Caine has a post over at Affinity [aff] about Valley Fever – a poor person’s disease.
Back in the late 90s I started a company, which entails borrowing a few million dollars from very rich people, in hopes of turning their millions in to tens of millions (for them) and pocketing a bit oneself. Capitalists call this “creating jobs” but really it’s rent-taking: otherwise the money would sit in a portfolio somewhere offshore, growing inexorably thanks to the favorable tax laws that make Wall St a front-end for a gigantic scam in which the very rich make lots and lots and the middle class (if the very rich aren’t skimming too much that year) make enough that they don’t catch on and slaughter them. If you think I’m exaggerating, I’m not. Even a mere centimillionaire’s standard of living is shocking to a normal person. A billionaire’s life is so profoundly different from everyone else’s that, as Harry Harrison* once wrote, “the rich are a different species.”
One of my investors, Stanley S., a sweet old duffer who spent his life playing golf and gambling on startups and horses, had made his fortune running a wedding mill in Montauk, NJ. He earned it. Another had bought a mis-managed company that made batteries, turned it around and flipped it to Duracell, then backed the guy who started Home Shopping Network, and cashed out with a few hundred million dollars. Which, he then proceeded to multiply dramatically. None of them talk to me anymore, because I no longer represent possible additional wealth for them, but I’m pretty sure Lewis S. could tell me some Donald Trump stories – but he wouldn’t. Lewis used to meet with me at the suite he owns at the Ritz-Carlton in NYC, up on the top floor. The suite is always there in case he or anyone in his family want to fly the gulfstream in for a day and need a place to crash.
I had a call scheduled with Stanley and his executive assistant called me and said that Stanley couldn’t make it because he had an emergency and was going to be offline for a few weeks. Then, through some back-channelling, I learned that Stanley had been hit by a golf cart and his hip had been broken. That’s a serious injury for a 70-year-old, but I was assured that he was getting the best medical care and his prognosis was great. What that meant, it turned out, was that Stanley was holed up in a suite in a nice hotel in Pebble Beach, and his personal physician was in the suite next door. The best surgeon available had been flown out (from Mayo Clinic or Johns Hopkins, I forget which) and they had cleared a surgical theater at some local hospital and moved their own staff in, checked the place out, and done the repairs. That’s how medicine is for the rich and the powerful.
When I broke my jaw in 2013, I went to the local hospital and was told that the facial specialist would be in Monday and here’s his number to schedule an emergency appointment. Oh, and here’s a scrip for Vicodin, go home. When I woke up the next morning my pillow was covered in CSF that had dripped out of my ear during the night. I was in shock and they hadn’t even done a basic neuro check; I was too out of it (especially when the Vicodin hit and the shock sunk in) to think. That’s what medical care is like if you have good health insurance like I did at the time. I’m embarrassed to admit that the next morning, when I came out from under the Vicodin, I hired a limo (smooth ride is good when you have teeth that are banging together on a shattered mandible!) and got my ass to Johns Hopkins, 200 miles away. When I staggered out of the limo, into the reception at JHH, someone immediately yelled “head trauma” and I was getting a neuro check, shock was expressed about what was leaking from my ear, and someone jabbed me with a godzilla dose of antibiotics and some “feel great” stuff. I ruthlessly leveraged my privilege – my sister’s (a big-shot partner at Baltimore’s most prestigious law firm) dance partner is head of surgery at Johns Hopkins and I come from a Hopkins family, so I only had to wait another 6 days before I could get it set, and my teeth wired together. So: I am extremely privileged and was able to throw money at the problem; my experience was vastly better than what a typical denizen of Clearfield, PA, could expect.
Let me urge you to read this article in the New York Times. It lays it out pretty well. [nyt]
SAN FRANCISCO – When John Battelle’s teenage son broke his leg at a suburban soccer game, naturally the first call his parents made was to 911. The second was to Dr. Jordan Shlain, the concierge doctor here who treats Mr. Battelle and his family.
“They’re taking him to a local hospital,” Mr. Battelle’s wife, Michelle, told Dr. Shlain as the boy rode in an ambulance to a nearby emergency room in Marin County. “No, they’re not,” Dr. Shlain instructed them. “You don’t want that leg set by an E.R. doc at a local medical center. You want it set by the head of orthopedics at a hospital in the city.”
Within minutes, the ambulance was on the Golden Gate Bridge, bound for California Pacific Medical Center, one of San Francisco’s top hospitals. Dr. Shlain was there to meet them when they arrived, and the boy was seen almost immediately by an orthopedist with decades of experience.
For Mr. Battelle, a veteran media entrepreneur, the experience convinced him that the annual fee he pays to have Dr. Shlain on call is worth it, despite his guilt over what he admits is very special treatment.
“I feel badly that I have the means to jump the line,” he said. “But when you have kids, you jump the line. You just do. If you have the money, would you not spend it for that?”
I sure as hell jumped the line, when my brain-juice was leaking down my shirt, I was seeing double, and spitting blood. Steve Jobs, when his woowoo therapy didn’t help (honestly, nothing would have: he had advanced pancreatic cancer) used his money to buy a residence in a state where the line for liver transplants is short so he could get a slight shot at another year of life. When Ghandi, who had denied his wife advanced medical care – he hated that western nonsense – was dying, he hopped a private jet to the Mayo Clinic. Nothing causes a re-assessment of fairness like impending death.
As Caine cites at Affinity:
New research directly links the rise in Valley Fever to the rise in dust storms, which in turn is driven by climate change. Valley Fever, which the Centers for Disease Control and Prevention calls “a fungal lung infection that can be devastating” is caused by inhaling soil-dwelling fungus. When the soil dries out and turns to dust, the wind can make the fungus airborne.
I’m pretty sure congresspeople – the congresspeople who are in the process of trying to make America’s medical experience even worse – don’t encounter Valley Fever. It sounds like something that Mexican migrant workers encounter, not Congresspeople. Because if the rich, and Congresspeople, encountered Valley Fever, there would be Valley Fever Centers at Johns Hopkins and the Mayo Clinic, and the limos would come and go. The very rich would be in their suites, and the doctors would come to them, perhaps in limos, perhaps in helicopters.
(from the NYT article, hospital food) What, stainless steel flatware? WTF?! Hospital food is practically inedible.
I didn’t experience the food at Johns Hopkins (I used to work there in the 80s. Not interested.) because I was resorting to using a dispenser bottle to squirt coffee and pureed baked beans (not mixed, I had 2 bottles) through a convenient hole on the left side of my jaw where I am missing a molar. Also, like most people: I was an outpatient. “Outpatient” means ‘you really don’t want to know what a night here costs, so we’re sending you home to where your suffering isn’t visible.” But I’m sure that, at the right hospital, someone would have whipped up some lobster bisque for me without my even asking. But only if they mistook me for a Congressperson.
Part of why the American system works, with its massive inequality, is because the super rich hide how good they’ve got it. What you see in the media, as “wealth” are clowns, like the Kardashians, or Johnny Depp, and the stories are calibrated to show that the mighty fall and the middle class still have upward mobility. Johnny Depp is going to lose his $100 million island that used to be Marlon Brando’s. Meanwhile, the deep wealth of the truly rich becomes like a black hole, distorting everything in our civilization that comes into its radius, accreting more and more to itself and never letting go. Like a black hole, deep wealth cannot be seen except through its second-order effects: a political system that is constructed to enshrine it and worship it, and a massive army of Renfields that have been duped into serving its interests, instead of their own.
*I think it was Harrison. Maybe it was Haldeman. Unfortunately, I don’t remember the name of the story or I’d be re-reading it right now instead of writing this. [SPOILER] The story was about a guy who meets a mysterious woman. They fall in love. She suggests they visit this island getaway she knows of, and he agrees. It turns out to be a sort of paradise, with a beautiful hotel (where they stay) and great food and a pretty little town with locals and beaches and whatnot. Over time, the hero slowly has the dawning realization that his girlfriend is rich. Very rich. In fact, when she decided they were going to have a little getaway, someone bought the island, renovated the hotel, and flew in a bunch of actors to be “locals” and some top notch cooks. That’s just a side-bit to the story, which is otherwise also pretty scary. Billionaires can do things like that. They really can. They usually don’t, but not always.
[source]
PS – the Great Leveller got Kashoggi. Time is the one thing that money can’t buy.
Re: outpatient – I’m happy with that, really. I have a friend who works as a nurse and I’ve heard stories about MRSA that fill me with existential dread. At this point, I will pretty much only go to a hospital if something is hanging off and squirting blood, or there’s brain-juice dripping down my shirt. Which, in this case, there was.
Oh, hang on, I’ve read that story… Pretty sure it wasn’t Harrison, but I can’t remember who it actually was or what it was called either.
The sort of people who most ordinary people think of as rich buy a lot of flashy “prestige” brands. Comfortably wealthy people regard all that stuff as crass and tacky, and buy some combination of brands most people have never even heard of, and stuff that isn’t branded at all. Rich people have their stuff custom made, and really rich people have their stuff custom made by the world’s foremost artisans. If Valley Fever becomes a big problem, Hermès will start making beautifully elegant hand-tooled dust masks in a selection of fine leathers, with optional subtle detailing in jewels and precious metals, for the unfortunate times when you have to leave your HEPA-filtered air-conditioned bubble.
On venture capital, there’s a huge survivorship bias. Sure, some of them have actually done something worthwhile along the way, but they’ve been bloody lucky with it. I often think that looking to venture capitalists to solve our societal problems (as seems to be the fashion these days) is a lot like giving a thousand schmoes a thousand bucks each, sending them all off to Vegas to play roulette for a few weeks, and then asking the one with the most money at the end how to cure cancer.
So…that’s hospital food. If you’re filthy rich. I’ve had a couple of hospital stays in the recent past, and that’s not what the food is like. At all.
In fairness, the medical care in nDakota is excellent (at least at the not catholic hospital, don’t know about St. A’s), but they are feeling the stranglehold of their new corporate overlord lately too (Sanford), which makes care worse for everyone, and I’m one of those people with good insurance. For now.
My favourite example of medical hypocrisy is that of the oh so sainted Mother Theresa – she refused the dying poor pain relief, telling them suffering was good, bring you closer to god and all that shit. They lay on shitty cots on dirt floors, in tremendous pain. When her heart went bad? Flown first class all the way to uStates, ensconced in a private room, with the very best medical care money can buy. :spits:
Caine@#2:
I’ve had a couple of hospital stays in the recent past, and that’s not what the food is like. At all.
You’re not suffering from “affluenza” apparently. That’s one of the symptoms.
When her heart went bad? Flown first class all the way to uStates
Yup. Clearly she believed in all that afterlife shit she was spouting.
Dunc@#1:
On venture capital, there’s a huge survivorship bias. Sure, some of them have actually done something worthwhile along the way, but they’ve been bloody lucky with it.
I’m tempted to say “don’t get me started…”
But, you’re exactly right. What drives me nuts about VCs is that they assume that since they managed to make a ton of money, they must be brilliant businesspeople – which is funny because at least half of it is luck and having the right starting position (another form of luck). When I was trying to fund that startup I was working on last winter, we met with this one guy who had been Mark Andreesen’s college roommate, and who had a bit of Netscape stock for doing small unspecified favors and cleaned up $30 million or so. Suddenly he was a tech god, raining ex cathedra pronouncements down on all the people in his vicinity. Most of whom had technical chops and business experience that he could never touch.
I’d like to think I’d sacrifice a goat to Sithrak as a way of saying “thanks for killing me anyway” and spend the rest of my life trying to do something interesting with the money. That’s a lot – you can’t spend it all unless you’re Johnny Depp Stupid(tm). Sure, live well, but change lives for the better; it’s pretty fun to do that.
For some reason I can’t explain right now, Kashoggi’s house drives me nuts: there’s something really sick about having something so beautiful made and then setting it aside because he didn’t have enough time to hire interior decorators to furnish it so he could live in it.
Marcus:
That was almost a lifestyle of Kashoggi though, not finishing things. About a hundred years ago (late ’80s maybe), everyone in SLC was all excited about this insanely fabulous mall Kashoggi was going to build, it was gonna do so much for the economy, the investors were gonna get rich, etc. Never happened. Stayed not quite half finished for years, then Kashoggi backed out entirely.
Since I’ve just put down some of Juvenal’s tenth Satire over at chez Myers on the thread about the London fire tragedy, the next lines seemed appropriate for this one:
“Codrus possessed a bed too small for a dwarf, a marble slab adorned by six cheap cooking pots, with a small drinking cup, and a recumbent Chiron below, and an old chest containing Greek books whose divine lays were being gnawed by unlettered mice. Poor Codrus had nothing, it is true: but he lost that nothing, which was his all, in the fire; and the last straw in his heap of misery is this, that though he is destitute and begging for a bite, no one will help him with a meal, no one will offer him board or shelter.
But if the grand house of Asturicus be destroyed, the matrons go out in ostentatious dishevelment to arouse pity, your great men put on mourning, the praetor adjourns his court: then indeed do we deplore the calamities of the city, and bewail its fires! Before the house has ceased to burn, up comes one with a gift of marble or of building materials, another offers nude and glistening statues, a third some notable work of Euphranor or Polycleitus, or bronzes that had been the glory of old Asian shrines. Others will offer books and bookcases, or a bust of Minerva, or a hundredweight of silver-plate. Thus does Persicus, that most sumptuous of childless men, replace what he has lost with more and better things, and with good reason incurs the suspicion of having set his own house on fire.”
When I broke my jaw in 2013, I went to the local hospital and was told that the facial specialist would be in Monday and here’s his number to schedule an emergency appointment. Oh, and here’s a scrip for Vicodin, go home. When I woke up the next morning my pillow was covered in CSF that had dripped out of my ear during the night. I was in shock and they hadn’t even done a basic neuro check; I was too out of it (especially when the Vicodin hit and the shock sunk in) to think. That’s what medical care is like if you have good health insurance like I did at the time.
Such situation would be unimaginable where I live. Here doctors never send home people with head traumas. They just don’t. When I broke my leg, I was immediately taken to a hospital by an ambulance. Once I was in the hospital, doctors immediately put me to sleep and the next thing I remember was waking up in the hospital bed with my leg fixed. I don’t remember who my doctor was, but he did a great job (my leg was broken in multiple places, they had to use a wire to hold it together, but it heeled just fine). And there was no waiting time even though my family was far from rich.
I won’t claim that Latvian medical care system is perfect. There are plenty of problems, but, in general, it does a better job with helping poor patients compared to USA medical system. Hospitals are owned by the state, and state also covers majority of the costs for treatment. How much patients have to pay depends on a lot of variables, but it’s mostly affordable for everybody. Oh, and by the way, Latvian GDP per capita is less than half of what USA has.
There is no reason to claim that the way how things happen in USA is normal. Other countries manage to get better outcomes with a lot less money and resources.
Medical care isn’t the only example of this. Many countries, which are a lot poorer than USA, have free university education for everybody. It’s no wonder that France, Norway and Germany can afford this, but poorer countries like Estonia do this too. In Latvia there’s a complicated system where those students who manage to keep their grades high study for free, but those with very low grades have to pay tuition. I have studied in Latvia and Germany and I never had to pay any tuition.
Public transportation systems are another example. In USA, if you can’t afford to own a car, you are screwed. There are no decent options for public transportation. This is not so in other places. Among my acquaintances there are a lot of people who don’t even have a driver’s license, even though they could afford to own a nice and shiny car. Public transport can get you anywhere and it is often more convenient than using your own car.
In USA everything is designed only for the rich and the poor are expected to somehow survive. But humanity is capable of doing better than that. Incidentally, in Europe “socialist” isn’t an insult, here it’s a perfectly normal political position held by countless people.
I don’t care much when the rich can have a prettier house, rarer food and more expensive exotic hobbies. Such things don’t influence happiness that much and lack of them does not significantly reduce life quality. When it comes to healthcare, access to education, medical care, homelessness, then it’s a different situation, and I start caring a lot. Basic human needs shouldn’t be left to for profit businesses. A business just tries to maximize their profits and won’t serve a poor person who cannot afford to pay them. That’s why you need state owned hospitals, universities, public transportation network, prisons etc. Even tap water must be provided by the state, or else the bill is going to become huge. Some years ago I could buy my electricity from only one source (state owned). Then some stupid politicians came up with the idea to allow a free market for electricity. It resulted with electricity bills instantly jumping up. So much for competition reducing prices in free market…
Cartomancer:
Who, as did not escape Juvenal’s notice, I’m sure, did not refrain from handing over things dripping with wealth and antiquity. When you’re rich, you can get away with anything, and even if the filthy rich pals think they are a nasty stinker, they’ll still stand by their side.
cartomancer@#6:
That’s beautiful and right to the point.
I’m sure that if Kashoggi’s palace burned down, it would be news. But nobody’s counting all the homes that are being destroyed with white phosphorus in Mosul. And those were actually lived in.
Calamities (natural or human caused) are fractally detailed and have knock-on effects that can change lives for generations. As Epicurus said, the wealthy and powerful desire wealth and power in order to protect themselves from the calamities of life, but then they get lost along the way and mistake the means for the end.
Re: outpatient care: My mother-in-law practiced medicine in Argentina and later in Israel for many years. She was shocked to learn that in the US people get sent home immediately after surgery.
Ieva Skrebele@#7:
Here doctors never send home people with head traumas. They just don’t.
Non-standardized response to patients is one of the “side benefits” of privatized medical care. In a competently run civilization, there would be baselines for how patients are supposed to be treated (but there are not, because some Americans are completely irrational about anything to do with sex, and baselines would have to specify a minimum standard that might include abortion or teaching a young girl how not to get pregnant, or reporting signs of sexual violence, etc)
I will say that I showed up at the hospital with the broken jaw and a badly injured woman; they did the right thing there and separated us, got the state police in to “chat” with us and cross-check our story, etc. I don’t fault how they handled that aspect of the event but they really were incompetent about the head trauma. I could have been bleeding inside my skull (I was severely concussed) and they just sent me home to die.
Hospitals are owned by the state, and state also covers majority of the costs for treatment. How much patients have to pay depends on a lot of variables, but it’s mostly affordable for everybody. Oh, and by the way, Latvian GDP per capita is less than half of what USA has.
I haven’t heard of Latvia spending trillions of dollars on losing imperial wars, and more trillions on weapons. There may be some connection – I keep grasping for it, but it eludes me. Is it maybe that the Latvian government is trying to serve the people?
Many countries, which are a lot poorer than USA, have free university education for everybody.
Yes, our rulers haven’t figured out yet that educated people make better F-35s and H-bombs and soldiers. As soon as they figure that out, then it’ll be compulsory. Joking aside, in the US, the rich get all the education they want, so who cares?
In USA everything is designed only for the rich and the poor are expected to somehow survive.
There is an old Russian saying: The rich can’t eat money.
My version is: The rich can’t eat money, but the poor can eat the rich.
anat@#10:
She was shocked to learn that in the US people get sent home immediately after surgery.
Gotta get those beds turned around so we can keep revenues up!
Anat:
I wasn’t too happy about that after having my gall bladder out. I’ve rarely been shoved out the doors faster. I was barely awake from the anesthesia, when I was dumped in a wheelchair, taken to the little changing room my clothes were in, and told I could go home. I couldn’t even stand up straight, and my recovery was long and fuckin’ miserable.
Dunc@#1:
Pretty sure it wasn’t Harrison, but I can’t remember who it actually was or what it was called either.
I am pretty sure, after wracking my brain, that it’s a short story in Joe Haldeman’s collection None So Blind. I can’t find my copy after The Great Library Downsizing of 2002, so now I have to get another. And read it. No, no, I don’t need your pity.
By the way, his All My Sins Remembered is pretty good, too.
In a competently run civilization, there would be baselines for how patients are supposed to be treated (but there are not, because some Americans are completely irrational about anything to do with sex
Theoretically it’s possible to create baselines for how patients with broken bones are supposed to be treated and just conveniently skip the part about sex altogether.
Besides, sometimes doctors conveniently bend any rules anyway because of their moral beliefs. Last time I told a gynecologist that I have chosen to have no children, her response was that I mustn’t say such a thing, because God will hear me. My answer was that I don’t believe in God and I’m certain that I definitely don’t want any babies. Her answer – it doesn’t matter whether I believe in God, because God believes in me. Obviously her words weren’t in accordance with local laws, which say that abortions, voluntary sterilization and contraceptives are legal and doctors aren’t supposed to talk about God.
As for sex education, some lessons where kids are told about contraceptives, STIs and consent are better than nothing, but I’m skeptical about the possibility of actually making decent sex education lessons in public schools. Decent lessons would include information like 1) same sex relationships are ok, 2) sex toys are ok and fun to use, 3) casual sex without love and with many partners is ok, 4) BDSM is ok, 5) watching porn is ok, 6) group sex is ok, 7) masturbation is ok. See where I’m going? Try proposing teaching THAT is public schools and some of the parents will go crazy. There’s no way it can happen and get approved. Result: regardless of what they teach in sex education classes, children will have to resort to “Google University” anyway. And at this point you can only hope that their search keywords will also include things like “STIs” and “how to correctly use condoms” in addition to the obligatory “free porn”.
I actually had sex education lessons at school. It was sort of ok, they did get the facts about STIs and contraceptives correctly and they didn’t even mention the word “abstinence”. But those lessons were close to useless for several reasons: 1) those lessons were too late, by then half of my classmates were already having sex (parents would never approve of talking about sex with young children); 2) they only talked about the very basics. There wasn’t even a demonstration of how to put a condom on some elongated vegetable (apparently parents wouldn’t approve of that). Of course they only talked about safety and didn’t even touch the, in my opinion important, question about how to make the experience pleasurable. The result was that these lessons weren’t very useful and instead I learned everything from Google search results anyway.
I haven’t heard of Latvia spending trillions of dollars on losing imperial wars, and more trillions on weapons.
NATO members have an agreement to spend at least 2% of their GDP on military. Large part of NATO members (including Latvia) don’t get even close to that. I find this “failure” a very good thing. Amusingly, Trump uses this fact to claim that USA is getting ripped off by its allies who don’t exactly fancy spending that much money on weapons. Whenever I start thinking that Trump can’t get any worse, he does something disgusting to prove me wrong.
Is it maybe that the Latvian government is trying to serve the people?
Of course not. That’s just naive. Governments consist of politicians. And politicians aren’t there to serve the people; they are there to steal some taxpayers’ money for themselves. The difference lies elsewhere. In USA a politician can get away with saying that poor people are poor, because they are lazy, and they just need to stop being lazy and start working, and, besides, the free market will solve everything and it’s wrong for governments to provide social services. If a politician tried saying the same words here, that would be a political suicide, and their party would never ever be reelected. Here people expect the government to provide healthcare, social benefits for the unemployed and elderly etc. Thus politicians are forced to provide them. Of course politicians are masters of promising one thing before the elections and doing something totally different after they are elected. People have a tendency to forget, to not notice and so on, and all that gets exploited by politicians. But there is a limit of how far a politician can go with this. If they really annoy voters very badly, then voters won’t forget. And once they have not just two but countless political parties to choose from, voters really do vote for another party next time. Result: politicians are forced to at least pretend that they care about social welfare.
There is an old Russian saying: The rich can’t eat money.
Do you know where you heard this? I have never heard it in Russian, so I asked my Russian speaking acquaintances and also did a Google search in Russian, but I found no confirmation that such a saying would exist in Russian. I only found a similar quote in English by Canadian filmmaker Alanis Obomsawin. And all the Russian results Google gave me about eating money were translations of Obomsawin.
Not for the first time, really glad I live in the UK. In March and April I turned my left shin into a mess of splinters after I brought a paraglider in for what could only loosely be called a “landing”. Mountain Rescue carried me to the helicopter, they gave me morphine to keep me singing (Barry Manilow hits mainly) and when it came time to pull the leg straight in the hospital, ketamine (which I don’t recommend). Next day a titanium nail was put into the tibia, later that week a skin graft operation for where the bones had been poking out, and the next week another for where the first one hadn’t worked. Three operations, 25 days in the hospital, and ongoing appointments with both the plastics (graft) and orthopaedic specialists, plus physiotherapy (to get me walking again) and occupational therapy (managing the scarring). I’ll be walking soon.
Total cost to me so far has been slightly less than ten of our English pounds, for a prescription for painkillers.
The party that just got the most seats in our election (I can’t calling it “winning”) is committed to dismantling this system and bringing it closer to the American model. And yet people like me, and bafflingly people with a lot less money than me, persist in voting for them, rather than tarring and feathering them.
sonofrojblake@#16:
Total cost to me so far has been slightly less than ten of our English pounds, for a prescription for painkillers.
Yeah, here it would have been thousands even with insurance, because of the copays. Without insurance, ouch.
Didn’t like the ketamine? I’ve never tried it but I know a few people who swear by it recreationally.
I’m glad you made it more or less OK. What’s that “any landing you walk away from…” saying? What if you kind of crawl away? Is that still a good landing?