The Macroeconomic impact of "Homoe fragilis"

Investment Analysis Clubs Macro Economic Trends and Risks
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Medical care already absorbs about 1/7 of U.S. GDP.

This is a cri de coeur from a doctor who foresees greater economic burdens from increasingly difficult to treat patients.

Treating a New Species: Homoe Fragilis

— Our fragile patients are increasingly dependent on a crumbling healthcare system

by Edwin Leap, MD, Contributing Writer, MedPage Today September 17, 2024

…
We seem to have transcended our ability to provide care for significant numbers of the population. Maybe a better way to look at it is that physicians often seem to be dealing with a whole new kind of biology; a whole new pathophysiology of Homoe sapiens…

[snip examples of very sick patients including chronic diseases, mental illness, obesity and drug use]

Our hospital systems – in particular those administrations that hoped to make great profits – have run into a wall. The patients they wanted have arrived in vast numbers. But they are so sick that they cannot stay out of the hospital long (and this is despite the financial punishment for early readmission, which patients apparently ignore when they’re sick.)

These patients are so complicated that their care demands enormous resources in staffing and material. And after a while, they are out of money, or their insurers can scarcely afford what the patients need…

Homoe fragilis, at least as a diagnostic category, begins earlier and earlier in life and often results not only in a tribe of people dependent on medications but also, “relying on the kindness of strangers.” No, maybe better put, “demanding the kindness of strangers.” These individuals require food, shelter, medication, affirmation, and often money from others because they cannot function in the wild… [end quote]

Our local hospital is deeply in debt, partly due to hundreds of thousands of dollars spent on patients who are well enough to release but are kept in the hospital because they do not have a safe and stable home to release them to.

With younger people becoming more obese and developing chronic diseases such as Type 2 diabetes this problem will only get more prevalent and more expensive.

Wendy

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I think we should make assisting in hospice care part of required high school education. With a little luck it would provide missing spiritual education combined with the strongest possible warning against life management stupidity.

d fb

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Yet other large industrialized nations seem to be able to do it at half US cost and their citizens have life expectancies 3 years longer or more.

I wonder what’s holding us back?

I blame Private Equity and the bipartisan culture of corruption in Washington.

intercst

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The Shinies tell us they are “Commies!!!” Remember the rallying cry of my youth “better dead than red!”.

And 80 years of propaganda that all things socialistical are, by default, bad. If you reject everything with a whiff of socialism, what is left is rationing by ability to pay, which is what we have.

Steve

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That’s pretty easy.

Salaries were markedly lower than €100,000 in France, Italy, and Spain. There are several other countries in the EU, including Portugal and Greece, where specialists earn less than €50,000. These figures all reflect annual gross remuneration for salaried specialists.

GPs are paid less than specialists. For example, specialists earn 85 per cent more in the UK, where the average annual gross salary for GPs was €73,408 while specialists received €136,375 on average.

While across the pond:

According to the [2024 MedScape Physician Compensation Report,](https://www.medscape.com/sites/public/physician-comp/2024) doctor salaries continue to rise. In 2023, Primary Care Physicians (PCPs) in the United States earned an average of $277,000, while Specialists earned an average of $394,000

Average Doctor Salaries by Specialty – Kaplan Test Prep.

I don’t maintain that these two snippets are perfectly representative, but I’ll wager there’s some truth somewhere in these numbers.

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In some ways, the article is correct…there are more sick people around. Medical science has come so far …and will continue further…in creating a class of folk who, maybe as recently as 23-30 years ago would have died from their conditions. Oftentimes prematurely and of diseases not of their own making. The article isn’t about survivors of childhood leukemia, heart disease, liver disease etc., though. These folk are just as prevalent in other countries.

The specific circumstances that the author is describing in this new species is (or has been) a particularly American phenomenon. I have an inkling that, if said species were transported en masse to the countries that show better outcomes for less money…with the lifestyle habits referred to in the article and the expectations American healthcare consumers display…there’d be a dramatic shift in those figures before too long.

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Re: govt medical care is socialism

Recall the many TV ads run in opposition to Hillary care. A couple of seniors who would have to give up their favorite doctors and go to one chosen by govt.

No mention of socialism. But clear indication of deep pockets to support existing system. Medicine for those who can pay is very profitable.

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The problem is medicine for those who must be treated by law but can’t pay.

Wendy

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My solution is a tiered insurance system. Basic coverage for all with higher tier programs offering better coverage like private rooms and more advanced care.

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Something like this already exists, doesn’t it?
Wendy

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The notorious “Harry and Louise” ads.

And the lampoon by a pair of now private citizens.

So we got the inevitable “compromise”: “free enterprise” bureaucracy, with the government paying.

Steve

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Don’t forget, either, that they were ads…and about as accurate as later ads attracted by Hillary.

Funny about face happening at the moment…when “government medical care” (i.e. traditional Medicare) still allows beneficiaries reasonable access to physicians and medical facilities but “private enterprise” in the form of insurance industry run Medicare Advantage is increasingly leaving beneficiaries short changed.

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Don’t forget the “JCs” who promised employees they would receive medical coverage in retirement, for twenty years of service, then cut off the medical and stuff the money in their own pocket instead.

Steve

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Until Obama Care, health care was the third rail of politics. After Hillary Care no one would touch it.

And Obama Care was based on a program supported by Republicans in Massachusetts. But when adopted by Democrats they opposed it and worked to undermine effectiveness.

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Re: tiered insurance exists.

Yes, Medicare supplemental is exactly that.

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Never before has there been a preventable epidemic the size of the current one,

Insulin resistance is a complex condition in which your body does not respond as it should to insulin, a hormone your pancreas makes that’s essential for regulating blood sugar levels. Several genetic and lifestyle factors can contribute to insulin resistance.

The solution is not more care but more prevention, healthy eating. This is an epic MegaProject. Another is to get our genes to deal with it, takes only a few hundred generations.

The Captain

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I know in France university education costs are low, funded by the government. France then reaps the income of university graduates via taxation for the next 30 to 40 years to fund new crops of university graduates. Medical doctors have little education costs thus no big education debts to pay off. Seems to be a good system. University graduates likely have higher income that is taxed to provide for more future productive workers.

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And they have lifetime employment. Once you get a full time job, you are guaranteed an income all the way to retirement. Yes, they pay for it with higher taxes.

I worked for a French company. They found it better to give perks to executives like flying first class and staying in first class hotels on business. That’s because raises and bonuses get taxed heavily. Perks are more useful to the employees.

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Self reported averages are basically useless. Physician salaries are like real estate - location, location, location besides the obvious specialty. Plus, numbers are skewed lower by academic/teaching positions.

During my career, I made over twice the self reported national average for my specialty. Why? Grew up and lived in a place that unless you were from there, there really wasn’t a reason to be there unless it was for business purposes. Hard to recruit people to come there. I’ve been gone from my previous practice going on 7 years and they still haven’t hired a permanent replacement.

DW was probably closer to 3 times national average primarily because she was a “super specialist” that was typically only found in academic institutions and not private practice. I think the close association with academics is because “weird stuff” tends to congregate/get passed along to teaching hospitals.

I have no solution to the “problem with medicine” but I will say this. I entered the profession with the typical altruistic idea of helping people, soon learned that it was like any other business and at the end of the day I had bills to pay, retired early because I got tired of all the non-medical outsiders telling me how to practice medicine.

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Jessie is French.

Jessie Inchauspé is a world-leading biochemist and founder of the Glucose Goddess movement. She is also the bestselling author of books such as, ‘Glucose Revolution: The life-changing power of balancing your blood sugar’ and ‘The Glucose Goddess Method’.

The Captain

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