Monthly Archives: May 2017

Republican Healthcare – or Lack Thereof

About the only way I know to lower the cost of health insurance for those willing and able to buy it is to let people die on the curb in front of the hospital. Yep, give up your humanity and you too can save on health insurance.

If you opt for humanity and take that person into the hospital, it will cost you, and likely cost you a lot. That person without health insurance will incur costs which the hospital must absorb. The only way a hospital to stay in business if they accept indigent care is to charge paying customers, usually insurers, more to offset the unreimbursed care.

If we are to be humane and provide care for the free riders, is there a better way? If we wait for high blood pressure to cause a heart attack, treatment of that one condition can cost hundreds of thousands to millions of dollars. Alternately, drugs to manage the high blood pressure can cost pennies a day – Penny wise, pound foolish.

The reason the republicans struggle to produce a health plan to replace the ACA, even though they have had several years, is there is no plan that actually works if it doesn’t include everybody. There are two ways to do that – make sure everybody has access to affordable care through private insurers or go to a less costly single payer universal healthcare system like just about every other country in the world.

Government managed systems work well. We currently spend much more per capita for healthcare and with poorer outcomes. There are over 40 countries with lower infant mortality rates, greater life expectancies and lower costs.

The new president said while campaigning that his replacement healthcare plan would cover everybody and cost less. As to the costs we won’t know until after the Congressional Budget Office (CBO) scores the new bill. I can predict immediately however that it won’t cover everybody because the first line of conservative talking points is repealing the mandate to purchase insurance, guaranteeing free riders. Another promise is to lower ACA spending, which means that subsidies for the poor will be lowered or eliminated, further reducing the pool of insured.

For those middle income folks there may be cheaper insurance policies available, but only because substandard policies will again become available. Lower costs mean lower coverage. The ACA policies required a minimum standard of coverage which included preventive care. Cheap policies will be available which only cover catastrophic costs. Ironically, avoiding the costs of preventive care leads to greater catastrophic costs.

The real winners with the proposed healthcare law are the rich, no surprise there. Taxes will go down while at the same time subsides not previously available to the rich will go up.

Conservatives continue to try to view healthcare as subject to the same market forces as buying unessential commodities, but it just doesn’t work that way. We are alone in the world with our failure to make that recognition.

The Eyes Have It

Charles Darwin published the “Origin of Species” in 1859 and established evolution as the central organizing principle of biology. The molecular basis of evolution became clear about a century later with the understanding of the structure of Deoxyribonucleic Acid – better know as DNA.

DNA is the stuff of inheritance, and changes in DNA are the stuff of mutations and ultimately evolution. The code of life is defined by a simple alphabet consisting of only 4 letters and a grammatical structure which demands words can only be three letters long. Although this means there are only 64 words (called codons) in the DNA dictionary, “sentences” in the genetic code can be crazy long, literally tens of thousands of words long. The functional unit of DNA are strings of codons called genes which specify instructions about life.

Most importantly, the code is shared by all life. The codons mean the same thing in an aardvark and a zebra, from simple bacteria to you and I. Closely related organisms have closely related sequences of codons. This has allowed confirmation or rearrangement of the cladistic relationships of life. Not only can whole organisms be compared but also individual organs.

The evolution of the eye can be seen by comparing DNA across many organisms. Devotees of the idea of intelligent design, i.e, the god did it crowd, have suggested that an organ as complex as an eye cannot have arisen by evolution. They proffer the idea of irreducible complexity. It’s the old “what good is half an eye” argument. Mammalian eyes, just as one example, have several parts including a retina, an iris, a lens, a pupil, etc. Arthropods have compound eyes with multiple lenses and retinas.

There is a range of types of eyes that serve different functions and therefore have different levels of complexity, but in the last analysis they all share one common feature and that is the detection of light. The basic requirement for light detection, shared across all life, is a group of closely related molecules called rhodopsins. If light shines on this molecule, it changes shape and that triggers a signal to the brain that says light! Multiple copies of the molecule allow greater sensitivity and features such as a lens add acuity to the detection. Slight variations in the structure of the rhodopsin allows for detection of different wavelengths (colors). That the rhodopsin occurs across all kinds of life is seen in the gene which codes for the production of the molecule.

Here is the really interesting part. The gene for rhodopsin synthesis occurs in forms of life that have no eyes, such as a primitive organism know as cyanobacteria. These ancient bacteria have been around for billions of years. Why would a bacteria that couldn’t care less about detecting light have rhodopsin? It turns out the bacteria use this molecule for an entirely different reason.

Minor mutations in the rhodopsin gene allowed for the “repurposing” of the molecule to serve as a light gathering structure, rather than the function it serves in bacteria. This repurposing of structures is not an uncommon feature in evolution and allows for small changes to make big differences. Life is not irreducibly complex.