The Fallacy of Medicare for all!

 Politicians are generally ignorant of economic factors. Let us examine Medicare for All, MFA. 

First let us look at the individual costs.

1. Currently a Medicare subscriber has contributed for 40 to 50 years the fund. If properly managed this would have provided a substantial base.

2. Subscribers after 65 still pay about $250 per month per subscriber. That is just for 80% out of hospital costs and no drug, dental etc. That means if say you have chemo for cancer, or targeted therapy for macular degeneration, it costs about $4000 per month which you owe $320 at the time of each treatment.

3. If you want a supplemental plus prescription plan you may easily pay $500 per month plan, $150 for prescription for a total of $650 per month per person.

4. You may still have an out of pocket of $2500 for drugs.

5. The total is $900 per month for supplemental or $10,800 per person per year plus $2000 for prescriptions for a total of $12,800 per person per year.

Now it appears that not a single Marxist understands the current situation. One suspect they will give all free to those never have paid a cent to Medicare and put the burden on the older folks who would continue to see 10-20% annual increases.

Now for costs. Medicare negotiates the lowest reimbursement rates.  Namely a physicians reimbursement for standard care may be $600 per hour, or 6 ten minute sessions at $100 per session. Now this must pay the physician, insurance, staff, rent, etc. If they are lucky the physician can recover $100 per hour, say $1000 per day, or $250,000 per year, which they must pay Medicare taxes as well as others.

It appears that the Marxists are clueless of these factors. If they want to give free rides then they must drive down costs. That means driving competence out of Medicine.

Death then become the only option in a MFA system! 

OK, So why is this so smart?

 The NY Times reports that our Gov in NJ is threatening shippers with tens of millions in fines if they dare bring in Russian diesel fuel. Now NJ has a massive number of diesel trucks paying astronomic amounts per gallon. Along comes this person, with highly questionable authority, to prohibit the fuel further driving up costs.

The paper notes:

Gov. Mikie Sherrill sent a letter to 12 port and terminal operators in the state, warning them they “could be subject to millions of dollars in penalties” long after President Trump leaves office. Ms. Sherrill, a Democrat, said that accepting the fuel would violate federal law and that she was prepared to use “every available legal and regulatory tool” to block any tanker from offloading Russian fuel in New Jersey. It is unclear if any Russian fuel is headed toward New Jersey, but Ms. Sherrill’s position could put the state on a collision course with President Trump, who last month lifted a ban on the import of Russian diesel as part of his efforts to bring down the cost of the fuel. Gasoline and diesel prices have risen since the United States and Israel attacked Iran at the end of February.

 This is a blend of hubris and arrogance along with total disregard for the populace. 

 

 

Incompetence Returns

 Westchester County in NY has created a massive voter suppression action by its, in my opinion, gross incompetence in using paper ballot which cannot be read by the machines. They note:

The Westchester County Board of Elections (BOE) is aware of an issue involving the thickness of paper ballots that is preventing voting machines from accepting ballots at polling locations throughout the County. The Westchester Board of Elections wants to reassure every voter that your vote matters, your ballot will be secure and your vote will be counted. The Board of Elections is in constant communication with New York State officials, Westchester County Government and poll workers to address this issue and ensure that voting continues with as little disruption as possible. In the meantime, voters should continue to complete their paper ballots as instructed by poll workers. Ballots will be placed in designated orange emergency ballot bags, which will remain secure and monitored. These ballots will subsequently be counted in accordance with applicable election procedures. We strongly encourage all voters to remain in line, exercise patience and, most importantly, cast their ballots. The BOE sincerely apologizes to voters and poll workers for the inconvenience this situation has caused, and the BOE recognizes the importance of a smooth and efficient voting process. They are taking every necessary step to address the issue as quickly as possible. Let us be absolutely clear: Every eligible vote will be counted. No voter should be discouraged from participating in this election because of this issue. Your voice matters. Your vote matters. Please stay in line and vote.

 

 This should suppress a massive number of votes. Prior planning prevents poor performance. One wonders who may benefit from this? Follow the money? Or "you just cannot make this stuff up"

 

Cancer Therapeutics

Nature discusses the new drug from Moderna and Merck for treating advanced melanoma. They note:

A personalized mRNA vaccine reduced the risk of skin cancer returning or the recipient dying by 42% when used alongside an immunotherapy drug, according to long-awaited results for what could become the first approved mRNA vaccine for cancer. Oncologists regard a risk reduction of 10% as substantial, says Kristen Radford, an immunotherapist at Mater Research in Brisbane. A more than 40% risk reduction “would send many researchers over the Moon”, adds Seth Cheetham, a geneticist at the University of Queensland in Brisbane, Australia. The personalized vaccine, called intismeran, is not designed to prevent skin cancer, or melanoma, from developing in the first place, but to stop it returning in people who have already undergone surgery to remove tumours.

 As shown in the graphic, this is one of the personalized approaches. Simply the approach is as follows:

1. Get a sample of the tumor from the patient.

2. Sequence the DNA and determine what unique cancer mutations may be there.

 3. Generate a mRNA using these mutations.

4. Place the mRNA in a package, such as a liposome, and inject in patient.

5. mRNA will generate these related protein, many of which produce cello surface targets.

6. The patients immune system will see these as antigens and attack cells with these Ag surface targets

7. Add a PD-1 blocker which insures that the immune system remains on and not turned off

8. Pray the immune system works on the cells targeted and does not explode on everything else.

Now the key here is personalizing the surface proteins. In reality if we can do this for many patients then we can get a reference set, and the identity of the correct one may be more easily done by antibody tests. Say a patient comes in, we have this database of targets based upon many prior patients. We can then have Ab targeted for each one of the gene mutations and can then simple use Abs targeted for them. From this we get in no time the mRNA profile, generate it, put in liposome and voila! Kind of.

In reality we must always be concerned about immune system over response, such as cytokine storms. I fell the full story is yet to unfold. One must remember CAR-T cell promises.

I have noted a similar approach but using antibody drug conjugates, ADCs. It requires a database of surface targets on cancer cells, and then generates polyspecific Ab with a conjugated drug.  

But, and this is important, many cancers are "protected" by a tumor micro environment, TME, and one must break through that as well. 

 

The Collapse of the University

 One wonders who is behind these actions. The Tech at MIT notes:

 Out of 1,708 ballots, 92.5% of members of MIT’s Graduate Student Union (GSU) voted yes to authorize a strike yesterday evening. During a strike, graduate workers and fellows would be expected to stop all work and “not cross the picket line.”  After six months of bargaining and 15 sessions with MIT, seven articles (5, 7, 10, 13, 14, 19, and 25) have reached a tentative agreement, while the majority remains in limbo or has been closed. However, central issues to the GSU’s campaign — union shop, establishing a three-year contract, wages, healthcare, and protections for international workers — remain at a standstill with the Institute.

 So let me try to get this correct. A Grad student will refuse to work on their thesis or perform Teaching Assistant duties to undergrads who are paying nearly $100,000 per year! 

This may very well  be the start of the collapse of the University system. Who are these people who are behind this. We have teachers unions who have been able to destroy Grammar and High Schools in the US while union leaders collect millions. 

This strike is a great way for some adversary to destroy US academic excellence. Remember that nothing is necessarily what it appears to be. In this case it may very well not be some "poor" grad students. 

And This is Science?

 

I was amazed by the interview in the NY Times of the so-called science advisor to the President. This person, a BA from Princeton in Poly Sci, not any apparent technical expertise, notes:

S.I. for science is going to be the biggest unlock for scientific discovery in the history of the world. It’s going to impact everything from material science to chemistry to math. In our plan, I think the belly button of it all is something called the Genesis Mission, the idea that we should build a scientific instrument in the federal government to be able to leverage S.I. for scientific discovery, and that’s what we’re building in our national labs. And we’ve opened it up, and now have access to it, from all of our agencies across the government. So if you’re doing very important health care work or biomedical work that requires superintelligence, you can access this instrument at the D.O.E., and the same goes for lots of other agencies. The core thing we want to do is provide S.I. as an enabling tool for whatever scientific discovery you want to make.

Great, just what we need, more Government Labs building stuff!

I had the good fortune to have known three Presidential Science Advisors: Vannevar Bush, Jerome Wiesner, and EE David. In my opinion this is not one of them. But I continue:

 So right now, American Ph.D. programs are geared toward this, at a minimum, five-year Ph.D. But they’re also tailored to try to optimize the curriculums in order to train students to be academics, and the numbers don’t play out. About 60 percent of people who get Ph.D.s do not end up becoming academics. So we asked ourselves: In that environment, shouldn’t we be trying to do a better job of training these young technologists and scientists to go out and actually be prepared for what they’re ultimately going to do in industry? So we launched a four-year Ph.D. program in partnership with universities and with industry, so that during the last year of your Ph.D. program — at year four — you’re at an industry lab. You do work in industry, and your dissertation is written on the work that you do at that company.

 This is a work study program, not a research training exercise. Now to be simple, my PhD took 18 months. I had an SM from MIT already and needed a few extra courses, but I stuffed it all in. I also was a junior faculty member as well as finishing my first book. Plus a few other things along with two children. I never could have done that in some work study program. 

With my MIT PhD I ran the gamut of academic, Government Advisor, Movie and CATV business, COO of mobile phone business, venture investor and operator, etc. The PhD allowed versatility and MIT, at the time (and that was during the Viet Nam War folks) allowed me to explore. 

The current so-called Science Advisor seems to follow the path of using neologisms to espouse new policies. PhDs are not "trained". They are educated and tested. You may "train" your poodle but please let's not insult the Academy, it already has a multitude of problems.  

Would it not have been better to have an experienced PhD in this position, say in Science or worst case Engineering like the three I have known! Instead we get an apparently inexperienced political entity.