—like price tags, competition, and plentiful health savings contributions—crush costs while granting everyone equal access to the world’s best healthcare services.”

    A free Nook sample excerpt from the ebook edition is available to download and read.

    The Ricochet hosts are right that — from a technological perspective — America has some of the best medical technology and expertise available.  But we don’t have anything like free market health care.  (How many people have any real idea about the price of medical care?  How many could effectively comparison shop, even if they wanted to?  Do even the healthcare providers have a sense of comparative cost?  Generally, no.)

    The unsurprising result is that we don’t get quality provided efficiently.  We pay more than we should and get less than we should.

    For those who would like to hear about what actual free market healthcare in the U.S. can look like, check out this EconTalk interview with entrepreneur and anesthesiologist Keith Smith of the Surgery Center of Oklahoma to get a glimpse of top quality healthcare provided for a small fraction of the price.

    Keith Smith on Free Market Health Care
    Nov 18 2019

    The Free Market Medical Association has an annual conference coming up on August 5-7, 2021 with the theme: Are you ready for the red pill?

    The podcast Healthcare Americana (about the direct to consumer healthcare world) had a recent episode with a short interview with the FMMA’s Executive Director, James Dunavant, about the conference.

    • #7
  8. Henry Castaigne Member
    Henry Castaigne
    @HenryCastaigne

    ericB (View Comment):
    The Ricochet hosts are right that — from a technological perspective — America has some of the best medical technology and expertise available.  But we don’t have anything like free market health care.  (How many people have any real idea about the price of medical care?  How many could effectively comparison shop, even if they wanted to?  Do even the healthcare providers have a sense of comparative cost?  Generally, no.)

    I felt that too. I’m glad that well-off people like my grandparents and Rob Long have access to so much expertise and technology. But one of the reasons Obamacare care passed is that it the cost of health insurance really hurts low-income Americans and small businesses. 

    • #8
  9. RufusRJones Member
    RufusRJones
    @RufusRJones

    They have to wipe out employer-based insurance. 

    Force everybody to get a straight indemnity contract.

    Force everybody on to direct primary care.

    Somehow figure out how to appropriately subsidize it like employee-based insurance is now, straight out of the US treasury so it’s strictly progressively subsidized. 

     

    • #9
  10. kedavis Member
    kedavis
    @kedavis

    RufusRJones (View Comment):

    They have to wipe out employer-based insurance.

    Force everybody to get a straight indemnity contract.

    Force everybody on to direct primary care.

    Somehow figure out how to appropriately subsidize it like employee-based insurance is now, straight out of the US treasury so it’s strictly progressively subsidized.

     

    Isn’t the simplest, most direct path, just “single-payer” and make all doctors federal employees?

    • #10
  11. Henry Castaigne Member
    Henry Castaigne
    @HenryCastaigne

    kedavis (View Comment):

    RufusRJones (View Comment):

    They have to wipe out employer-based insurance.

    Force everybody to get a straight indemnity contract.

    Force everybody on to direct primary care.

    Somehow figure out how to appropriately subsidize it like employee-based insurance is now, straight out of the US treasury so it’s strictly progressively subsidized.

     

    Isn’t the simplest, most direct path, just “single-payer” and make all doctors federal employees?

    The market is insanely complicated but it works better than more simplistic government stuff.

    • #11
  12. kedavis Member
    kedavis
    @kedavis

    Henry Castaigne (View Comment):

    kedavis (View Comment):

    RufusRJones (View Comment):

    They have to wipe out employer-based insurance.

    Force everybody to get a straight indemnity contract.

    Force everybody on to direct primary care.

    Somehow figure out how to appropriately subsidize it like employee-based insurance is now, straight out of the US treasury so it’s strictly progressively subsidized.

     

    Isn’t the simplest, most direct path, just “single-payer” and make all doctors federal employees?

    The market is insanely complicated but it works better than more simplistic government stuff.

    That never stops them from doing it anyway.

    • #12
  13. RufusRJones Member
    RufusRJones
    @RufusRJones

    Obamacare is about trying to get everybody to give up and just accept single payer. Democrat control of the assets and labor. Of course the GOP can’t think of any creative way out of this pretty much ineluctable path.

    • #13
  14. ericB Lincoln
    ericB
    @ericB

    I don’t think that it would be best to choose even “the simplest, most direct path” to another government monopoly that would lock us into an inferior system.

    We already have government provided Medicaid and by some assessments the health outcomes for those on Medicaid (and locked into seeing doctors who accept Medicaid) can be worse than those who have no coverage at all.  Another failed example would be veterans trapped into the monopoly of government provided healthcare (some of whom died on waiting lists while the providers cooked the books).

    The unofficial motto of monopolies:
    We don’t care because we don’t have to.”

    Competition works when there is true market competition because it forces providers to care about the satisfaction of customers who are free to take their business elsewhere.

    The book I mentioned is titled “The Cure That Works” both because it already works in Singapore and because, as the author shows, they succeeded using ideas that were first thought of in the U.S.

    “Whole Foods Markets, the State of Indiana, and innovators around the world have used forgotten American ideas to slash healthcare costs by 75 percent while simultaneously delivering true universal access, coverage for preexisting conditions, and an ironclad safety net.”

    It would be one thing if we had no idea of any better way to do things.  In reality, we have multiple examples of countries (not only Singapore) that show that a system can get the strong benefits of that come from prices and competition (high quality at low cost), and at the same time provide those other benefits (universal access, coverage for preexisting conditions, safety net).

    • #14
  15. kedavis Member
    kedavis
    @kedavis

    ericB (View Comment):

    I don’t think that it would be best to choose even “the simplest, most direct path” to another government monopoly that would lock us into an inferior system.

    We already have government provided Medicaid and by some assessments the health outcomes for those on Medicaid (and locked into seeing doctors who accept Medicaid) can be worse than those who have no coverage at all. Another failed example would be veterans trapped into the monopoly of government provided healthcare (some of whom died on waiting lists while the providers cooked the books).

    The unofficial motto of monopolies:
    We don’t care because we don’t have to.”

    Competition works when there is true market competition because it forces providers to care about the satisfaction of customers who are free to take their business elsewhere.

    The book I mentioned is titled “The Cure That Works” both because it already works in Singapore and because, as the author shows, they succeeded using ideas that were first thought of in the U.S.

    “Whole Foods Markets, the State of Indiana, and innovators around the world have used forgotten American ideas to slash healthcare costs by 75 percent while simultaneously delivering true universal access, coverage for preexisting conditions, and an ironclad safety net.”

    It would be one thing if we had no idea of any better way to do things. In reality, we have multiple examples of countries (not only Singapore) that show that a system can get the strong benefits of that come from prices and competition (high quality at low cost), and at the same time provide those other benefits (universal access, coverage for preexisting conditions, safety net).

    Part of the problem you run into in situations like these is that even if you got it set up to be the absolute best anyone ever thought possible, the next person put in charge of it would want to change things, Just Because.  It’s common with management types everywhere, they figure that nobody will think it was a good idea to hire them if they make it seem like everything was already just fine.

    • #15
  16. SParker Member
    SParker
    @SParker

    When my brother was doing his pathology residency in mid-80s, he found himself sharing a table and a seriously tedious task with a fellow resident.  At some point he hears her plaintive cry:  “Geeeene, I never wanted to be a real doctor!  I wanted to be a TV doctor!”

    On Switzerland, one thing (the only thing) I know is that ER visits are much cheaper.  This is possibly because there’s a universal and–unlike ACA–a strictly enforced requirement to be insured.  Maybe it’s a combination of the hospitals always getting paid for their services and the insurance companies being intolerant of non-emergencies getting attended to and charged at ER rates.  My brother also worked ER after his internship, once suggesting to a not-yet admitted patient that they could fix his minor, not-an-emergency problem with complete safety and much more cheaply just down the street.  The administrator was very not pleased on hearing about that.  Why people saw insurance companies as the source of the cost problem is beyond me.

    • #16
  17. ericB Lincoln
    ericB
    @ericB

    For a different perspective, FREEOP has a their own ranking and assessment.  The following is an excerpt from Key Findings from the 2021 FREOPP World Index of Healthcare Innovation

    Single payer is not the only route to universal coverage

    One of the central misconceptions in the U.S. debate over health reform revolves around the term “universal coverage.” On both the left and the right, “universal coverage” is understood to equate to a health care system in which a single, government-run insurer provides coverage to all residents: that is, a “single payer” system.

    But as the FREOPP World Index of Healthcare Innovation illustrates, not all countries with universal coverage do so via government insurance. The five countries on top of the Index — Switzerland (#1), the Netherlands (#2), Germany (#3), Ireland (#4), and Israel (#5)—all have achieved universal coverage using private insurance. The Czech Republic (#16) is also a universal private system.

    Several other countries have achieved universal coverage with a combination of public and private health insurance, including Belgium (#9), Singapore (#12), and Portugal (#17).

    Why do countries with universal private insurance do so well in the FREOPP survey? There are several reasons. Private insurance systems empower patient choice, and create room for insurers to organically evolve their benefit designs without having to wait for politicians or regulators to act. In addition, …

    • #17
  18. RufusRJones Member
    RufusRJones
    @RufusRJones

    kedavis (View Comment):
    Part of the problem you run into in situations like these is that even if you got it set up to be the absolute best anyone ever thought possible, the next person put in charge of it would want to change things, Just Because. 

    This is exactly right. You could solve a million problems if you just had a public option that was guaranteed worse than any other employer-based plan in that economic area. At some point the Democrats would just hijack it, subsidize it with debt and taxes, and reck everything to force single-payer and Socialism. This is a real mess because they screwed up so bad during World War II.

    The GOP hasn’t shown a shred of forethought about anything plus dealing with the political part of it. 

    • #18
  19. RufusRJones Member
    RufusRJones
    @RufusRJones

    SParker (View Comment):

    When my brother was doing his pathology residency in mid-80s, he found himself sharing a table and a seriously tedious task with a fellow resident. At some point he hears her plaintive cry: “Geeeene, I never wanted to be a real doctor! I wanted to be a TV doctor!”

    On Switzerland, one thing (the only thing) I know is that ER visits are much cheaper. This is possibly because there’s a universal and–unlike ACA–a strictly enforced requirement to be insured. Maybe it’s a combination of the hospitals always getting paid for their services and the insurance companies being intolerant of non-emergencies getting attended to and charged at ER rates. My brother also worked ER after his internship, once suggesting to a not-yet admitted patient that they could fix his minor, not-an-emergency problem with complete safety and much more cheaply just down the street. The administrator was very not pleased on hearing about that. Why people saw insurance companies as the source of the cost problem is beyond me.

    One of the things the GOP could do is learn how the Swiss screwed up their own system and try not to do that. 

    SParker (View Comment):
    Why people saw insurance companies as the source of the cost problem is beyond me.

    I think the ROI on health insurance companies is pretty low.  

    • #19
  20. ericB Lincoln
    ericB
    @ericB

    SParker (View Comment):
    On Switzerland, …

    As you see, Switzerland is at the top of the FREEP ranking, and they did this without single payer, government provided monopoly.  For more, see their detail page.

    Switzerland: #1 in the 2021 World Index of Healthcare Innovation
    Switzerland’s universal system of individually-purchased health insurance is a model for U.S. reform.”

    • #20
  21. RufusRJones Member
    RufusRJones
    @RufusRJones

    The GOP Congress is too dumb and corrupt to figure out what we are figuring out right now. It’s pathetic.

    • #21
  22. kedavis Member
    kedavis
    @kedavis

    ericB (View Comment):

    SParker (View Comment):
    On Switzerland, …

    As you see, Switzerland is at the top of the FREEP ranking, and they did this without single payer, government provided monopoly. For more, see their detail page.

    Switzerland: #1 in the 2021 World Index of Healthcare Innovation
    Switzerland’s universal system of individually-purchased health insurance is a model for U.S. reform.”

    But if they require everyone, even young healthy people, to buy insurance, that’s the kind of “mandate” stuff that Americans bristle over, and with pretty good reason.

    • #22
  23. kedavis Member
    kedavis
    @kedavis

    RufusRJones (View Comment):

    The GOP Congress is too dumb and corrupt to figure out what we are figuring out right now. It’s pathetic.

    Their top priority, as with the Dims too really, is Getting Re-Elected.

    • #23
  24. RufusRJones Member
    RufusRJones
    @RufusRJones

    kedavis (View Comment):

    ericB (View Comment):

    SParker (View Comment):
    On Switzerland, …

    As you see, Switzerland is at the top of the FREEP ranking, and they did this without single payer, government provided monopoly. For more, see their detail page.

    Switzerland: #1 in the 2021 World Index of Healthcare Innovation
    Switzerland’s universal system of individually-purchased health insurance is a model for U.S. reform.”

    But if they require everyone, even young healthy people, to buy insurance, that’s the kind of “mandate” stuff that Americans bristle over, and with pretty good reason.

    The alternative is the dumb employer-based insurance we have now. The system we have now is so stupid it’s unbelievable. People bitch about libertarians, but the GOP is too stupid and corrupt to think this through.

    • #24
  25. ericB Lincoln
    ericB
    @ericB

    kedavis (View Comment):
    But if they require everyone, even young healthy people, to buy insurance, that’s the kind of “mandate” stuff that Americans bristle over, and with pretty good reason.

    A government mandated, government provided single payer monopoly is also a mandate that people pay for (in taxes), but without even the option to freely choose between providers that need to compete for your business.  Everyone simply becomes a slave to the only option.

    (Personally, I also believe there is a constitutional problem with government mandated healthcare.  Medical care cannot be separated from medical ethics, and medical ethics cannot avoid the differences in how people have different ethical convictions concerning healthcare.  The government cannot become the monopoly provider without violating the ethical convictions of one group or another.  The constitutionally acceptable solution is to allow people to choose a provider whose medical ethics are consistent with their own convictions.)

    Switzerland is not the only model.  FREEOP mentions several that obtain quality outcomes because they avoid government provided monopolies.  They each have variations on how they do this.  See the links for details.

    The most important single point is to avoid monopolies, especially government provided monopolies.

    • #25
  26. Miffed White Male Member
    Miffed White Male
    @MiffedWhiteMale

    kedavis (View Comment):

    kedavis (View Comment):
    But if they require everyone, even young healthy people, to buy insurance, that’s the kind of “mandate” stuff that Americans bristle over, and with pretty good reason.

    A government mandated, government provided single payer monopoly is also a mandate that people pay for (in taxes), but without even the option to freely choose between providers that need to compete for your business.  Everyone simply becomes a slave to the only option.

    I’m fine with not requiring people to buy insurance.

    As long as they’re willing to pay for their own medical care.  Or go without.

     

    • #26
  27. Nanocelt TheContrarian Member
    Nanocelt TheContrarian
    @NanoceltTheContrarian

    I’ll apologize in advance. But take off the gloves. 

    What Rob Long described as his care for vertigo (BENIGN POSITIONAL VERTIGO, an entirely benign and self limited medical condition that resolves with or without treatment) is a medical obscenity. And he didn’t even realize it. Benign positional vertigo is an extremely common entity. It can be diagnosed on the spot by a good history and physical exam. No testing necessary. No admission necessary. No Neurological stroke team (what a joke) needed. No multiple consultants needed. Any trainees who were involved in Rob’s care got a serious illustration of absolutely unnecessary medical care, shoved down their throats as if it were standard of care. Any acute care physician who did what was done to Rob should have his license revoked. 

    But in NYC they apparently have the wokest of the woke  medical care. They treated Rob like Louis XVI and Rob thinks that’s what makes American medicine great. It’s actually what makes American medicine an embarrassment and a joke. 

    Rob and his writers guild insurance and the medical care he received illustrate everything that is wrong with American medicine. When you have to do CT scans and call a Neurlogical/Stroke team for benign positional vertigo, you might as well quit. The whole scenario was absurd. Lennox Hill, for doing such nonsense, should be shut down. No citizenry should put up with this kind of nonsense. 

    I have a rich uncle in Las Vegas who has made a fortune off of a wedding chapel on the Strip that he owns.  Weddings are (or at least had been) $15 a pop. However, once a couple entered the chapel, they of course got the slick sales job:  You want the organist, right? Of course?  The photos, right? Of course.  This, that and the other. On and on. Until the cost of the wedding, done in 15 minutes, is on the order of a couple of thousand dollars. That’s what Rob got, only it wasn’t presented in that way. It was a doctor, or doctors, of course, who ordered tests and Rob did not object. It was his health after all. Who would object?  And then his cost was $318. He paid nothing. His premiums are paid out of his contracts. So, unlike his friend who took his dog to the vet, and wouldn’t do it again because he knew the cost, Rob WILL DO IT AGAIN, and again think he is getting the best healthcare in the world. 

    A total crock of nonsense. While he is getting schlepped around Manhattan  unnecessarily at a thousand dollars a mile, I can’t get Farxiga for a patient with type 2 diabetes with nephropathy and congestive heart failure without jumping through a thousand hoops for Prior Auth, and then the patient can’t afford it anyway. 

    I’m sorry, but I deeply resent the obscene waste indulged in here to no benefit to anyone, not even Rob. Travesty.

     

    • #27
  28. EHerring Coolidge
    EHerring
    @EHerring

    Henry Castaigne (View Comment):

    kedavis (View Comment):

    RufusRJones (View Comment):

    They have to wipe out employer-based insurance.

    Force everybody to get a straight indemnity contract.

    Force everybody on to direct primary care.

    Somehow figure out how to appropriately subsidize it like employee-based insurance is now, straight out of the US treasury so it’s strictly progressively subsidized.

     

    Isn’t the simplest, most direct path, just “single-payer” and make all doctors federal employees?

    The market is insanely complicated but it works better than more simplistic government stuff.

    VA for everybody? No thank you. 

    • #28
  29. EHerring Coolidge
    EHerring
    @EHerring

    Positional vertigo is quite common ( for us older folks). I get it about once a year to 18 months and can’t predict it. I always keep Bonine around and take one every day until it resolves. That is one of the  OTC medicines for motion sickness ( mezcline).

    I hope Larry Elder wins. He was really wired for the podcast. I could tell he is quite passionate about his state’s problems.

    The good doctor was a welcome bit of Covid sanity.

    • #29
  30. Henry Castaigne Member
    Henry Castaigne
    @HenryCastaigne

    EHerring (View Comment):

    Positional vertigo is quite common ( for us older folks). I get it about once a year to 18 months and can’t predict it. I always keep Bonine around and take one every day until it resolves. That is one of the OTC medicines for motion sickness ( mescaline).

    I hope Larry Elder wins. He was really wired for the podcast. I could tell he is quite passionate about his state’s problems.

    The good doctor was a welcome bit of Covid sanity.

    Larry Elder can talk to people who don’t usually vote Republican and make a good case that conservatism will help them. Not many Republicans can do that.

    • #30