When Getting Up Isn't a Win

My foot is way more swollen for no reason at all. I'm up most of the night due to charley horses in both my feet. The other neuroma is acting up now too. The second cortisone shot doesn't seem to be doing anything positive.

I did start taking magnesium. I've gotten away from my vitamin regimen, but I've been low on magnesium in the past so I started that up again in the hopes it might be helpful.

And I'm taking Advil and Tylenol at night again. I might try taking some during the day as well to see if that makes a difference with what happens at night. 

Ironically, I'm fine during the day.

When I lay down, it destabilizes everything and makes it worse. Same for swimming. Weight on my foot is actually better than being weightless. But I can't handle a lot of weight bearing either. 

I'm so tired. 

I don't know. I might try sleeping sitting up between now and surgery. I'm trying to picture how that would work and how to make it comfortable...

Geopolitics again...

So what's going to happen? No one knows, but the risks are concerning.

I keep hearing this war is an existential fight for survival for Russia.

But the thing is, it's an existential fight for survival for the West too.

No one can afford to lose in Ukraine now.

Which means we have a very dangerous conflict, much more dangerous than I think most people realize.

And, again, if you look at global leadership as a continuum with one end being leaders of functional democracies and the other being ISIS or Hitler, we have more and more leaders, most of the leaders with nukes in fact, moving toward radicalization.

Nukes in the hands of people who don't have to listen to anyone is a big problem.

If Russia loses, we can try to solve that problem. The West could pull back from the brink of being an autocracy like China or Russia and actually stabilize the world. There's a chance, at least. The amount of Russian and Chinese fueled corruption in Western governments is definitely a heavy thumb on the scale. We'd need a lot of grassroots energy coming in to counter that corruption, but do the people of the West have it? Eh. We'll see. Still, it's a better scenario than the West losing.

If Russia wins, we will eventually see some kind of nuclear exchange somewhere because autocratic states will be the norm in a world run by BRICS, and once autocracies run out of resources to plunder within their own borders, they go a pillaging with a side of genocide. It's just a question of time.

Given that Russia can't afford to lose, it's unlikely we'll see them withdraw unless there's a major change somewhere in their sense of reality. That leaves our best hope as a negotiated end to the war where everyone gets enough something to commit to a new status quo. At that point, whether we publicly admit it or not,  and if we're smart (which who knows!), we switch to a Cold War style footing and covertly work to destabilize autocrats with nukes.

This means, Ukraine may have to cede Crimea and perhaps other territory for now. And potentially Ukraine may be barred from joining the EU or NATO, although I think that's a dumb move on Russia's part. Limiting Ukraine's options will just result in them being a loose cannon. They have too much military experience and are far to interested in fucking up Russia to leave them at loose ends.  At least if they join NATO, they are a known quantity and you know the rules they have to operate by. But hey, it's Putin's mistake to make.

But it's all around mostly bad news. I am looking for whether we have better outcomes on the table but I'm not finding them so far. Sorry. I know it's distressing. Give what energy and support you can to democratic institutions where you live. That's one way to feed the world's better angels in this mess.

I think I'm about done with geopolitics right now. I've got more on AI and medicine in the wings and then psychedelics and feminism....which ought to be interesting. At the rate I'm going, I just might combine psychedelics with feminism. We'll see.

PS: Someone asked me if Clinton as president would have made a difference. I doubt it. A President Hilary Clinton might have done less damage overall, but I don't know that she would have outperformed the chaos machine on PCP that was President Trump. Clinton was Secretary of State under Obama, a president who was exceptionally weak on foreign policy. Trump was also weak, but was such a wild card that he accidentally landed some wins because people had no idea what he would do next...it was a weird presidency, more like a psychedelic fever dream than anything else. One that directly fed into Putin's fever dreams.

However, no president since the Cold War 'ended' was clear eyed enough about Putin to actually invest the political capital to deal with him proactively. Our leadership has largely been lacking on the geopolitical front for the last 30ish years. It's not any one president who did us in. It's all of them.

 (There's a conversation to be had about how we can improve our geopolitics. We have more guardrails on domestic policy than foreign, but given what we're facing now, I'm not feeling that has served us or the world so well. Trumps shouldn't be able to come in and just blow up policy because he feels like it. Bushes can't be allowed to get distracted by one issue. Clintons and Obamas can't be wilted wallflowers.)

Love him or hate him, Biden is probably the best man (of the choices we had) for this moment in history. He not only remembers the Cold War, he actually had a seat in the front row. He knows the game and that knowledge will serve us well. He's also less corrupt than other options and generates very little drama (I mean, they can keep trying to make senile and Hunter's laptop happen, but it's pretty hollow), which means national interests can lead over other, more self serving agendas.

I Talked to a Journalist and They Sucked

 US-A T0d@y popped onto my radar looking to talk to people with chronic illness about covid now that everyone's back to normal.

I offered to be interviewed and we had a call.

But I didn't meet the requirements of their narrative bias and was told a few weeks later that they didn't use me in the article, but that my thoughts informed their take.

And then it wasn't even an article published in US-A T0d@y. It ended up in some regional paper that had the kind of hard paywall conservatives could only dream of having at the southern border. 

The misrepresentation of their affiliation and allowing people to think they were national media was interesting. (Perhaps they do work at that publication or are part of the syndicate, but I wouldn't know the details because the journalist didn't disclose shit. Apparently, even as a nobody, I need to do due diligence with the media.)

The things I said that disqualified me from being part of the article...

1. We need better vaccines and treatment and it needs to be more widely available.

2. I don't need anyone else to wear a mask or be vaccinated because I can control my risk well with an N95. We don't get sick when we wear masks.

3.If we had better vaccines or treatments, I wouldn't even need the N95.

So guess what angle the article took? It focused on 'everyone needs to wear a mask and get vaccinated and this is why people with chronic illness are suffering, because people won't protect them' which is a flawed narrative when N95s (or p100s if you want to get hardcore) work and when the vaccines are imperfect. The latest reporting is that the boosters start waning after two months and are not protective for those with chronic illness...far from the efficacy we need.  (Here's the full preprint study if you need it: https://www.medrxiv.org/content/10.1101/2023.03.02.23286561v1.full.pdf --they have a whole discussion about why it might be the vaccines aren't working.)

WTF is a vaccine going to do better than an N95? Nothing.

The article was solely focused on interpersonal dynamics and fomenting the discontent that feeds the culture wars. People won't protect us. Other people need to get vaccinated. Other people should do what I need. 

Apparently we're still not allowed to say things like 'wear an N95' or 'the vaccines kind of suck' or 'I can't access Paxlovid or other treatments reliably, the system isn't working.' And I must be the only person in the world more interested in where science is on better vaccines and treatments, instead of trying to control or blame what millions of other people do.

We are moving too slow and fighting without effective tools.

We are choosing flawed narratives that ignore that. 

We are not having quality discourse.

Humans really suck at pandemics and the media isn't helping. Like, wow. I didn't expect everyone to be so awful. How have we not gone extinct long before now? Oh right. Smart people have been saving our asses for centuries now. But to what end? This? Is this the pinnacle of human achievement??? Is this what all our smarts have achieved? This bullshit? Really???

PS: From that article I linked above: "The omicron-targeted shots also did not reduce the risk of severe Covid in chronically ill adults younger than 65, the study found."

I just want to point out, I can feel the flu vaccine kick in when I have the flu. I can tell the difference between having the vaccine and not having it. In comparison, I could not feel any of the covid vaccines kicking in when I was sick. It was like I had nothing on board.

I know this is an unpopular take, that it counters the overarching narrative that's been crafted, BUT THE VACCINES ARE NOT DOING ENOUGH. The media and the government can scream all they want that people need to get vaccinated, but it's not working as advertised and the data is starting to show that.

Recap

Since the covid vaccines and covid itself...

I've had major irritation and inflammation of multiple nerve growths that has resulted in two surgeries now, with a third on the way.

A previously stable pancreatic growth has suddenly started growing.

(For the record, there are other people dealing with growths after covid and I've been talking to Infectious Disease about it. I'm not off base. At the very least, the inflammation is fueling things that were already brewing. If there's an actual growth factor beyond that, no one knows yet. But this isn't all coincidental, it's covid.)

I have the joints of a seventy+-year-old and I'm not seventy.

I suddenly have sleep apnea that waxes when I have covid and appears to wane when I don't.

I struggle to walk. I struggle to sleep. I pant like a dog and feel like I'm going to pass out if I'm too active. The asthma is worse.

I doubt science will be able to do much to counter this chaos in my lifetime.

But I just wanted to recap where we are.

Now...on to geopolitics...because at least I'm still very curious and interested in all the things.

I've got a few YouTube videos for you from college professors and topic experts. 

1. Professor Sachs is up first. Note his position mirrors Russia's, but I like his game theory and there's a lot in here to think about.

However, he's an economist not a geopolitical expert, and apparently he also doesn't believe in a nation's right to self determination or sovereignty. In this talk, he participates in the dehumanization of E. Europe--treating the countries and their people as pawns that can be sacrificed at will. This is a very Russian point of view, one that has resulted in genocide in Ukraine multiple times at this point. Perhaps, since Sachs has advised various Russian leaders, he's adopted their world view. It certainly sounds like it.

But, as I'm someone linked to E. Europe in a variety of ways that don't include keeping the leaders of Russia happy, consider this question...

If Russia is so awesome, why did the vast majority of E. Europe align with the EU and NATO?

Russia will tell you that it's because the West was meddling and connived to make it so, but in reality, it's because the USSR treated E. Europe as an ATM during the Cold War. They plundered and bullied and impoverished E. Europe, and as a result, are generally not perceived as good or trustworthy in the region. There is a history of abuse behind why Poland has armed itself to the teeth and joined NATO. And they are not alone in that.

Sure, you can find Russian apologists, but ask around and you'll find there's a large contingent that really dislike Russia and want nothing to do with them. They want to be like the EU. They don't want a mafia state. 

Keep in mind, for the last 25-30 years, Europeans have been working in the West and making money hand over fist, money Russia certainly never deigned to spare, and they like it. There are cities in the US that are the second largest population centers for some E. European countries. There are countries were 20% of their population is overseas. 

Compared to the two main exports from Russia during the Cold War--what's-yours-is-mine imperialism masquerading as communism and the heavy hand of the Russian Mafia--and the fact that's what Russia is offering now, there's no competition. Russia doesn't want to add value, they want to take it.

E. Europeans know what they're choosing. Their eyes are open.

So that's why E. Europe isn't going to war to kick out the EU and NATO, but does work to kick Russia's ass. It's not because the West bamboozled them into NATO. They want to be part of NATO. They will literally supply tanks and planes and bullets and aid to ensure they don't have to go back to Russia. The logic of Russia's premise on this doesn't hold. (A ten-year-old could figure out the truth on this. Russia lies to us like we're dumb, and well, sadly, some of us are...)

So when experts and pundits go on and on about how this war is the West's fault, what they are really saying is that Poland, Slovakia, Latvia etc... don't have the right to sovereignty and that we should sacrifice the countries and people of E. Europe to appease Russia.

Put another way: Russia demands that in order for the West to have security, freedom, and peace, we must deny E. Europe their security, freedom, and peace. 

How is that okay? None of us would stay in relationships with someone like Putin. It's toxic.

Sachs is also concerned about wealth inequality, which is very real, but note he doesn't talk about Latvia or Lithuania or Botswana or El Salvador. No, he talks about Russia and China. In this case, wealth inequality is code for 'we want to control everything.' I'm all for putting Costa Rica or Mauritius in charge...they're actually functioning democracies but economically disadvantaged compared to the West, Russia, and China. Like, let's go. Let's have actual democracies lead. But equality of any kind isn't really the agenda here so...

Professor Sachs also says that we know the problems of geopolitics, but no one has any solutions, which is inaccurate. We know that democracy, while imperfect, interjects enough churn into the power structure to keep agendas from getting a stranglehold on a nation. We know keeping dark money out of governments and fighting corruption matters. We know free speech and education and strong labor movements make a difference. We know that every nation needs to be vigilant about their geopolitical strategy, not only building bridges, but having expectations that productive things will cross those bridges too.

If we'd done half the above, we wouldn't have a war right now.

But hey, if you've been on the payroll of corrupt autocrats, probably you've gotten used to not saying that democracy is good and corruption is bad. 

Despite my criticism, Sachs' talk is a good listen for testing the merits of different ideas and provides a good example of how insidious Russian propaganda is. I will note, much like more pro Ukrainian analysis, he is very concerned about a nuclear weapon being used. That, I think, is more concerning. When all sides see the same danger, you have to imagine there's some clarity there. 

Next up is Julia Ioffe, a reporter and analyst who knows Russia well. Her take here is more psychological, but it's interesting nonetheless. Very good overview of Putin's machinations and some of the missteps and wins of the West in dealing with him. She also sees nukes as a possibility.

And here's Marie Yovanovitch the former ambassador to Ukraine sharing the history she witnessed and also highlighting how the West screwed this up. And boy, did the West screw this up. 

(Note: If you're interested, PBS has a whole series of interviews with different players involved in the geopolitics of Russia and Ukraine.)

Then we have Professor Kotkin, a historian with the Hoover Institute at Stanford. The Hoover Institute is a center right think tank, so pre-MAGA Republican. This is a largely factual interview and it gets more into the impact of Russia's war on China and Asian geopolitics. It's a very interesting interview that reveals some of the scope of Russia's actions outside of Europe. The long tail on all of this is insane. What happens in Ukraine isn't going to stay there.

I will say, no one that I've found so far is talking about the BRICS colluding to pull off this war (at least when I wrote this). Since the BRICS are all largely headed by autocratic leaders no one can say no to (imagine a room full of Trumps trying to negotiate with each other--to one extreme or another, that's the dynamic), sustaining a high level of cooperation is or will be difficult, but I do think there's some effort to pull together going on despite competing agendas, vainglorious narcissism, and international pressure to not do so. 

The payoff is too big for them not to work the spots where their interests align. If they can find a way to cooperate, they'll do it. 

If Russia pulls off a win, China probably gets Taiwan, Iran probably gets nukes, India gets to hang in the winner's circle perhaps taking Pakistan, Brazil and South Africa probably get to be the very rich autocratic Kings of their continents (whether their coalition will give them nukes, I'm undecided, but it's a possibility) and the dollar and the pound and the euro go pfffft and there's a massive, painful (for the West) polar shift in how the currents of global, economic, and military power flow. 

And then someone, somewhere will get nuked. Because the BRICS will eventually turn on each other. Again, global leadership is devolving to have more in common with ISIS than not. Quality isn't improving, it's eroding. We have leaders with nukes who kill people who tell them the truth so no one says boo. We already see how that led to major miscalculations in the assault of Ukraine. 

And you can bet the West will be in the mix trying to subvert and topple various leaders which will compound risk. We're not going to cede power quietly and we could very well make things worse in the process. A lot of people will die.

Not to mention Russia, China, and India all have long standing territory disputes amongst themselves. The second resources are scarce or the economy is bad, take your pick of which friction point manages to throw a spark first. 

So. Our biggest mistake was not dealing with Putin decades ago. A mistake we made worse by failing to mount a strong deterrence against aggression once we knew were in for it. There's still a chance to create effective deterrence in Taiwan...I hope the West takes it. 

And we should be destabilizing the absolute shit out of the rest of the BRICS. No more dollar diplomacy without an overt, tangible ROI. It doesn't work. Americans will abandon their principles for money, but the cultural ethos in other places isn't that shallow. (Yes, I just called us shallow. We are. At least on a nation state level. Individual results may vary.) We need to stop trying to buy outcomes from frenemies and take our dollars to our allies and build them up instead. 

Let the strongmen of the BRICS make do with Rubles and Yuan with a 1000 to 1 (or worse) exchange rate. Let them struggle to afford genocide or conflict that could go nuclear. 

Again, the West just sort of abdicated all responsibility for ourselves and the world except for the War on Terror, taking bribes from Russia, sometimes even China, and then being manipulated via social media until we're more divided than we've ever been. (Y'all there were literal Nazis protesting in my area this past week. Nazis. NAZIS. Like...what. the. fuck.)

Ultimately, even if he gets the root cause wrong, Putin is right to blame the West. This was our war to prevent. (This doesn't excuse Putin. He certainly could have been the better man here, but he decided to double down on autocratic dysfunction and start a genocide. No points for him either.) But now the West has been blind to reality for so long, we may not be able to pull everything back from the brink.

This is an absolute cluster. We'd better hope Ukraine can spank Russia hard enough that they give up and go home without escalating to nukes.

As to why I care...win or lose, this is going to change the world same as covid, same as AI. I pay attention trying to extrapolate--if I can--where the hits will land. I'm not so old that it doesn't matter yet and I've got a kid to launch, which means career choices need to be tight.

How Many Ways Can You Cut a Foot?

 The podiatrist is recommending surgery. A neurectomy to be precise.

So. I'm having surgery. I know it's relatively minor surgery, but I'm not thrilled about it.

The treatment options for Morton's Neuroma run something like this...

A variety of injections and ablations.

Then surgery of which there are two approaches--decompression or neurectomy.

The injections can work but don't work for most, and thus, aren't preferred. So there goes all my previous excitement about maybe avoiding surgery.

Decompression surgery is the sole provenance of private podiatry practices and their marketing outreach. How do I know this? Well, there apparently isn't much to say about Morton's Neuromas in the medical literature which means search results are 90% sites for private clinics.

Private clinics where the doctor always seems to be an exceptional genius who invented a decompression procedure to treat Morton's Neuroma.

After like, the fifth site where the podiatrist had this whole spiel about how they invented a new technique and are the only ones who can save you with nary a mention of failure rates*, I was like...okay, this is bullshit. (See also: All the previous times I've talked about how surgeons will say anything to get you into surgery.)

Did they all hire the same marketing firm or something? How is this peacockery allowed by the state medical boards? Can you just claim to invent a procedure like that? OR are there that many super special ways to cut out a neuroma? 

100 Ways to Slice a Foot, Invent a Procedure, and Increase Podiatry Clinic Profits--some conference workshop somewhere.

Even more insidious, some of these geniuses start patient communities where they can shill their patented surgical miracles. There's a whole marketing machine that overtly manipulates patients.

But if decompression surgery for Morton's Neuroma is the second coming of Christ the private podiatrists say it is, mainstream hospital system medicine has yet to convert. 

Mainstream medicine cuts out the nerve and that's the only option on the menu I've been provided.

Either way, the procedures work about the same from what I can tell. So surgery here I come. Bah.

*For those looking for an ethical podiatrist...if their website mentions failure rates, if they talk about decompression surgery being an option in a specific use case (earlier in the development of symptoms) instead of trying to sell it 100% of the time, and don't claim to have invented the 5,000th special procedure for Morton's Neuroma, which is a condition so boring and unexciting that there aren't even 5,000 medical studies on it (this isn't cancer)...probably they are good egg. At they very least they're more up front than 90% of their private practice peers.

Why Is the Media Pitting Patients Against Each Other?

 A few months ago, I got a hot and bothered text from my anarchist extreme left sibling ranting about people taking Ozempic from diabetics. The injustice of it all was too much for them.

They'd seen an article.

An article.

Since then, that one article turned into dozens which has sparked all sorts of nasty commentary from the Greek Chorus that is social media.

No one will google. No one will shut up. No one will ask why am I jumping on the hate bandwagon? Or why the media is pitting patients against each other? Or where is the voice of authority that properly calibrates the narrative?

Hating on non diabetic users of Ozempic is a huge dopamine hit and nothing unites people like what they hate.

And everyone really hates fat people.

Never mind there are at least six other medications in the same class.

Never mind that Ozempic is new and expensive and likely not cheap compared to its peers. 

No one is dying for lack of Ozempic. Seriously. No one. They may have to wait a bit until they can get Ozempic, but they'll have medications they can use in the interim, likely at a lower cost than Ozempic to boot.

People are confusing the crisis around cost and accessibility of insulin with Ozempic having supply issues.

And then they hear people like Chelsea Handler dog it too. But, here's a headline for you, this is a person whose comedy act includes a bit about how she swallowed her yeast infection ovule like a pill. I don't know what vaginas out there reach the age of what? 50? and don't know how to take yeast medication, but apparently that makes you a medical savant when you're famous.

Why the media decided to weaponize the hate on this particular issue is beyond my ken. It serves no one but the stock market.

But yes, let Chelsea Handler be the medical expert. I mean, at least we're consistently stupid in the narratives we amplify.

Again, our ideal and actual culture are so far apart they may as well be in different dimensions. Again, how do we get back to center? Because if we don't, bad things will happen. Simple things like this go into the pot and simmer with everything else and the end product isn't good.

We are collectively having our pet hates weaponized, pushing us to choosing violence. That's my take on it, anyway.

Life update...

I'm still struggling with the post covid nerve and joint pain with a side of foot neuromas--taking lots of  NSAIDs--but I finally did get out into the garden to start preparing for spring proper. I was going to start a bunch of seeds, but I realized I'm going to be out of town and can't count on anyone to water them.

(I've paid people. Tried different people. Paid more. Asked family to do it. The reality is...no one waters the garden. They kill it. Every time.)

So starting seeds will have to wait until we're home. I'll just keep plugging away at clean up and organizing for now. Maybe clean out the one flower bed and sow the flower seeds...

The big question is whether or not we smothered the strawberries to death trying to protect them from -40 temps. Which I hope not, but...eesh I'm not so sure they're okay.

Shapewear for the wedding dresses has arrived. I realized a bit late that I need all new Spanx because everything's too big. Both dresses look great. Ahh. It's going to be hard to decide which one to wear!

Hair cuts are up next. I haven't been to a salon in over three years. I've been cutting my own hair all this time. I have hair that hides mistakes well so it's just been easier to DIY it, but I'm doing my best to spiff up for the wedding.

My energy is doing okay. I get tired faster, but my carrying capacity isn't as limited as it was with my first round of Covid. The biggest issue right now is the unrelenting 'painsomnia' from my joints and nerves. Yawn.

But the covid inflammation is going down. I think? My foot has been the main indicator. At its worst, it felt like I was walking on just the toe box of a flip-flop...there was a cliff near my arch where the swelling suddenly dropped off. It's gone down to more like half a thin sandal sole.

Maybe in another week the pain will mostly be gone?

It's Not Zero Luck or Bad Luck, It's Negative Luck

 

Oh the teen. The poor teen. Just when we think we've got a win, that we've got something sorted, it all turns upside down again.

The dynamics gunning for her beggar belief. They really do. This is unbelievable.

So. Got a new diagnosis. One we thought was simple and straightforward. It's common, there's a turnkey system in place, meds should be plug and play. Easy peasy, right?

Wrong.

It interacts with one of her medications, the meds we can't get to work, that we are constantly back at the specialist trying to find a solution. Naturally, medication #11 looked like it might be a win aaaaaand she can't take it anymore. It's not considered safe.

This has thrown everything into chaos for the teen. This is the #1 thing that limits her ability to function right now so not having it buttoned up is a huge problem. We start medication #12 now and have no clue if it'll work. After this, we're out of pills to try... 

The one time we had a medication that seemed like it might work, she's disqualified from using it because of another diagnosis. I can't believe it. I'm aghast.

If we can't get this under control, eventually she'll have to have surgery. 

I can't believe how complicated simple things can be. I really just can't believe it. 

Also, it seems to me that the teen has some kind of issue processing this class of medications. Like, a med will work initially, but then her body seems to adjust or stop processing it and then it doesn't work anymore. Times eleven. And now her options are even more limited because of risks associated with another diagnosis.

I know I've said it a lot already, but honestly, I can't believe this. Every other kid and adult takes these meds and is fine. How is the teen not fine too?????????????????????????????????????????????????????

(And yes, she does take everything as instructed. I've done the whole are you sure you're taking your pills correctly thing and supervised what she's doing. Like, yes, I did actually go down the rabbit hole of maybe my kid is screwing this up, or worse, purposely engineering problems and no...that's not the issue.)

Will the Lottery Get Better?

 

I'm having a moment of serious irritation that my main function in this civilization's healthcare system is to produce profit for those who really don't give a shit what happens to me.

The delay in the MRI didn't save the insurance company any money, and in fact, it let things fester to the point where I may never have proper biomechanics in my foot again. I'll be extra expensive on the back end dealing with that fall out.

Here we are again, proving what I keep saying...we need to get to imaging faster. Yes, I hate the contrast and that's not ideal, but we've also got to stop letting things fester into the worst outcome for patients.

We've got to stop delaying it because of costs. By my rough estimation, the insurance company will end up paying the equivalent of at least one more MRI in extra costs that could have been avoided by the time this is over, if not more.

Of course, apparently the math holds that most people don't need any imaging at all and they've decided all the extra they pay delaying imaging is still cheaper (in my experience, corporate finance sucks at capturing all the cost impacts of poor management so...I have some reservations on that...they make the numbers say what they want and there's a bonus incentive for it*). So I guess I win society's Shirley Jackson style lottery here. Again. Unfortunately, I'm not inclined to be gracious about it. This is bullshit.

I wonder what happens as our demographics make people more valuable and less expendable? We see this new term 'labor hoarding' being bandied about in financial analysis. Companies are giving raises to retain staff now because they know they can't replace people easily anymore. If they can't afford to lose people, they also can't afford for them to be medically fucked by insurance companies and inefficient standards of care. You don't want people out on disability for longer than necessary. And competitive employers will poach your best people with better insurance.

Will we see things shift toward more proactive healthcare to preserve the output of the population? Or will large corporations suddenly discover a newfound love for immigrants who will bolster the demographics and maintain the status quo? (Or will AI just take over? But then who's earning enough money to buy what AI produces?)

Low wages and lots of people have allowed corporations to make healthcare costs a high deductible personal responsibility complete with a heavy dose of moralizing gaslighting when people can't afford it. What does it matter if people die or end up disabled when there are 50-100 in the labor pool who can replace them at any given time? 

What happens when you don't have those people anymore? Even if we increase immigration there'll be a gap period while people get up to speed in a new country...perhaps there'll be a short lived, but golden era of improved care and access for people. Maybe we can win a better lottery for a while. Or somehow AI will fill all the gaps and it'll be same ol', same ol'.

*Oh man. Now I'm really wondering how AI is going to hit corporate taxes. Maybe I just worked with particularly stupid C-suite execs in my corporate days, but to my mind, you just know they're going to eliminate the Accounting Dept, turn it all over to AI, not realizing it doesn't know the loopholes and tricks, that it'll follow tax law as written, and then they're going to be so surprised when the shit hits the fan. At some point somewhere somehow AI is going to get the C-suite crew fired lol.