Thursday, March 30, 2023

Surviving Medical System Collapse - by Karl Denninger

Yes, the title of this posting may sound dramatic.

It is also likely.

CMS (Medicare and Medicaid) is one third of the entire Federal Budget.  When those programs were put into place the tax rates for Medicare were approximately equal to the percentage of GDP spent on medical care.  The medical system then embarked on a multi-decade program of felony anti-competitive practices and neither party has or will stop itso the percentage went from about 3-4% of GDP to roughly 20% today.  The tax rate did not materially change and would have to be multiplied by five to be reasonably coherent which, of course, is politically impossible.

I projected forward in the 1990s when running MCSNet that this would bankrupt the Federal Government by about 2025 and when it did Medicare and Medicaid would be unable to be funded.  The pressure this would place on the medical system since nobody would or will enforce the law means that the ratchet job on everyone will continue and get worse, ending in an effective collapse.  Whether that collapse is complete or partial does not matter if you're the one who needs it and doesn't get it; statistical numbers are all fine and well but meaningless in the example of one -- you.

I have long stated that you better not need the medical system within the next decade or so (going back to the '08 blow-up timeframe) and if you do the odds are you won't get it, thus you will be in serious trouble or dead and there's nothing you can do about it at that point. The only defense is to not need it.

Well, there are times you can't avoid needing it.  A car crash is obviously one of them, but there are more.  Nonetheless knowing when you need it and when you don't is quite important particularly when there is little supply.

But most of the time you can avoid it.  I did during Covid, for example, by being proactive and having on-hand that which I believed would help, fully aware that if they failed I was probably fucked.  They succeeded.  Someone I knew put his trust in the medical system instead of laying in supplies in advance.  He's dead and that sucks, but it was a free choice.

A few years from now it is unlikely to be a free choice as the system you think you can rely on, even if they aren't being wild-eyed crazy as they were during Covid, will not be there.  If you put your belief in it being there and its not, and needing it was avoidable, you will be dead.  You can't prevent the possibility of being run over by a car, but you can take many steps to reduce the risk of needing the medical system at all, and given what's going on in this country you're nuts if you don't, especially those steps which have little or no cost.

In my opinion you ought to have these things on-hand in any household.  They're not expensive.  Learning how to use one of them in particular will take a bit of time, but learn you should.  They can and will often provide key information -- perhaps critical information to discern between "not a big deal" and "oh crap", never mind quite possibly driving lifestyle changes that can wildly reduce the risk of "oh crap."

Let's go down the list on the what and why:

  • Thermometer.  Pick either contact is IR non-contact; doesn't matter, but intended for human use (thus the range of reading is suitable for same.)  The purpose is obvious -- determining if a person (you) has a fever and if so, how bad.

  • Pulse oximeter.  Cheap.  Buy one.  These clip on your finger and are about $20.  Unless you have COPD or similar you should be reading 97%+ all the time.  Sick, not-sick, feeling good, feeling not-so-good, same.  Readings below about 95% indicate serious trouble and if trending downward are very serious trouble.  As I pointed out several times early on during the viral outbreak if you are even in relatively crappy physical condition you have a reserve of several times your resting metabolic demand for oxygen; if you're in good cardio condition you likely have an exercise tolerance of ten or more times your resting demand.  Once your saturation starts to fall you have lost all of that so this is a lot more-serious than you may think it is.  These take seconds to read and are non-invasive.

  • Blood pressure cuff.  Automated, decent ones are under $100.  Some of the cheap Chinese ones are ok but of questionable accuracy because, well, Chinese.  Welch-Allyn makes one that's a few bucks more (~$65 or so), is more-accurate, has a better hose and connector arrangement and is not expensive.  High blood pressure typically has no symptoms until it gives you a hemorrhagic stroke which usually kills you or a heart attack which may also do so.  One reading doesn't mean much as damn near anything can spike your numbers for a few minutes to a couple of hours, but over a period of time this is a very big deal.  It used to be that every drug store and most grocery stores had one of the "sit down and insert arm" machines for zero cost but those are either disappearing or being replaced with ones that want information from you and have cameras in them.  You may be ok with that but you shouldn't be.

  • Glucose and/or ketone meter.  If you are over 65 or have a gut at any age you should have one of these.  Again, high blood glucose, unless extreme, shows no outward symptoms but over time destroys your heart, kidneys, eyes and results in serious neuropathy in the extremities along with circulation disorders that lead to amputations.  Unless you know you're diabetic prefer the one with individual wrapped strips as once you open a container within 30 days the strips are trash, and your use is intermittent.  You want to use this on an every three to six month basis to take both a fasting (before you eat anything) blood glucose level and then just before and on 30 minute intervals after a carb-heavy meal if you eat carbs.  If you are not back to your baseline levels within 2 hours you are insulin compromised no matter what the doctor tells you and thus you should be considering removing all fast carbohydrates from your diet.  Read here for more on this.  Type II diabetes can be stopped and even in many cases reversed without use of a single drug.  Failure to do so will, over time, wildly screw you metabolically and if you think you can just go on the medical roller-coaster, well, in a few years no you won't be able to unless you have hundreds of thousands of dollars of your personal money to spend on it.  If you care to monitor ketones as well (e.g. "am I really eating a ketogenic diet?") the KetoMojo meter will tell you both and it has individually-wrapped strips and thus is intermittent-use friendly to your wallet.

  • A hand-held EKG device.  This is relatively new in terms of availability at a reasonable (under $100) price.  Prefer one that does not require a cloud connection or subscription; this is extremely valuable data to insurance companies as cardiac problems are a huge marker for money, of course.  It will take you a bit of study to learn how to read it but most of these will alert you to any gross abnormality.  Be aware that they're not perfect and materially less-sensitive than a full "leads on the chest" EKG, but they do work.  With about an hour's worth of reading you can learn how to interpret the trace with reasonable accuracy.  You won't be a cardiologist but you will be able to spot many things of material concern that might otherwise have no symptoms and, if you do, then its time to talk to someone who really does know.  If you got clot-shotted, in particular, this might spot a potential electrical block that otherwise has no symptoms but can result in a no-warning thud.  You're welcome.

do not recommend an AED in your own home especially if you live alone.  They're damned expensive (a thousand bucks plus!) and worthless if nobody is there in immediate attendance as if you get hit you won't be able to use it on yourself.  If you live with someone and are almost-always around them, and have any indication of cardiac trouble, then maybe the math works out differently on this but that's a hell of a lot of money that will only help someone else if you're the one using it.  Note that if you go into vFib while you and your SO are both in bed sleeping odds are they're waking up next to a corpse as there is typically no warning before it happens.  A person who goes into vFib when there is no defibrillator available is extremely likely to die even with prompt and well-applied CPR and if someone else doesn't immediately notice (e.g. you and/or your SO/wife/husband are asleep) your odds of survival are an effective zero.

One likely-controversial point: I do recommend a personal wearable device that can do HRV overnight.  Several of the Garmin watches can do so but not all, and the ones that can aren't the cheap options.  This data is unbelievably sensitive and can be used to identify things you don't know are trouble in your particular person; if you see an unexplained deviation it is real so put in the effort to find the cause.  For instance I have recently isolated and proved that I have a very mild allergy to peanuts.  I never knew this and it likely has been lifelong.  It doesn't produce any obvious symptoms but if I eat just one small spoonful of peanut butter a couple of hours before I go to bed it will materially harm my HRV overnight.  Eating a crap-ton of pork rinds and salsa with the same amount of time before bed, on the other hand (e.g. as a snack while watchin a movie) does nothing.  There is no way I could have isolated this otherwise.  I love peanut-butter milk stouts, as just one example -- guess who won't be drinking any more of them?

This sort of knowledge and device makes personal "challenge trials" of that kind, done in a "notch" fashion (that is, do it, don't do it then do it again and see if you get the deviation and then it goes away) very simple.  It will also show you the immediate and immutable impact of things like consuming alcohol and exactly how badly it "gets" you if you go out for a few rounds with your buds.  Finally it will warn you a solid day or more in advance if you're getting something (a virus, etc.) in that you'll see it in the data even though you didn't do anything the previous day to provoke the decline and know it.  If you're into athletic pursuits then this is obviously even better but even for those who are not, in my view this data is ridiculously useful and not obtainable in any other non-invasive way.

This sort of sub-clinical harm is likely a huge deal over time and yet there is exactly zero attention paid to it in the medical community nor will there ever be as there's no money in it.  These sorts of reactions are nasty because being sub-clinical it isn't obvious on the surface. Sub-clinical inflammation is likely responsible for a large percentage of long-term systemic damage including heart attacks, strokes and various and sundry autoimmune disorders of unknown origin or cause.  If you find these things and get them out of your life you avoid clinical exposure and the cost of it, never mind the personal debilitation.  There's absolutely no downside to that sort of knowledge and now you can obtain it with a bit of effort as the instrumentation on a personal basis is now within rational grasp.  I'd like it a lot if the price was lower but it isn't, and unlike the other things in the kit getting accurate data requires wearing the watch for a couple of weeks to get the baseline and then continuing to do so nightly, so its entirely-personal and thus you can't amortize the cost across multiple people in your household.  Garmin brought this to my Fenix 6x in August of last year and I have come to consider it a "must" personally, and well worth the money.

One very-important note: There are stand-alone devices that do this and most require some sort of subscription.  I consider these poor secondary substitutes for several reasons, with the most-serious being that they're not typically worn all the time and the subscription-style nonsense.  In short IMHO if you decide you want to try to exploit this knowledge Garmin, at present, is the go-to for doing so.