For exhibit One, let's turn to our national medical/healthcare (a.k.a. "sickcare") on which we spend some $2.6 trillion, or almost 20% of our GDP:

Chronic Disease Battle Requires Better Tools (BENJAMIN BREWER, M.D., wsj.com)

The lab results didn't look good. My 57-year-old patient's blood sugar was high. He was obese and already on cholesterol medication.

My diagnosis was metabolic syndrome, an assortment of risk factors that is often a precursor to heart disease and diabetes.

His was the third case I'd come across that week.

The chronic disease epidemic is upon us. Patients with health problems are younger and fatter. I had to buy a heavy-duty scale last year to replace the one I started in practice with a decade ago. I have more obese patients now and needed something accurate up to 400 lbs.

When I was growing up, nearly half the kids in this country walked or rode their bikes to school. By the early part of this decade, the figure had dropped to about 15%. Meanwhile, the proportion of kids who are seriously overweight has climbed, with 16% of kids in the 95th percentile or higher on a measure of body mass, according to the Centers for Disease Control and Prevention.

Certainly there is more we can do to help ourselves. We can be active with our kids. We can exercise more and eat less.

The biggest challenge in primary-care medicine is dealing with the complications of obesity, diabetes and hypertension.

The current financial disincentives to providing proper care for chronic disease are daunting, and the waste created by ignoring the problem is growing as the population ages.

So what we have "works"? According to the standard Propaganda, "we have the finest medical care system in the world." Heh.

According to the standard Pandering, it's not the responsibility of the patient/citizen to take an interest in their own health; poor thing, you're a couch potato because you're addicted to sugar-water, and it's somebody else's "fault," hence you're a "victim."

Since when did everyone who refuses to lift a finger on their own behalf become a victim?

This reminds me of the welfare recipient (pre-welfare reform days) who said she couldn't get a job because "I'm not a morning person." Hmm. Ever heard of the afternoon shift?

The Standard Posturing is that our bloated sickcare system is horrendously expensive because of all those tests and drugs and stuff. Somehow the financial system behind the sickcare never gets mentioned.

Correspondent Mark R. is a physician, and I asked for his input on non-profit managed care. Here is his eye-opening response:

My perspective on this discussion as a provider is the same as it is as a consumer of healthcare. Namely, the financiers in our system have cajoled their way into a position of ultimate control. You've heard the aphorism "he who owns the gold makes the rules," and so we have it in spades with healthcare insurers. The consumer is squeezed with spiraling cost and spiraling frustration; and the private physician is frustrated with tighter managed-care rules and shrinking profitability. (I know of physicians in varied specialties who have left healthcare because of challenging finances including malpractice insurance premiums that are sky high.)

Frankly, we are chained to a system that keeps corporate profits growing for the financing arm of healthcare, lest the entire system collapse. Dollars are drained to keep insurance company profits growing, year after year. It has to end sometime, and hopefully we aren't all shocked into accepting the next financing scheme that diverts dollars away from the product itself. The power to make this right in the future will probably come from both consumers and regulators (politicians) that demand a shift in emphasis away from the profitability of insurers/bankers.

Exhibit Two, the Machinist's strike against Boeing. Boeing has been minting money during this decade of debt-based prosperity, and I can certainly understand the line workers' anger over what they perceive as a sly sales-job contract offer. Here are two reports, one from the Seattle newspaper and the second from the IAM negotiating team's website:

Strike has big risks for Boeing, union

Contract 2008 Web Site 80% Reject Offer, 87% Vote to Strike (IAM website)

Paid time off was another area Boeing was “not interested” in improving. Despite members working over 3.37 million hours of overtime last year, Boeing does not think you deserve even one more hour of paid time off.

If during record profits and record backlogs, we cannot get Boeing to make improvements on these issues this time, when will we get these long overdue improvements?

Another reason to strike: Respect. Have you been ordered to attend meetings to hear the Company pitch its contract negotiations spin? Have you been pressured by managers to vote against a strike? Does Boeing really think you can be bullied into a bad agreement?

Vote to strike to show the Company that you are the Fighting Machinists. You will not succumb to pressure tactics. The Union has filed charges with the National Labor Relations Board challenging Boeing’s one-on-one interrogation of union members. Boeing’s disrespect and pressure tactics show how much they underestimate your intelligence and courage.

Read the proposed contract and its fine print for yourselves. Decide what you think of the offer. Ask yourself whether we will ever have another chance to improve job security. Are takeaways in medical insurance really justified? Your Negotiating Team unanimously recommends rejection.

But however you vote on the contract, stand up for your rights and vote to strike.
It will send a clear message to the Company:
• You won’t be intimidated or disrespected.
• You will not tolerate Boeing violating the law, AND
• It gives your negotiators options to get you a better offer.

After tomorrow, the price goes up and Boeing will have to pay. It’s Our Time This Time!

If there is any industrial sector more vulnerable to Peak Oil and global recession/ depression than the aircraft industry, none comes to mind (autos, construction equipment and farm machinery are close behind).

Yes, the remaining airlines will be seeking more fuel-efficient aircraft, but with China poised to enter the commercial aircraft space, one would imagine Airbus and Boeing are wondering just how many of those hundreds of aircraft orders from insolvent airlines will still be on the books in a year or two.

In case nobody noticed, large commercial aircraft cost $100-$300 million each and thus their purchase is financed. Anyone notice what's happening in the grand world of global finance? Is money tightening up a wee bit, and is risk being priced in a wee bit more? How much will a lender be willing to risk on a billion-dollar loan to a shaky airline in a shaky industry?

If I were a union employee of Boeing, I too would be trying to line up job security. But on the other hand, where is the recognition in these negotiations that if global tourism and business travel decline precipitously--both are utterly discretionary--then how many workers will Boeing need to build the aircraft which can actually be paid for?

Our Thai friend reports that tourism is off about 60% in Thailand, and no, not the part plagued by Muslim rebels, the "safe" resort islands and coast on the east. Corporate travel is being slashed as needless expense, and even worse, is now picking up the reputation of being a planet-destroying environmental nightmare.

Given these realities, I wouldn't bet on overtime or profit holding up in the coming era.

Undoubtedly, much of the national preference for Propaganda, Pandering, Posturing flows from fear: fear that we can't repair our own health, that we no longer have the discipline, that without pandering giveaways our lifestyle will crumble, and without posturing and propaganda then we'd have to face painful sacrifices and ugly realities.

The preference for fantasy, magical thinking and simplistic solutions are certainly fundamental to the human race--I am as prone to wishful thinking as the next bloke-- as is fear of reality (hey, getting older and poorer is simply not fun). But the consequences of acting on magical thinking, fantasy and simplistic solutions (i.e., just take this pill and you won't have to do anything about those "difficult" lifestyle issues, just roll your debts over into this new loan, just borrow another $trillion from the oil exporters and Chinese central bank, etc.) are daunting: the problems only get worse.

A key part of our national mythology is the rugged individual taking on the world. An individual who welcomes, swallows whole or even actively seeks as cover denial, Propaganda, Pandering and Posturing is a frightened individual. "Rugged" lies somewhere on the other end of the spectrum from lame excuses and turning a blind eye to reality.

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An excerpt from For My Daughter

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