His tenet is an old one. And, like so many pseudo intellectual thinkers, his "solutions" are wishy washy, glib, and infantile. He offers no practical answers to serious questions. In fact, he appears to be as clueless as the politicians he derides. Oh, and he said all he had to say in the first two minutes, making the remainder of the video somewhat surplus to requirement. Right, I'm off to meditate, which will put me on a level where I can say; "F*ck work, bills, responsibility and commitments........"

Now you have enough bits and pieces to create a stimulating, surreal piece of folk art. Getcha some super glue and turn that passion for meditative deconstruction into, Canon Conglomerate #7! (hoping you're not disassembling Leica und Hasselblad, jah?!)

Yep-Doesn't belong here because like myself, a buncha folks can't stand that faces-of-death shit for the sake of entertainment or spectacle....it's fucking twisted as far as I'm concerned and deleterious otherwise to the psyche and soul to meditate on the same, voyeuristically-speaking....reflects a general lack of healthy socialization and higher-cortical function.

Get a fucking life, stop watching ambulances and listening to television news stories about the carnage, fires, wife-beatings and human suffering in your local area, and have a NICE goddamned day

Can I down-vote this fucking shit that's not snuff but sucks huge, bulging moose cock yet??

@enoch, thanks for your comments. I thought it better to respond directly to your profile than on the video, about which we're no longer discussing directly. Sorry for the length of this reply, but for such a complex topic as this one, a thorough and plainly-stated response is needed.

You wrote: "the REAL question is "what is the purpose of a health care system"? NOT "which market system should we implement for health care"?"

The free market works best for any and all goods and services, regardless of their aim or purpose. Healthcare is no different from any other good or service in this respect.

(And besides, tell me why there's no money in preventative care? Do nutritionists, physical trainers/therapists, psychologists, herbalists, homeopaths, and any other manner of non-allopathic doctors not get paid and make profit in the marketplace? Would not a longer life not lead to a longer-term 'consumer' anyway? And would preventative medicine obliterate the need for all manner of medical treatment, or would there not still remain a need to diagnose, treat, and cure diseases, even in the presence of a robust preventative medical market?)

I realize that my argument is not the "popular" one (and there are certainly many reasons for this, up to and including a lot of disinformation about what constitutes a "free market" health care system). But the way to approach such things is not heuristically, but rationally, as one would approach any other economic issue.

You write "see where i am going with this? It's not so easy to answer and impose your model of the "free market" at the same time."

Yes, as a matter of fact, it is. The purpose of the healthcare system is to provide the most advanced medical service and care possible in the most efficient and affordable way possible. Only a free competitive market can do this with the necessary economic calculations in place to support its progress. No matter how you slice it, a socialized approach to healthcare invariably distorts the market (with its IP fees, undue regulations, and a lack of any accurate metrics on both the supply-side and on the demand-side which helps to determine availability, efficacy, and cost).

"you cannot have "for-profit" and "health-care" work in conjunction with any REAL health care."

Sorry, but this is just absurd. What else can I say?

"but if we use your "free market" model against a more "socialized model".which model would better serve the public?"

The free market model.

"if we take your "free market" model,which would be under the auspices of capitalism."

Redundant: "free market under the auspices of free market."

"disease is where the money is at,THAT is where the profit lies,not in preventive medicine."

Only Krugman-style Keynesians would say that illness is more profitable than health (or war more profitable than peace, or that alien invasions and broken windows are good for the economy). They, like you, aren't taking into account the One Lesson in Economics: look at how it affects every group, not just one group; look at the long term effects, not just short term ones. You're just seeing that, in the short-run, health will be less profitable for medical practitioners (or some pharmaceuticals) that are currently working in the treatment of illness. But look at every group outside that small group and at the long run and you can see that health is more profitable than illness overall. The market that profits more from illness will have to adapt, in ways that only the market knows for sure.

Do you realize that the money you put into socialized medicine (Medicaid, Medicare, Social Security, etc.) is money you deplete from prevention entrepreneurship?

(As an aside, I wonder, why do so many people assume that the socialized central planners have some kind of special knowledge or wisdom that entrepreneurs do not? And why is there the belief that unlike entrepreneurs, socialist central planners are not selfishly motivated but always act in the interest of the "common good?" Could this be part of the propagandized and indoctrinated fear that's implicit in living in a socialized environment? Why do serfs (and I'm sure that, at some level, people know that's what they are) love the socialist central planners more than they love themselves? Complex questions about self-esteem and captive minds.)

If fewer people get sick, the market will then demand more practitioners to move from treating illness into other areas like prevention, being a prevention doctor or whatever. You're actually making the argument for free market here, not against it. Socialized bureaucratically dictated medicine will not adapt to the changing needs as efficiently or rapidly as a free market can and would. If more people are getting sick, then we'll need more doctors to treat them. If fewer people are getting sick because preventive medicine takes off, then we'll have more of that type of service. If a socialized healthcare is mandated, then we will invariably have a glut of allopathic doctors, with little need for their services (and we then have the kinds of problems we see amongst doctors who are coerced -- by the threat of losing their license -- to take medicaid and then lie on their reports in order to recoup their costs, e.g., see the article linked here.)

Meanwhile, there has been and will remain huge profits to be made in prevention, as the vitamin, supplements, alternative medicine, naturopathy, exercise and many other industries attest to. What are you talking about, that there's no profit in preventing illness? (In a manner of speaking, that's actually my bread and butter!) If you have a way to prevent illness, you will have more than enough people buying from you, people who don't want to get sick. (And other services for the people who do.) Open a gym. Become a naturopath. Teach stress management, meditation, yoga, zumba, whatever! And there are always those who need treatment, who are sick, and the free market will then have an accurate measure of how to allocate the right resources and number of such practitioners. This is something that the central planners (under socialized services) simply cannot possibly do (except, of course, for the omniscient ones that socialists insist exist).

You wrote "cancer,anxiety,obesity,drug addiction.
all are huge profit generators and all could be dealt with so much more productively and successfully with preventive care,diet and exercise and early diagnosis."

But they won't as long as you have centrally planned (socialized) medicine. The free market forces practitioners to respond to the market's demands. Socialized medicine does not. Entrepreneurs will (as they already have) exploit openings for profit in prevention (without the advantage of regulations which distort the markets) and take the business away from treatment doctors. If anything, doctors prevent preventative medicine from getting more widespread by using government regulations to limit what the preventive practitioners do. In fact, preventive medicine is so profitable that it has many in the medical profession lobbying to curtail it. They are losing much business to alternative/preventive practitioners. They lobby to, for example, prevent herb providers from stating the medical/preventive benefits of their herbs. They even prevent strawberry farmers to tout the health benefits of strawberries! It is the state that is slowing down preventive medicine, not the free market! In Puerto Rico, for example, once the Medical Association lost a bit to prohibit naturopathy, they effectively outlawed acupuncture by successfully getting a law passed that requires all acupuncturists to be medical doctors. Insanity.

If you think there is no profit in preventative care or exercise, think GNC and Richard Simmons, and Pilates, and bodywork, and my own practice of psychotherapy. Many of the successful corporations (I'm thinking of Google and Pixar and SalesForce and Oracle, etc.) see the profit and value in preventative care, which is why they have these "stay healthy" programs for their employees. There's more money in health than illness. No doubt.

Or how about the health food/nutrition business? Or organic farming, or whole foods! The free market could maybe call for fewer oncologists and for more Whole Foods or even better natural food stores. Of course, we don't know the specifics, but that's actually the point. Only the free market knows (and the omniscient socialist central planners) what needs to happen and how.

Imagination! We need to get people to use it more.

You wrote: "but when we consider that the 4th and 5th largest lobbyists are the health insurance industry and the pharmaceutical industry is it any wonder that america has the most fucked up,backwards health care system on the planet."

You're actually making my point here. In a free market, pharmaceutical companies cannot monopolize what "drugs" people can or cannot take, sell or not sell, and cannot prevent natural alternatives from being promoted. Only with state intervention (by way of IP regulations, and so forth) can they do so.

Free market is not corporatism. Free market is not crony capitalism. (More disinformation that needs to be lifted.)

So you're not countering my free market position, you're countering the crony capitalist position. This is a straw man argument, even if in this case you might not have understood my position in the first place. You, like so many others, equate "capitalism" with cronyism or corporatism. Many cannot conceive of a free market that is free from regulation. So folks then argue against their own interests, either for or against "fascist" vs. "socialist" medicine. The free market is, in fact, outside these two positions.

You wrote: "IF we made medicare available to ALL american citizens we would see a shift from latter stage care to a more aggressive preventive care and early diagnosis. the savings in money (and lives) would be staggering."

I won't go into medicare right now (It is a disaster, and so is the current non-free-market insurance industry. See the article linked in my comment above.)

You wrote "this would create a huge paradigm shift here in america and we would see results almost instantly but more so in the coming decades."

I don't want to be a naysayer but, socialism is nothing new. It has been tried (and failed) many times before. The USSR had socialized medicine. So does Cuba (but then you may believe the Michael Moore fairytale about medicine in Cuba). It's probably better to go see in person how Cubans live and how they have no access to the places that Moore visited.

You wrote: "i feel very strongly that health should be a communal effort.a civilized society should take care of each other."

Really, then why try to force me (or anyone) into your idea of "good" medicine? The free market is a communal effort. In fact, it is nothing else (and nothing else is as communal as the free market). Central planning, socialized, top-down decision-making, is not. Never has been. Never will be.

Voluntary interactions is "taking care of each other." Coercion is not. Socialism is coercion. It cannot "work" any other way. A free market is voluntary cooperation.

Economic calculation is necessary to avoid chaos, whatever the purpose of a service. This is economic law. Unless the purpose is to create chaos, you need real prices and efficiency that only the free market can provide.

I hope this helps to clarify (and not confuse) what I wrote on @eric3579's profile.

I do have some anger issues-The crux of that issue perhaps possibly, my perception that I might be living in an era of mass-hypnotism of the planet's inhabitants through technologies envisioned originally to afford power now hi-jacked (and historically so) by charlatans posing as world leaders?

Another obvious turd lodged in my craw? How about a social-evolutionary path akin to Bradbury's "Fahrenheit" or Orwell's "84" turning an entire continent of what formerly consisted of self-determined, practical, and classically educated hard-working sorts into a cast of extras from "Idiocracy?"

Yeah, it pisses me off that so many people are distracted by what they are being told about some illusory process in which the common citizen might take part to imagine some bright future for mankind falling somewhere between the golden rule and the code of Hammurabi. The planet is being hi-jacked by a new breed of criminals frighteningly similar to the most egregious of old-For everything there is a season my friend, Solomon's wisdom in Ecclesiastes 3 it just as pertinent today as it will be for humans for the next 10,000 years-"a time to kill and heal, a time to break down, and a time to build up."

I'd like to imagine the new-construction-upon-the-ashes to include projects both organic and nano-technological in nature with the transformation of our specie's bodies, minds, souls and spirits as a prime objective.

You are living in these wonderful and frightening times, consider this incarnation your most favorable having been born when, where, how, why, and what you are-You are an amazing collection of cellular consciousness manifest in the wonder of flesh.
It's pretty fucking cool actually, and these are the ideas upon which I try to meditate upon every waking hour.

Oh yeah, and I'm mad as hell and I'm not going to take it anymore, Hail Satan, Hail Eris, Jesus Saves.


(BTW, to answer your inquiry as to the "knowledge" that administrations keep in the dirty-little-secrets folder? Do you really have to ask about need-to-know information that would end the lives of yourself and everyone you know, because that's what the United States can do for you alla-Hoover, alla-Bush, alla-New World Order Über Alles.
What you think you know you don't, and you can't form an opinion or come to a conclusion on a subject for which you have incomplete data with which to arrive at those opinions or conclusions. Simple deductive reasoning or even a pragmatic model of the scientific method should make this screamingly clear to anyone who distrusts the anemically hostile Babylonian system .

The problem with this is how Americans continue to mistake the office of the president as this all powerful dictator position.

The office of the president is not a kingship, it is not totalitarian. It is one branch of three and it's not even the most powerful branch. Congress is the most powerful branch.

So whenever we have these scandals (left or right) the focus is always on the president even though they may or may not have anything to do with it. I'm not saying they're blameless, but they're certainly not the ringleader. There may be no ringleader. Whenever we have this scandal, there's always this mistaken notion that it was some grand conspiracy with very specific aims and goals and I don't think that is typically the case. I think most of these scandals are simply born out of laziness or negligence or simply just protecting one's ass. Government is a big machine (even in the right wing fantasy of small gov't, it will always be big) and it's more likely it's some unintentional screwup than some pre-meditated maneuver.

IMO, this is most evident during Bush's administration. The guy is obviously not that bright. There was something else going on behind the scenes pulling the strings. Even though Obama certainly is far more intelligent, it still doesn't change a thing that there is a bigger machinery at work and one person alone doesn't steer the boat.

And no I'm not talking about some cliche'd Iluminati-style group. You've just got a large go'vt mechanism that wields a lot of power and it's run by fallible people which is a far simpler plausible explanation.

The only way it's going to be better is if people demand it. But we don't even have half the nation voting. So you have a better than 50 percent chance that any time you hear someone complaining about the gov't...they probably didn't vote.

This idea is old. We used to have kings and dictators, but eventually people demanded something different so they came up with councils and parliaments and congresses, etc that wielded the real power, but they kept the kings and queens as a distraction, as a symbol even though they lost the bulk of their power.

Again, I'm not saying the office of the president is blameless, i'm just trying to inject some perspective.

I randomly thought of INXS - Kick the other day. All the music on that album has aged really well if you ask me. "Mystify" or "Meditate" could pass for current music, along with other tracks.

@criticalthud
Yeah, I've been accused of that, but I blame that on the "arguing on the internet" aspect of things, rather than my actual mindset. For instance, as much as I talk up Medical Science, I still don't trust doctors, and in the last 10 years, have only visited to A) get a Physical Examination required by a job, B) get a prescription for a PT, C) Get innoculated for one of the bird/swine flu, as I had been sick for a week after spending a weekend at a "Gamer Convention" (PAX), where there were many confirmed cases.

But, while I don't trust doctors, I actively campaign against "Alternative Medicine", as I've seen many people hurt by it. I've seen one person poison themselves after getting food poisoning, because "like cures like", and I've had one friend commit suicide after they were convinced that the anti-psychotic medicine they were taking wasn't "natural", and quit it.

Whenever I think of alternative medicine practitioners and their criticism of Proper Medicine, I have one quote that sticks in my head, courtesy of The Big Lebowski:
"You're not wrong, Walter. You're just an asshole"

Sure, Medical Science can be improved. But you can't improve it by removing the science. You improve it by removing the politics. Remove the kickbacks from big pharma. Remove the groveling and begging for research funds. Remove the Actual Politics of Insurance and Medicare and Medicaid and VA Benefits. Remove the Actual Politics of the 'War on Drugs".

Those are the problems in our current medical community. But rather than attempting to solve the actual problems that we all agree on, most naturopaths are just treating the symptoms... working on the edges of society, and contributing to the distrust of the individual doctors, rather than the overhaul of the entire system.

And there are certainly many types of naturopaths. Of those that I've met (my wife spent three years in a "Traditional Western Herbalism" school, so I've met quite a few), most have problems differentiating between an idea and a fact. An unsettling amount believed that herbalism is effective because the ancient aliens that brought us to earth also brought us a dramatic and intelligent plant-system which was created to diagnose and treat all of our illnesses.

They believe that through meditation, they are able to connect to this awareness, and this awareness is what will tell them what to give their patients.


It's not the individuals I have a problem with, it's their poor education that I have a problem with. Some NPs can overcome the disadvantage of their environment that de-values scientific method and fact-gathering. Many MDs can overcome the disadvantage of years of de-valuing their own intuition.

But acknowledging the similarities between the two ignores the actual harm that is caused by alternative medicine. Alternative medicine shares the same risks as Proper Medicine, with the same chances of mis-treatment.... but it removes any chance of surgery or active treatment to cure issues. It removes the huge base of shared understanding, and replaces it with a very small base of folklore that has been accumulated through "give the patient this plant, if they don't die, it must have cured them".

Anyone else find that meditative?

Ahhh nature's fury. It's almost as cute as a puppy or kitty to warm-up to all that destruction and damage and human suffering and economic and material loss, and incapacitating pain for life from injuries sustained, etc., etc, etc. (better hit that sarcbox for the cheap seats or someone might think I actually MEDITATE on puppies and kitties and carnage all day long.....)

Shit! You're right. What have I done? What have I done?!

I will now have to find a secluded monastery high up in the mountains and meditate on this for many years...

Falun Gong is a meditative practice. It involves no nudity, no harassment, no physical contact and literally nothing that could offend anyone in public. It doesn't cause harm to the people who practice it and poses no threat to anyone who observes it. There is absolutely no logical reason to ban it.

Gambling, drugs, public nudity, etc, are not valid comparisons because they are either potentially harmful (financially or physically) or generally offensive (most people are against public nudity because the average body is not appealing to look at). A meditative practice that you perform in the privacy of your own home or with others who share your beliefs isn't analogous to any of those things.

Again, if you want a valid comparison, you should compare Falun Gong to a religion. In the U.S., there is no ban against any religion. Actually, gay marriage is an example that could work in your favor. There are no victims as a result of gay marriage (though the long-term effects of having gay parents hasn't been well-researched) so the ban isn't really justified. And while it is indeed banned in many states, the government isn't sending gay couples to prison camps and you won't be arrested for trying to get married if you're gay. The state just won't allow it.

So when you consider the crime and the punishment, there is no U.S. equivalent of how China is dealing with Falun Gong.

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all

One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked.
Related

Upstairs, my 85-year-old father, Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain. The size of a pocket watch, it had kept his heart beating rhythmically for nearly five years. Its battery was expected to last five more.

After tea, I knew, my mother would help him from his narrow bed with its mattress encased in waterproof plastic. She would take him to the toilet, change his diaper and lead him tottering to the couch, where he would sit mutely for hours, pretending to read Joyce Carol Oates, the book falling in his lap as he stared out the window.

I don’t like describing what dementia did to my father — and indirectly to my mother — without telling you first that my parents loved each other, and I loved them. That my mother, Valerie, could stain a deck and sew an evening dress from a photo in Vogue and thought of my father as her best friend. That my father had never given up easily on anything.

Born in South Africa, he lost his left arm in World War II, but built floor-to-ceiling bookcases for our living room; earned a Ph.D. from Oxford; coached rugby; and with my two brothers as crew, sailed his beloved Rhodes 19 on Long Island Sound. When I was a child, he woke me, chortling, with his gloss on a verse from “The Rubaiyat of Omar Khayyam”: “Awake, my little one! Before life’s liquor in its cup be dry!” At bedtime he tucked me in, quoting “Hamlet” : “May flights of angels sing thee to thy rest!”

Now I would look at him and think of Anton Chekhov, who died of tuberculosis in 1904. “Whenever there is someone in a family who has long been ill, and hopelessly ill,” he wrote, “there come painful moments when all timidly, secretly, at the bottom of their hearts long for his death.” A century later, my mother and I had come to long for the machine in my father’s chest to fail.

Until 2001, my two brothers and I — all living in California — assumed that our parents would enjoy long, robust old ages capped by some brief, undefined final illness. Thanks to their own healthful habits and a panoply of medical advances — vaccines, antibiotics, airport defibrillators, 911 networks and the like — they weren’t likely to die prematurely of the pneumonias, influenzas and heart attacks that decimated previous generations. They walked every day. My mother practiced yoga. My father was writing a history of his birthplace, a small South African town.

In short, they were seemingly among the lucky ones for whom the American medical system, despite its fragmentation, inequity and waste, works quite well. Medicare and supplemental insurance paid for their specialists and their trusted Middletown internist, the lean, bespectacled Robert Fales, who, like them, was skeptical of medical overdoing. “I bonded with your parents, and you don’t bond with everybody,” he once told me. “It’s easier to understand someone if they just tell it like it is from their heart and their soul.”

They were also stoics and religious agnostics. They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Things took their first unexpected turn on Nov. 13, 2001, when my father — then 79, pacemakerless and seemingly healthy — collapsed on my parents’ kitchen floor in Middletown, making burbling sounds. He had suffered a stroke.

He came home six weeks later permanently incapable of completing a sentence. But as I’ve said, he didn’t give up easily, and he doggedly learned again how to fasten his belt; to peck out sentences on his computer; to walk alone, one foot dragging, to the university pool for water aerobics. He never again put on a shirt without help or looked at the book he had been writing. One day he haltingly told my mother, “I don’t know who I am anymore.”

His stroke devastated two lives. The day before, my mother was an upper-middle-class housewife who practiced calligraphy in her spare time. Afterward, she was one of tens of millions of people in America, most of them women, who help care for an older family member.

Their numbers grow each day. Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the “oldest old” have become the nation’s most rapidly growing age group. Nearly a third of Americans over 85 have dementia (a condition whose prevalence rises in direct relationship to longevity). Half need help with at least one practical, life-sustaining activity, like getting dressed or making breakfast. Even though a capable woman was hired to give my dad showers, my 77-year-old mother found herself on duty more than 80 hours a week. Her blood pressure rose and her weight fell. On a routine visit to Dr. Fales, she burst into tears. She was put on sleeping pills and antidepressants.

My father said he came to believe that she would have been better off if he had died. “She’d have weeped the weep of a widow,” he told me in his garbled, poststroke speech, on a walk we took together in the fall of 2002. “And then she would have been all right.” It was hard to tell which of them was suffering more.

As we shuffled through the fallen leaves that day, I thought of my father’s father, Ernest Butler. He was 79 when he died in 1965, before pacemakers, implanted cardiac defibrillators, stents and replacement heart valves routinely staved off death among the very old. After completing some long-unfinished chairs, he cleaned his woodshop, had a heart attack and died two days later in a plain hospital bed. As I held my dad’s soft, mottled hand, I vainly wished him a similar merciful death.

A few days before Christmas that year, after a vigorous session of water exercises, my father developed a painful inguinal (intestinal) hernia. My mother took him to Fales, who sent them to a local surgeon, who sent them to a cardiologist for a preoperative clearance. After an electrocardiogram recorded my father’s slow heartbeat — a longstanding and symptomless condition not uncommon in the very old — the cardiologist, John Rogan, refused to clear my dad for surgery unless he received a pacemaker.

Without the device, Dr. Rogan told me later, my father could have died from cardiac arrest during surgery or perhaps within a few months. It was the second time Rogan had seen my father. The first time, about a year before, he recommended the device for the same slow heartbeat. That time, my then-competent and prestroke father expressed extreme reluctance, on the advice of Fales, who considered it overtreatment.

My father’s medical conservatism, I have since learned, is not unusual. According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

When Rogan suggested the pacemaker for the second time, my father was too stroke-damaged to discuss, and perhaps even to weigh, his trade­offs. The decision fell to my mother — anxious to relieve my father’s pain, exhausted with caregiving, deferential to doctors and no expert on high-tech medicine. She said yes. One of the most important medical decisions of my father’s life was over in minutes. Dr. Fales was notified by fax.

Fales loved my parents, knew their suffering close at hand, continued to oppose a pacemaker and wasn’t alarmed by death. If he had had the chance to sit down with my parents, he could have explained that the pacemaker’s battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state. He could have discussed the option of using a temporary external pacemaker that, I later learned, could have seen my dad safely through surgery. But my mother never consulted Fales. And the system would have effectively penalized him if she had. Medicare would have paid him a standard office-visit rate of $54 for what would undoubtedly have been a long meeting — and nothing for phone calls to work out a plan with Rogan and the surgeon.

Medicare has made minor improvements since then, and in the House version of the health care reform bill debated last year, much better payments for such conversations were included. But after the provision was distorted as reimbursement for “death panels,” it was dropped. In my father’s case, there was only a brief informed-consent process, covering the boilerplate risks of minor surgery, handled by the general surgeon.

I believe that my father’s doctors did their best within a compartmentalized and time-pressured medical system. But in the absence of any other guiding hand, there is no doubt that economics helped shape the wider context in which doctors made decisions. Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.

And so on Jan. 2, 2003, at Middlesex Hospital, the surgeon implanted my father’s pacemaker using local anesthetic. Medicare paid him $461 and the hospital a flat fee of about $12,000, of which an estimated $7,500 went to St. Jude Medical, the maker of the device. The hernia was fixed a few days later.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

Shortly after New Year’s 2003, my mother belatedly called and told me about the operations, which went off without a hitch. She didn’t call earlier, she said, because she didn’t want to worry me. My heart sank, but I said nothing. It is one thing to silently hope that your beloved father’s heart might fail. It is another to actively abet his death.

The pacemaker bought my parents two years of limbo, two of purgatory and two of hell. At first they soldiered on, with my father no better and no worse. My mother reread Jon Kabat-Zinn’s “Full Catastrophe Living,” bought a self-help book on patience and rose each morning to meditate.

In 2005, the age-related degeneration that had slowed my father’s heart attacked his eyes, lungs, bladder and bowels. Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen. Long partly deaf, he began losing his sight to wet macular degeneration, requiring ocular injections that cost nearly $2,000 each. A few months later, he forgot his way home from the university pool. He grew incontinent. He was collapsing physically, like an ancient, shored-up house.

In the summer of 2006, he fell in the driveway and suffered a brain hemorrhage. Not long afterward, he spent a full weekend compulsively brushing and rebrushing his teeth. “The Jeff I married . . . is no longer the same person,” my mother wrote in the journal a social worker had suggested she keep. “My life is in ruins. This is horrible, and I have lasted for five years.” His pacemaker kept on ticking.

When bioethicists debate life-extending technologies, the effects on people like my mother rarely enter the calculus. But a 2007 Ohio State University study of the DNA of family caregivers of people with Alzheimer’s disease showed that the ends of their chromosomes, called telomeres, had degraded enough to reflect a four-to-eight-year shortening of lifespan. By that reckoning, every year that the pacemaker gave my irreparably damaged father took from my then-vigorous mother an equal year.

When my mother was upset, she meditated or cleaned house. When I was upset, I Googled. In 2006, I discovered that pacemakers could be deactivated without surgery. Nurses, doctors and even device salesmen had done so, usually at deathbeds. A white ceramic device, like a TV remote and shaped like the wands that children use to blow bubbles, could be placed around the hump on my father’s chest. Press a few buttons and the electrical pulses that ran down the leads to his heart would slow until they were no longer effective. My father’s heart, I learned, would probably not stop. It would just return to its old, slow rhythm. If he was lucky, he might suffer cardiac arrest and die within weeks, perhaps in his sleep. If he was unlucky, he might linger painfully for months while his lagging heart failed to suffuse his vital organs with sufficient oxygenated blood.

If we did nothing, his pacemaker would not stop for years. Like the tireless charmed brooms in Disney’s “Fantasia,” it would prompt my father’s heart to beat after he became too demented to speak, sit up or eat. It would keep his heart pulsing after he drew his last breath. If he was buried, it would send signals to his dead heart in the coffin. If he was cremated, it would have to be cut from his chest first, to prevent it from exploding and damaging the walls or hurting an attendant.

On the Internet, I discovered that the pacemaker — somewhat like the ventilator, defibrillator and feeding tube — was first an exotic, stopgap device, used to carry a handful of patients through a brief medical crisis. Then it morphed into a battery-powered, implantable and routine treatment. When Medicare approved the pacemaker for reimbursement in 1966, the market exploded. Today pacemakers are implanted annually in more than 400,000 Americans, about 80 percent of whom are over 65. According to calculations by the Dartmouth Atlas research group using Medicare data, nearly a fifth of new recipients who receive pacemakers annually — 76,000 — are over 80. The typical patient with a cardiac device today is an elderly person suffering from at least one other severe chronic illness.

Over the years, as technology has improved, the battery life of these devices lengthened. The list of heart conditions for which they are recommended has grown. In 1984, the treatment guidelines from the American College of Cardiology declared that pacemakers were strongly recommended as “indicated” or mildly approved as “reasonable” for 56 heart conditions and “not indicated” for 31 more. By 2008, the list for which they were strongly or mildly recommended expanded to 88, with most of the increase in the lukewarm “reasonable” category.

The research backing the expansion of diagnoses was weak. Over all, only 5 percent of the positive recommendations were supported by research from multiple double-blind randomized studies, the gold standard of evidence-based medicine. And 58 percent were based on no studies at all, only a “consensus of expert opinion.” Of the 17 cardiologists who wrote the 2008 guidelines, 11 received financing from cardiac-device makers or worked at institutions receiving it. Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.

This pattern — a paucity of scientific support and a plethora of industry connections — holds across almost all cardiac treatments, according to the cardiologist Pierluigi Tricoci of Duke University’s Clinical Research Institute. Last year in The Journal of the American Medical Association, Tricoci and his co-authors wrote that only 11 percent of 2,700 widely used cardiac-treatment guidelines were based on that gold standard. Most were based only on expert opinion.

Experts are as vulnerable to conflicts of interest as researchers are, the authors warned, because “expert clinicians are also those who are likely to receive honoraria, speakers bureau [fees], consulting fees or research support from industry.” They called the current cardiac-research agenda “strongly influenced by industry’s natural desire to introduce new products.”

Perhaps it’s no surprise that I also discovered others puzzling over cardiologists who recommended pacemakers for relatives with advanced dementia. “78-year-old mother-in-law has dementia; severe short-term memory issues,” read an Internet post by “soninlaw” on Elderhope.com, a caregivers’ site, in 2007. “On a routine trip to her cardiologist, doctor decides she needs a pacemaker. . . . Anyone have a similar encounter?”

By the summer of 2007, my dad had forgotten the purpose of a dinner napkin and had to be coached to remove his slippers before he tried to put on his shoes. After a lifetime of promoting my father’s health, my mother reversed course. On a routine visit, she asked Rogan to deactivate the pacemaker. “It was hard,” she later told me. “I was doing for Jeff what I would have wanted Jeff to do for me.” Rogan soon made it clear he was morally opposed. “It would have been like putting a pillow over your father’s head,” he later told me.

Not long afterward, my mother declined additional medical tests and refused to put my father on a new anti-dementia drug and a blood thinner with troublesome side effects. “I take responsibility for whatever,” she wrote in her journal that summer. “Enough of all this overkill! It’s killing me! Talk about quality of life — what about mine?”

Then came the autumn day when she asked for my help, and I said yes. I told myself that we were simply trying to undo a terrible medical mistake. I reminded myself that my dad had rejected a pacemaker when his faculties were intact. I imagined, as a bioethicist had suggested, having a 15-minute conversation with my independent, predementia father in which I saw him shaking his head in horror over any further extension of what was not a “life,” but a prolonged and attenuated dying. None of it helped. I knew that once he died, I would dream of him and miss his mute, loving smiles. I wanted to melt into the arms of the father I once had and ask him to handle this. Instead, I felt as if I were signing on as his executioner and that I had no choice.

Over the next five months, my mother and I learned many things. We were told, by the Hemlock Society’s successor, Compassion and Choices, that as my father’s medical proxy, my mother had the legal right to ask for the withdrawal of any treatment and that the pacemaker was, in theory at least, a form of medical treatment. We learned that although my father’s living will requested no life support if he were comatose or dying, it said nothing about dementia and did not define a pacemaker as life support. We learned that if we called 911, emergency medical technicians would not honor my father’s do-not-resuscitate order unless he wore a state-issued orange hospital bracelet. We also learned that no cardiology association had given its members clear guidance on when, or whether, deactivating pacemakers was ethical.

(Last month that changed. The Heart Rhythm Society and the American Heart Association issued guidelines declaring that patients or their legal surrogates have the moral and legal right to request the withdrawal of any medical treatment, including an implanted cardiac device. It said that deactivating a pacemaker was neither euthanasia nor assisted suicide, and that a doctor could not be compelled to do so in violation of his moral values. In such cases, it continued, doctors “cannot abandon the patient but should involve a colleague who is willing to carry out the procedure.” This came, of course, too late for us.)

In the spring of 2008, things got even worse. My father took to roaring like a lion at his caregivers. At home in California, I searched the Internet for a sympathetic cardiologist and a caregiver to put my Dad to bed at night. My frayed mother began to shout at him, and their nighttime scenes were heartbreaking and frightening. An Alzheimer’s Association support-group leader suggested that my brothers and I fly out together and institutionalize my father. This leader did not know my mother’s formidable will and had never heard her speak about her wedding vows or her love.

Meanwhile my father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. He fell repeatedly at night and my mother could not pick him up. Finally, he was weak enough to qualify for palliative care, and a team of nurses and social workers visited the house. His chest grew wheezy. My mother did not request antibiotics. In mid-April 2008, he was taken by ambulance to Middlesex Hospital’s hospice wing, suffering from pneumonia.

Pneumonia was once called “the old man’s friend” for its promise of an easy death. That’s not what I saw when I flew in. On morphine, unreachable, his eyes shut, my beloved father was breathing as hard and regularly as a machine.

My mother sat holding his hand, weeping and begging for forgiveness for her impatience. She sat by him in agony. She beseeched his doctors and nurses to increase his morphine dose and to turn off the pacemaker. It was a weekend, and the doctor on call at Rogan’s cardiology practice refused authorization, saying that my father “might die immediately.” And so came five days of hard labor. My mother and I stayed by him in shifts, while his breathing became increasingly ragged and his feet slowly started to turn blue. I began drafting an appeal to the hospital ethics committee. My brothers flew in.

On a Tuesday afternoon, with my mother at his side, my father stopped breathing. A hospice nurse hung a blue light on the outside of his hospital door. Inside his chest, his pacemaker was still quietly pulsing.

After his memorial service in the Wesleyan University chapel, I carried a box from the crematory into the woods of an old convent where he and I often walked. It was late April, overcast and cold. By the side of a stream, I opened the box, scooped out a handful of ashes and threw them into the swirling water. There were some curious spiraled metal wires, perhaps the leads of his pacemaker, mixed with the white dust and pieces of bone.

A year later, I took my mother to meet a heart surgeon in a windowless treatment room at Brigham and Women’s Hospital in Boston. She was 84, with two leaking heart valves. Her cardiologist had recommended open-heart surgery, and I was hoping to find a less invasive approach. When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors — perhaps with the exception of Fales — as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious — our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts — had been lost.

The surgeon was forthright: without open-heart surgery, there was a 50-50 chance my mother would die within two years. If she survived the operation, she would probably live to be 90. And the risks? He shrugged. Months of recovery. A 5 percent chance of stroke. Some possibility, he acknowledged at my prompting, of postoperative cognitive decline. (More than half of heart-bypass patients suffer at least a 20 percent reduction in mental function.) My mother lifted her trouser leg to reveal an anklet of orange plastic: her do-not-resuscitate bracelet. The doctor recoiled. No, he would not operate with that bracelet in place. It would not be fair to his team. She would be revived if she collapsed. “If I have a stroke,” my mother said, nearly in tears, “I want you to let me go.” What about a minor stroke, he said — a little weakness on one side?

I kept my mouth shut. I was there to get her the information she needed and to support whatever decision she made. If she emerged from surgery intellectually damaged, I would bring her to a nursing home in California and try to care for her the way she had cared for my father at such cost to her own health. The thought terrified me.

The doctor sent her up a floor for an echocardiogram. A half-hour later, my mother came back to the waiting room and put on her black coat. “No,” she said brightly, with the clarity of purpose she had shown when she asked me to have the pacemaker deactivated. “I will not do it.”

She spent the spring and summer arranging house repairs, thinning out my father’s bookcases and throwing out the files he collected so lovingly for the book he never finished writing. She told someone that she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden,” she wrote in her journal. “But so it goes. ACCEPT ACCEPT ACCEPT.”

Last August, she had a heart attack and returned home under hospice care. One evening a month later, another heart attack. One of my brothers followed her ambulance to the hospice wing where we had sat for days by my father’s bed. The next morning, she took off her silver earrings and told the nurses she wanted to stop eating and drinking, that she wanted to die and never go home. Death came to her an hour later, while my brother was on the phone to me in California — almost as mercifully as it had come to my paternal grandfather. She was continent and lucid to her end.

A week later, at the same crematory near Long Island Sound, my brothers and I watched through a plate-glass window as a cardboard box containing her body, dressed in a scarlet silk ao dai she had sewn herself, slid into the flames. The next day, the undertaker delivered a plastic box to the house where, for 45 of their 61 years together, my parents had loved and looked after each other, humanly and imperfectly. There were no bits of metal mixed with the fine white powder and the small pieces of her bones.

Katy Butler lives in Mill Valley, Calif., and teaches memoir writing at the Esalen Institute in Big Sur.

Actually, it would accomplish something.

Just like meditation does. Slows things down, puts things in perspective. Changes the mind -- from anger at losing the Presidency to some sort of acceptance.

Morgan Spurlock did a series on TV, where people would agree to go live for 30 days with folks who they hated without knowing. There was one episode where a Southern Christian man who hated Muslims agreed to spend 30 days with a young Muslim family who observed the praying five times a day thing. Terms of the deal was he had to pray, too.

What struck me most was how that praying changed this Christian fellow. They would get into heated debates, getting wound up, but then it would have to stop for the praying. And the tension would get diffused. Because a moment of calm was enforced.

And that is what I hear here. Romney is telling folks -- stop ranting and raving and hating, and take a moment for positive thoughts.

If everyone did that -- on both sides -- much much would be accomplished.

It's not about "god." It's about literally good intentions.

We need more good intentions.


>> ^Fred_Chopin:

Why is it so important to pray for Obama? What's that gonna accomplish?

>> ^colt45:

So those 82% are all owning guns for murder or war, then? Let's just take this absurd myopic view one step further: Rocks are dangerous weapons that need to be banned! They are readily available to children and highly dangerous!
>> ^L0cky:
Around 6% of US Americans hunt, yet around 34% own a gun; therefore around 82% of gun owners own a gun for something other than hunting. Bringing up hunting is just avoiding the issue.
Besides, I don't think that guy's UZI is for hunting rabbits.
Also, you don't need to teach children how to safely use firearms if they don't have access to firearms. Kinda like how you don't need to teach them how to safely use a particle accelerator, even though they too are dangerous.


Wow. That definitely made my top 10 list of "Really stupid things that I actually read on the internet".

Seriously, when was the last time a kid accidently threw a rock and blew his friends brains out? Accidently put a hole through their own foot / hand / leg?

Sure, they can be used as a close up blunt damage weapon. However, in order to actually kill someone with a rock, it would generally have to be pre-meditated (i.e. kill them when they're asleep, because if you try to kill someone with a rock when they're concious and healthy, it probably wont go well.)

I can think of countless stories over the years involving some idiot irrational gun owner going out and killing someone they knew nothing about, because they felt threatened. Lately, the one I remember is of Trayvon Martin. You know, the kid shot for eating skittles on a street he didn't live on.

But let's go ahead and get back to the point @spoco2 was making earlier. Rocks have existed since the beginning of time. They serve no purpose, they have no design, or goal. They're simply there.

Guns, on the other hand, were designed as an instrument of death. In no part of the gun design was someone thinking "AND it'll function as a paperweight!". It was just another step further in the direction of long ranged combat, specifically for ending the life of another human being.

That's not to say that everybody who does own a gun has it for the sole reason of killing someone, after all, people still collect swords, axes, fascinating weapons from throughout the ages.

But I can't honestly see the amount of collectors being too high.